Board Bulletins and Subject Numbers

August 11, 2025

The NYS Office of Health Insurance Programs has calculated rates of reimbursement for the period January 1, 2025, through December 31, 2025, for acute per case, exempt hospital, exempt unit, and chemical dependency detoxification services. These rates have been developed in accordance with Section 2807-c of the Public Health Law, as amended by the Health Care Reform Act, and Part 86-1 of the Title 10 (Health) of the Codes, Rules, and Regulations of the State of New York.

For discharges beginning on or after January 1, 2025, the Service Intensity Weights (SIWs), cost thresholds, and average length of stay (ALOS) effective July 1, 2018, should continue to be used for payment purposes with the 3M All Patient Refined Diagnosis Related Groups (APR-DRGs) grouper version 34.

The rates on the newly posted schedules are based upon the same methodology and data used in the rates effective January 1, 2024, through December 31, 2024, but also take into consideration the following update:

• Inclusion of 2025 budgeted capital, as reported by hospitals and calculated in accordance with Section 8 of Article 2807-c of the Public Health Law.
• The inclusion of a 2025 trend factor of 2.4% based upon the initial Consumer Price Index (CPI), as published by the Congressional Budget Office and as required by Section 10 of Article 2807-c of the Public Health Law. The final trend for 2023 was also updated to 4.1%.
• Adjustments to the acute, specialty hospital, critical access hospital, and medical rehabilitation hospital rates, where applicable, as a result of Article 19 of the NYS Labor Law that established new minimum wage increases beginning January 1, 2025.
• Implementation of prospective capital rate adjustments associated with capital cost and utilization reconciliations for the period January 1, 2021 - December 31, 2021. For some hospitals, this resulted in an overall negative capital rate.

Please see Medical Fee Schedules.