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.