Bill Text: NY A06677 | 2019-2020 | General Assembly | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relates to general hospital and safety net hospital reimbursement rates and Medicaid adjustments.
Spectrum: Partisan Bill (Democrat 16-0)
Status: (Introduced - Dead) 2020-01-22 - reported referred to ways and means [A06677 Detail]
Download: New_York-2019-A06677-Introduced.html
Bill Title: Relates to general hospital and safety net hospital reimbursement rates and Medicaid adjustments.
Spectrum: Partisan Bill (Democrat 16-0)
Status: (Introduced - Dead) 2020-01-22 - reported referred to ways and means [A06677 Detail]
Download: New_York-2019-A06677-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 6677 2019-2020 Regular Sessions IN ASSEMBLY March 15, 2019 ___________ Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to the general hospi- tal indigent care pool, hospital reimbursements and adjustments to medical assistance rates to enhanced safety net hospitals; and to amend chapter 474 of the laws of 1996 amending the education law and other laws relating to rates for residential health care facilities, in relation to extending the effectiveness of such rates The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 5-d of section 2807-k of the public health law, 2 as amended by section 2 of part A of chapter 57 of the laws of 2018, is 3 amended to read as follows: 4 5-d. (a) Notwithstanding any inconsistent provision of this section, 5 section twenty-eight hundred seven-w of this article or any other 6 contrary provision of law, and subject to the availability of federal 7 financial participation, for periods [on and after January] April first, 8 two thousand [thirteen,] nineteen through [March] December thirty-first, 9 two thousand [twenty] nineteen and each calendar year thereafter, all 10 funds available for distribution pursuant to this section, except for 11 funds distributed pursuant to subparagraph (v) of paragraph (b) of 12 subdivision five-b of this section, and all funds available for distrib- 13 ution pursuant to section twenty-eight hundred seven-w of this article, 14 shall be reserved and set aside and distributed in accordance with the 15 provisions of this subdivision. 16 (b) The commissioner shall promulgate regulations, and may promulgate 17 emergency regulations, establishing methodologies for the distribution 18 of funds as described in paragraph (a) of this subdivision and such 19 regulations shall include, but not be limited to, the following: 20 (i) Such regulations shall establish methodologies for determining 21 each facility's relative uncompensated care need amount based on unin- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD10355-02-9A. 6677 2 1 sured inpatient and outpatient units of service from the cost reporting 2 year two years prior to the distribution year, multiplied by the appli- 3 cable medicaid rates in effect January first of the distribution year, 4 as summed and adjusted by a statewide cost adjustment factor and reduced 5 by the sum of all payment amounts collected from such uninsured 6 patients, and as further adjusted by application of a nominal need 7 computation that shall take into account each facility's medicaid inpa- 8 tient share. 9 (ii) Annual distributions pursuant to such regulations [for the two10thousand thirteen through two thousand nineteen calendar years] for each 11 calendar year beginning with the two thousand nineteen calendar year 12 shall be in accord with the following: 13 (A) [one hundred thirty-nine million four hundred thousand dollars] 14 one hundred one million seven hundred thousand dollars for each calendar 15 year (prorated, as may be necessary, to reflect any period less than a 16 year) shall be distributed as Medicaid Disproportionate Share Hospital 17 ("DSH") payments to major public general hospitals; and 18 (B) [nine hundred ninety-four million nine hundred thousand dollars] 19 seven hundred seven million six hundred thousand dollars for each calen- 20 dar year (prorated, as may be necessary, to reflect any period less than 21 a year) as Medicaid DSH payments to eligible general hospitals, other 22 than major public general hospitals. 23 (iii)[(A) Such regulations shall establish transition adjustments to24the distributions made pursuant to clauses (A) and (B) of subparagraph25(ii) of this paragraph such that no facility experiences a reduction in26indigent care pool payments pursuant to this subdivision that is greater27than the percentages, as specified in clause (C) of this subparagraph as28compared to the average distribution that each such facility received29for the three calendar years prior to two thousand thirteen pursuant to30this section and section twenty-eight hundred seven-w of this article.31(B) Such regulations shall also establish adjustments limiting the32increases in indigent care pool payments experienced by facilities33pursuant to this subdivision by an amount that will be, as determined by34the commissioner and in conjunction with such other funding as may be35available for this purpose, sufficient to ensure full funding for the36transition adjustment payments authorized by clause (A) of this subpara-37graph.38(C) No facility shall experience a reduction in indigent care pool39payments pursuant to this subdivision that: for the calendar year begin-40ning January first, two thousand thirteen, is