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Office of Mental Health

Medicaid Managed Care APG Rates

Non-Hospital APG Rates for Medicaid Managed Care  | Hospital APG Rates

Implementation date: Sept. 1, 2012. The Non-Hospital APG rates for Medicaid Managed Care and the Hospital rates spreadsheets list every OMH licensed Article 31 (free-standing, hospital-based and Diagnostic and Treatment Center (D&TC)) by National Provider ID (NPI). A clinic may be listed more than once if it has more than one NPI; however, the rates are the same.

The rates associated with each clinic mirror the fee-for-service Medicaid rates (minus Community Support Program (CSP) add-on for non-hospitals and capital for hospitals) and must be used in the calculations of payments due to OMH licensed clinics for authorized services delivered.

FULL services are paid at 100% of the APG peer group base rate * the service weight. There is no blend payment associated with FULL services.

Note: Hospital-based Article 31 clinics have fully transitioned to 100% APG payment. There is no blend payment.

BLEND services for non-hospital OMH licensed clinics are paid according to a transition schedule. From Sept. 1, 2012 to Sept. 30, 2012 BLEND services are paid using 50% of the Provider-Specific Blend Rate + 50% of the APG Peer Group Base Rate multiplied by the service weight. The transition moves to 75% APG + 25% Blend rate on Oct. 1, 2012. On Oct. 1, 2013 the Blend payment will no longer be paid and those services will be paid 100% APG.

Note: Hospital-based Article 31 clinics have fully transitioned to 100% APG payment. There is no blend payment.

For claims with dates of service Sept. 1, 2012 to Dec. 31, 2012:

For claims with dates of service on or after Jan 1, 2013:

Comments or questions about the information on this page can be directed to the Bureau of Financial Planning.