Bill Text: NY S05546 | 2019-2020 | General Assembly | Introduced


Bill Title: Relates to general hospital and safety net hospital reimbursement rates and Medicaid adjustments.

Spectrum: Partisan Bill (Democrat 5-0)

Status: (Introduced) 2019-05-06 - REFERRED TO HEALTH [S05546 Detail]

Download: New_York-2019-S05546-Introduced.html


                STATE OF NEW YORK
        ________________________________________________________________________
                                          5546
                               2019-2020 Regular Sessions
                    IN SENATE
                                       May 6, 2019
                                       ___________
        Introduced  by  Sens.  RIVERA,  BENJAMIN,  LIU -- read twice and ordered
          printed, and when printed to be committed 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 6 of part H of chapter 57 of the laws of 2019, 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
    13  distribution  pursuant  to  section twenty-eight hundred seven-w of this
    14  article, shall be reserved and set aside and distributed  in  accordance
    15  with the 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.
                                                                   LBD10355-03-9

        S. 5546                             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  two
    10  thousand  thirteen  through  two  thousand  twenty  calendar years] 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  to
    24  the  distributions  made pursuant to clauses (A) and (B) of subparagraph
    25  (ii) of this paragraph such that no facility experiences a reduction  in
    26  indigent care pool payments pursuant to this subdivision that is greater
    27  than the percentages, as specified in clause (C) of this subparagraph as
    28  compared  to  the  average distribution that each such facility received
    29  for the three calendar years prior to two thousand thirteen pursuant  to
    30  this section and section twenty-eight hundred seven-w of this article.
    31    (B)  Such  regulations  shall  also establish adjustments limiting the
    32  increases in indigent  care  pool  payments  experienced  by  facilities
    33  pursuant to this subdivision by an amount that will be, as determined by
    34  the  commissioner  and  in conjunction with such other funding as may be
    35  available for this purpose, sufficient to ensure full  funding  for  the
    36  transition adjustment payments authorized by clause (A) of this subpara-
    37  graph.
    38    (C)  No  facility  shall  experience a reduction in indigent care pool
    39  payments pursuant to this subdivision that: for the calendar year begin-
    40  ning January first, two thousand thirteen, is greater than two and  one-
    41  half  percent;  for the calendar year beginning January first, two thou-
    42  sand fourteen, is greater than five percent; and, for the calendar  year
    43  beginning  on January first, two thousand fifteen; is greater than seven
    44  and one-half percent, and for the calendar  year  beginning  on  January
    45  first,  two  thousand  sixteen, is greater than ten percent; and for the
    46  calendar year beginning on January first,  two  thousand  seventeen,  is
    47  greater  than  twelve  and  one-half  percent; and for the calendar year
    48  beginning on January first,  two  thousand  eighteen,  is  greater  than
    49  fifteen  percent;  and for the calendar year beginning on January first,
    50  two thousand nineteen, is greater than seventeen and  one-half  percent;
    51  and for the calendar year beginning on January first, two thousand twen-
    52  ty, is greater than twenty percent.
    53    (iv)]  Such  regulations shall reserve one percent of the funds avail-
    54  able for distribution in the two  thousand  fourteen  and  two  thousand
    55  fifteen  calendar  years, and for calendar years thereafter, pursuant to
    56  this subdivision, subdivision fourteen-f of section twenty-eight hundred