greater than two and one-41half percent; for the calendar year beginning January first, two thou-42sand fourteen, is greater than five percent; and, for the calendar year43beginning on January first, two thousand fifteen; is greater than seven44and one-half percent, and for the calendar year beginning on January45first, two thousand sixteen, is greater than ten percent; and for the46calendar year beginning on January first, two thousand seventeen, is47greater than twelve and one-half percent; and for the calendar year48beginning on January first, two thousand eighteen, is greater than49fifteen percent; and for the calendar year beginning on January first,50two thousand nineteen, is greater than seventeen and one-half percent.51(iv)] Such regulations shall reserve one percent of the funds avail- 52 able for distribution in the two thousand fourteen and two thousand 53 fifteen calendar years, and for calendar years thereafter, pursuant to 54 this subdivision, subdivision fourteen-f of section twenty-eight hundred 55 seven-c of this article, and sections two hundred eleven and two hundred 56 twelve of chapter four hundred seventy-four of the laws of nineteenA. 6677 3 1 hundred ninety-six, in a "financial assistance compliance pool" and 2 shall establish methodologies for the distribution of such pool funds to 3 facilities based on their level of compliance, as determined by the 4 commissioner, with the provisions of subdivision nine-a of this section. 5 (c) The commissioner shall annually report to the governor and the 6 legislature on the distribution of funds under this subdivision includ- 7 ing, but not limited to: 8 (i) the impact on safety net providers, including community providers, 9 rural general hospitals and major public general hospitals; 10 (ii) the provision of indigent care by units of services and funds 11 distributed by general hospitals; and 12 (iii) the extent to which access to care has been enhanced. 13 § 2. Section 2807 of the public health law is amended by adding a new 14 subdivision 23 to read follows: 15 23. Adjustments to medicaid rates. (a) The commissioner is authorized 16 to make adjustments to medical assistance rates in accordance with this 17 subdivision to enhanced safety net hospitals, as defined in paragraph 18 (a) of subdivision thirty-four of section twenty-eight hundred seven-c 19 of this article, and to qualified safety net hospitals, as defined in 20 paragraph (b) of this subdivision, for the purposes of supporting crit- 21 ically needed health care services and to ensure the continued mainte- 22 nance and operation of such hospitals. 23 (b) For the purposes of this subdivision, a "qualified safety net" 24 hospital shall mean a hospital, other than an enhanced safety net hospi- 25 tal, so designated by the commissioner pursuant to criteria developed by 26 the commissioner that take into account: (i) the hospital's financial 27 hardship, evidenced by the operating losses of the hospital or the 28 system of hospitals to which the hospital belongs and/or participation 29 by the hospital in programs established by the commissioner to enable 30 hospitals in financial distress to maintain operations and vital 31 services; (ii) the volume of Medicaid and/or medically uninsured 32 patients served by the hospital compared to other hospitals in the 33 hospital's region; and/or (iii) the importance of the hospital in the 34 hospital's region in enabling Medicaid and/or medically uninsured 35 patients' access to health care services in inpatient, outpatient and 36 community settings. 37 (c) For the state fiscal year commencing April first, two thousand 38 nineteen, and each state fiscal year thereafter, the commissioner shall 39 increase medical assistance rates of payments for inpatient and/or 40 outpatient services made by either state governmental agencies or organ- 41 izations operating in accordance with article forty-three of the insur- 42 ance law or article forty-four of this chapter by an aggregate of: 43 (i) thirty-seven million seven hundred thousand dollars for enhanced 44 safety net hospitals that are major public general hospitals; 45 (ii) two hundred seventy-four million eight hundred thousand dollars 46 for qualified safety net hospitals and enhanced safety net hospitals 47 other than major public general hospitals, of which at least twelve 48 million five hundred thousand dollars shall be allocated to enhanced 49 safety net hospitals that are federally designated as critical access or 50 sole community hospitals; and 51 (iii) twelve million five hundred thousand dollars for those hospitals 52 eligible under subparagraph (ii) of this paragraph for which the 53 combined payments made, or to be made, under subparagraph (ii) of this 54 paragraph and subdivision five-d of section twenty-eight thousand 55 seven-k of this article for calendar year two thousand nineteen, and 56 each calendar year thereafter, are projected by the commissioner to beA. 6677 4 1 less than payments made to such hospitals pursuant to subdivision five-d 2 of section twenty-eight thousand seven-k of this article for calendar 3 year two thousand eighteen. 