DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop S2-26-12
Baltimore, Maryland 21244-1850
AUG272013
Jason A. Helgerson
State Medicaid Director
Deputy Commissioner
Office of Health Insurance Programs
NYS Department of Health
Corning Tower (OCP - 1211)
Albany, NY 12237
D^rNO Sao:ai
ED
BUREAU OF HCRA OPERATIONS
AND FtNANIIALANAL`fSIS
RE: TN 13-31
Dear Mr. Helgerson:
We have reviewed the proposed amendment to Attachment 4.19 A of your Medicaid State plan
submitted under transmittal number (TN) 13-31. Effective April 1, 2013, this amendment proposes
to continue the trend factor to an amount no greater than zero for hospital inpatient services provided
on and after April 1, 2013 through March 31, 2015.
We conducted our review of your submittal according to the statutory requirements at sections
1902(a)(2), 1902(a)(13), 1902(a)(30), 1903(a) and 1923 of the Social Security Act and the
regulations at 42 CFR 447 Subpart C. This is to inform you that New York State plan amendment
13-31 is approved effective April 1, 2013. We have enclosed the HCFA-179 and the approved plan
page.
If you have any questions, please contact Tom Brady at 518-396-3810 or Rob Weaver at 410-786­
5914.
Enclosures
­
­
­
1H I'AR 11dI N'1 OF HEALTH AND I JUMAN SFRVICFS
IH A1;1H tARl- 1=1;vANCINO A0MINISTRA"1ION
FORM APPROVED
OMR NO. 093$-W9
TRANSMITTAL AND NOTICE OF APPROVAL OF
STATE PLAN MATERIAL
i. TRANSMITTAL NUMBER:­
13-31
2. STATE
New York
3. PROGRAM IDENTIFICATION: TITLE .......
XIX OF THE
FOR: HEALTH CARE FINANCING ADMINISTRATION
SOCIAL SECURITY ACT (MEDICAID)
T'O: REGIONAL ADMINISTRATOR
HEALTII CARE FINANCING ADMINISTRATION
DEPARTMENT OF IEAI.TIT AND H1.MAN SERVICES
5. TYPE OF PLAN MATERIAL (Check (rte):
4. PROPOSED LI l lC`T'[V E DATE
April 1, 2013
q NT Vb STATE PLAN
Q AMEN[ MENT TORE CONSIDERED AS NEW PLAN
AMENDMENT
COMPLETE BLOCKS 6 TIIRI-- 10 IF THIS IS AN AMI-NDMFN I (SeE.r<rrcac Trcrrzsrraittnl foi- ecu/r crwncnctrrrLLntf
6. FEDERAL STATUTE'REGI LATION CITATION;
7 FEDERAL BUDGET IMPACT;
Section 1902(a) of the Social Security Act, and 42 CFR 447
a. FFY 04/01/13-09/30 /13 (S32.30) million
h FFV 10/01/13-09/30/14 (S64.60) million
S. PAGI N M131;R OF')'E E PLAN SECTION OR ATTACIIMENI .
9. ['AGI NUMBER OF `T`HE SI PFRSFDED PLAN
SECTION OR AT°I'ACI1 ^4L'N'I"' flf.<Tp/rliccrhlej:
Attachment 4 .19-A: 120(a)(i)
Attachment 4.19-A: 120(a)(i)
-
10. SUBJECT OF AMENDMENT:
Eliminate Trend Factor Adjustments - IP
(FMAP =50%)
I I.­ GOVERNOR'S REVIEW (Cheek On(,):
Z GOVERNOR'S OFFICE REPORTIAED NO COMMENT
q COMMENTS OF GOV1 RNOR'S OFFICE INCLOSED
NO REPLY RECEIVED Lip I i'HIN 45 DAYS OF SUBMITTAL
12. S[GN­
3­
RE
'F
TA
r^ ENCY OFFICIAL:
16. RETURN `l`C1
New York State Department of Health
Bu reau of
analysis
99
ton Ave One Commerce Plata
Suite 810
Albany NY 12210
,. Jas n A. H person
14. TITLE:­ M edicaid Director
Department of Health
15, DATE SUBMITTED:
August 14,
17. DATE RECEIVED:
q OTHER. AS SPECIFIED:
2013
FOR REGIONAL 0171CE USE ONLY
I&.DATE APPROVED:
AUG 2 7 2013
PLAN 4 PROV F 1 ,- ONE COPY ,VTAC • . D
E 19. EFFECTIVE DATE OF APPROVED M
20. SIGN
E OF REGIONAL OFFICIAL:
`^1f^K'6
X013
1 21. TYPED NAME;
TllF a:
^M
23. REMARKS:
FORM IICFA-l79 (07-92)
o rJ
V
U
a a(L
k_._
PiNaz). ^L
.
(
Attachment 4.1 9 ­
New York
1 0(a)( )
Effective for 14.
services provided on and after April 1, 2011, the applicable
trend factor for
the 2011 calendar year period will be no greater than zero.
15.­
Effective for services provided on and after January 1, 2012, the applicable
trend factor
for the 2012 calendar year period will be no greater than zero.
The applicable
16. trend factor for the 2013 calendar yearwill be no greater than
zero for
services provided on and after January 1, 2013 [through March 31, 2013].
The applicable
17.trend factor for the 2014 calendar year period will be
no c neater than
zero for services provided on and after January 1, 2014.
The applicable
18. trend factor for the 2015 calendar year period will be no greate
r than
zero for services provided on and after January 1, 2015 through March 31,
2015.
TN #13-31
Su persedes TN
Approvall
12-6
(Effective Dat e
AUG272013
APR 01 2013