Comparing APG to 7 Tier
As of December 1, 2008 fee for service Medicaid reimbursement to Designated AIDS Centers will be based on Ambulatory Patient Groups (APG) rates. Except for Therapeutic Visits for case management, 7 Tier rates will no longer be available for fee for service Medicaid outpatient care.
In this first year of APGs the formula for reimbursement is 25% of the State regional (Downstate or Upstate) outpatient APG rate and 75% of the hospital blended clinic rate plus hospital capital. The State published APG regional rates for outpatient care are: $276.38 Downstate and $219.69 Upstate. The rates are posted here on the State’s web site. I have posted a spreadsheet example of a 7 Tier Routine visit for an AIDS patient using APG rates for NewYork-Presbyterian Hospital.
Click here for the spreadsheet example >>> 7tier-example
Note that the blended rate and capital allowance are selected from the State published hospital rate list here.
I offer this document for illustrative purposes only. Please verify the financial assumptions with your fiscal advisors to ensure validity.
The post has been corrected. The original had the percentages reversed. The spreadsheet did not require correction.
On November 21, 2008 the State announced that APG implementation for hospitals would be delayed until approval is received from CMS. Implementation would proceed two weeks following CMS approval. Details can be found at this link
http://www.nyhealth.gov/health_care/medicaid/rates/apg/index.htm
thanks for the assistance eli…most helpful!