All Patient Refined Diagnosis Related Groups (APR-DRGs)

Hospital Inpatient Reimbursement Rate Reform Effective December 1, 2009

Effective December 1, 2009 the Department has been authorized by state statute to implement a new hospital inpatient payment system. To provide a more equitable and fair payment method for services being rendered, New York will be implementing a severity-based methodology using 3M ™ All Patient Refined Diagnosis Related Groups (APR-DRGs). In addition, a new acute care payment methodology has been developed.

The information provided within the links on the left-hand side of this page will provide details regarding implementation, weights and additional web resources pertaining to the APR grouper. Questions related to the new payment system can be directed to the Bureau of HCRA Operations and Financial Analysis electronic mailbox bhofamail@health.state.ny.us or via phone at 518-473-8822.

Updated Rates

  • January 1, 2012 Inpatient Rate Update - Effective for discharges on or after January 1, 2012, version 29 of the 3M All Patient Refined Diagnosis Related Groups (APR-DRG) will be utilized for Medicaid, Workers Compensation and No-Fault. The Department of Health has completed the development of the applicable 2012 service intensity weights (SIWs), average length-of-stays and cost outlier thresholds, which are also effective January 1, 2012. The Department has implemented the new SIWs effective for all 2012 acute discharges that were processed beginning on March 1, 2012. All previously paid 2012 claims will be reprocessed once the 2012 hospital inpatient rates are approved and loaded into the eMedNY system.
  • The Medicaid Managed Care and Workers' Compensation/No-Fault Initial rates for 10/01/2010 and 01/01/2011 have been updated 01/10/2012. These updates have been posted under the 2010 and 2011 "Rate Schedules" for Medicaid Managed Care and Workers' Compensation/No Fault.
  • The Medicaid Fee-for-Service Revised rates for 10/01/2010 and 01/01/2011 have been added, as well as the Initial Medicaid Fee-for-Service and Medicaid Managed Care rates for 04/01/2011 and 10/01/2011. These rates have been posted under the 2010 and 2011 "Rate Schedules" for Medicaid Fee-for-Service and Medicaid Managed Care.

Inpatient Rate Processing Schedule

Inpatient rate processing schedule (XLS, 32KB, 3PG) for the 2012/2013 SFY.

The schedule is also available in PDF format (PDF, 53KB, 3PG).