4 (d) Payments made pursuant to this subdivision may be added to rates 5 of payment, or made as aggregate payments of equal amounts on October 6 one and April one of each state fiscal year, to such enhanced safety net 7 hospitals and qualified safety net hospitals in accordance with a meth- 8 odology to be established by the commissioner; provided, however, that, 9 the commissioner may make the twelve million five hundred thousand 10 dollars in payments due to eligible hospitals under subparagraph (iii) 11 of paragraph (c) of this subdivision by instead increasing the amount 12 otherwise awarded to such eligible hospitals under programs established 13 by the commissioner to enable hospitals in financial distress to main- 14 tain operations and vital services while working to achieve longer-term 15 sustainability, including, but not limited to, the Value Based Payment 16 Quality Improvement Program. 17 § 3. Subparagraph (v) of paragraph (a) of subdivision 1 of section 18 2807-c of the public health law, as amended by chapter 639 of the laws 19 of 1996, is amended and a new subparagraph (vi) is added to read as 20 follows: 21 (v) adjustments for any modifications to the case payments determined 22 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of 23 this section[.]; and 24 (vi) adjustments for any modifications to the case payments determined 25 in accordance with subdivision twenty-three of section twenty-eight 26 hundred seven of this article. 27 § 4. Subparagraph (v) of paragraph (a) of subdivision 1 of section 28 2807-c of the public health law, as amended by chapter 731 of the laws 29 of 1993, is amended and a new subparagraph (vi) is added to read as 30 follows: 31 (v) adjustments for any modifications to the case payments determined 32 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of 33 this section[.]; and 34 (vi) adjustments for any modifications to the case payments determined 35 in accordance with subdivision twenty-three of section twenty-eight 36 hundred seven of this article. 37 § 5. Subdivision 34 of section 2807-c of the public health law is 38 amended by adding a new paragraph (d) to read as follows: 39 (d) Notwithstanding any inconsistent provision of law or regulation to 40 the contrary, adjustments made pursuant to this subdivision shall be in 41 addition to any adjustments made to medical assistance rates to enhanced 42 safety net hospitals authorized by subdivision twenty-three of section 43 twenty-eight hundred seven of this article. 44 § 6. Subdivision 1 of section 211 of chapter 474 of the laws of 1996 45 amending the education law and other laws relating to rates for residen- 46 tial health care facilities is amended by adding a new paragraph (g) to 47 read as follows: 48 (g) Notwithstanding any inconsistent provision of law or regulation to 49 the contrary, effective for the state fiscal year beginning April 1, 50 2019, and annually thereafter, the department of health is authorized to 51 pay public general hospitals, other than those operated by the state of 52 New York or the state university of New York, as defined in subdivision 53 10 of section 2801 of the public health law, located in a city with a 54 population of over one million, additional payments for inpatient hospi- 55 tal services of 200 million dollars annually, as medical assistance 56 pursuant to title 11 of article 5 of the social services law forA. 6677 5 1 patients eligible for federal financial participation under title XIX of 2 the federal social security act, pursuant to federal laws and regu- 3 lations governing disproportionate share payments to hospitals, based on 4 the relative share of each such non-state operated public general hospi- 5 tal medical assistance and uninsured patient losses. The payments may be 6 added to rates of payment or made as aggregate payments to an eligible 7 public general hospital. 8 § 7. Subdivision 1 of section 212 of chapter 474 of the laws of 1996 9 amending the education law and other laws relating to rates for residen- 10 tial health care facilities, is amended by adding a new paragraph (c) to 11 read as follows: 12 (c) Notwithstanding any inconsistent provision of law or regulation to 13 the contrary, effective for the state fiscal year beginning April 1, 14 2019, and annually thereafter, the department of health is authorized to 15 pay public general hospitals, as defined in subdivision 10 of section 16 2801 of the public health law, operated by the state of New York or the 17 state university of New York or by a county, which shall not include a 18 city with a population of over one million, of the state of New York, 19 and those public general hospitals located in the county of Westchester, 20 the county of Erie or the county of Nassau, additional payments for 21 inpatient hospital services of 100 million dollars annually, as medical 22 assistance payments pursuant to title 11 of article 5 of the social 23 services law for patients eligible for federal financial participation 24 under title XIX of the federal social security act, pursuant to federal 25 laws and regulations governing disproportionate share payments to hospi- 26 tals. The payments may be added to rates of payment or made as aggregate 27 payments to an eligible public general hospital. 28 § 8. This act shall take effect immediately; provided however, that 29 the amendments made to paragraph (a) of subdivision 1 of section 2807-c 30 of the public health law by section three of this act shall be subject 31 to the expiration and reversion of such paragraph when upon such date 32 the provisions of section four of this act shall take effect.
