Review of Audited Wrap Rates for 2016-2019 Now Available

DOH has uploaded the audited wrap rates for 2016-2019 to the HCS portal for your review. Please note that these audited wrap rates have not been issued yet. They will be released alongside the 2023 wrap rates, which are effective from October 1, 2023, to September 30, 2024, and are currently pending approval from the Division of Budget. Please click here for HCS instructions and below for the email sent out to health centers.

Please review your rate sheets carefully for accuracy. Check the visit counts and managed care average rates, and ensure that any recent rate appeals have been incorporated. Click here for the calculator tool presented by Dolores DiRe from CohnReznick at the latest Reimbursement Committee meeting. This tool has been redesigned to match DOH’s rate sheets and will help you assess the financial impact of the new rates and verify their accuracy.

If there are any discrepancies in the 2016-2019 wrap rates (i.e., they do not reflect a rate appeal from that period), please contact the Bureau of Managed Care Reimbursement at BMCR@health.ny.gov. If you have a liability from these rates, please see below for how that will be collected. 

Recoupment Process for Health Centers with Liabilities:

• Recoupments will be automatically deducted at a rate of 15% from each Medicaid payment weekly until the total owed amount is fully repaid.
• Any remaining balance after 10 weeks will begin to accrue interest at the Prime rate plus 2%.
• The 15% recoupment rate may be increased if necessary to ensure full repayment within one year.

We have requested that DOH waive the interest accrual, as they did with the 2022 wrap rate recoupments, and are waiting for their response.

For health centers needing extended repayment terms, please contact the Medicaid Account Receivable Recovery Unit at bimamail@health.ny.gov to discuss individual agreements.