        S. 5546                             3
     1  seven-c of this article, and sections two hundred eleven and two hundred
     2  twelve of chapter four hundred seventy-four  of  the  laws  of  nineteen
     3  hundred  ninety-six,  in  a  "financial  assistance compliance pool" and
     4  shall establish methodologies for the distribution of such pool funds to
     5  facilities  based  on  their  level  of compliance, as determined by the
     6  commissioner, with the provisions of subdivision nine-a of this section.
     7    (c) The commissioner shall annually report to  the  governor  and  the
     8  legislature  on the distribution of funds under this subdivision includ-
     9  ing, but not limited to:
    10    (i) the impact on safety net providers, including community providers,
    11  rural general hospitals and major public general hospitals;
    12    (ii) the provision of indigent care by units  of  services  and  funds
    13  distributed by general hospitals; and
    14    (iii) the extent to which access to care has been enhanced.
    15    §  2. Section 2807 of the public health law is amended by adding a new
    16  subdivision 23 to read follows:
    17    23. Adjustments to medicaid rates. (a) The commissioner is  authorized
    18  to  make adjustments to medical assistance rates in accordance with this
    19  subdivision to enhanced safety net hospitals, as  defined  in  paragraph
    20  (a)  of  subdivision thirty-four of section twenty-eight hundred seven-c
    21  of this article, and to qualified safety net hospitals,  as  defined  in
    22  paragraph  (b) of this subdivision, for the purposes of supporting crit-
    23  ically needed health care services and to ensure the  continued  mainte-
    24  nance and operation of such hospitals.
    25    (b)  For  the  purposes  of this subdivision, a "qualified safety net"
    26  hospital shall mean a hospital, other than an enhanced safety net hospi-
    27  tal, so designated by the commissioner pursuant to criteria developed by
    28  the commissioner that take into account: (i)  the  hospital's  financial
    29  hardship,  evidenced  by  the  operating  losses  of the hospital or the
    30  system of hospitals to which the hospital belongs  and/or  participation
    31  by  the  hospital  in programs established by the commissioner to enable
    32  hospitals  in  financial  distress  to  maintain  operations  and  vital
    33  services;  (ii)  the  volume  of  Medicaid  and/or  medically  uninsured
    34  patients served by the hospital  compared  to  other  hospitals  in  the
    35  hospital's  region;  and/or  (iii) the importance of the hospital in the
    36  hospital's  region  in  enabling  Medicaid  and/or  medically  uninsured
    37  patients'  access  to  health care services in inpatient, outpatient and
    38  community settings.
    39    (c) For the state fiscal year commencing  April  first,  two  thousand
    40  nineteen,  and each state fiscal year thereafter, the commissioner shall
    41  increase medical assistance  rates  of  payments  for  inpatient  and/or
    42  outpatient services made by either state governmental agencies or organ-
    43  izations  operating in accordance with article forty-three of the insur-
    44  ance law or article forty-four of this chapter by an aggregate of:
    45    (i) thirty-seven million seven hundred thousand dollars  for  enhanced
    46  safety net hospitals that are major public general hospitals;
    47    (ii)  two  hundred seventy-four million eight hundred thousand dollars
    48  for qualified safety net hospitals and  enhanced  safety  net  hospitals
    49  other  than  major  public  general  hospitals, of which at least twelve
    50  million five hundred thousand dollars shall  be  allocated  to  enhanced
    51  safety net hospitals that are federally designated as critical access or
    52  sole community hospitals; and
    53    (iii) twelve million five hundred thousand dollars for those hospitals
    54  eligible  under  subparagraph  (ii)  of  this  paragraph  for  which the
    55  combined payments made, or to be made, under subparagraph (ii)  of  this
    56  paragraph  and  subdivision  five-d  of  section  twenty-eight  thousand

        S. 5546                             4
     1  seven-k of this article for calendar year  two  thousand  nineteen,  and
     2  each  calendar  year thereafter, are projected by the commissioner to be
     3  less than payments made to such hospitals pursuant to subdivision five-d
     4  of  section  twenty-eight  thousand seven-k of this article for calendar
     5  year two thousand eighteen.
     6    (d) Payments made pursuant to this subdivision may be added  to  rates
     7  of  payment,  or  made as aggregate payments of equal amounts on October
     8  one and April one of each state fiscal year, to such enhanced safety net
     9  hospitals and qualified safety net hospitals in accordance with a  meth-
    10  odology  to be established by the commissioner; provided, however, that,
    11  the commissioner may make  the  twelve  million  five  hundred  thousand
    12  dollars  in  payments due to eligible hospitals under subparagraph (iii)
    13  of paragraph (c) of this subdivision by instead  increasing  the  amount
    14  otherwise  awarded to such eligible hospitals under programs established
    15  by the commissioner to enable hospitals in financial distress  to  main-
    16  tain  operations and vital services while working to achieve longer-term
    17  sustainability, including, but not limited to, the Value  Based  Payment
    18  Quality Improvement Program.
    19    §  3.  Subparagraph  (v)  of paragraph (a) of subdivision 1 of section
    20  2807-c of the public health law, as amended by chapter 639 of  the  laws
    21  of  1996,  is  amended  and  a new subparagraph (vi) is added to read as
    22  follows:
    23    (v) adjustments for any modifications to the case payments  determined
    24  in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
    25  this section[.]; and
    26    (vi) adjustments for any modifications to the case payments determined
    27  in  accordance  with  subdivision  twenty-three  of section twenty-eight
    28  hundred seven of this article.
    29    § 4. Subparagraph (v) of paragraph (a) of  subdivision  1  of  section
    30  2807-c  of  the public health law, as amended by chapter 731 of the laws
    31  of 1993, is amended and a new subparagraph (vi)  is  added  to  read  as
    32  follows:
    33    (v)  adjustments for any modifications to the case payments determined
    34  in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
    35  this section[.]; and
    36    (vi) adjustments for any modifications to the case payments determined
    37  in accordance with  subdivision  twenty-three  of  section  twenty-eight
    38  hundred seven of this article.
    39    §  5.  Subdivision  34  of  section 2807-c of the public health law is
    40  amended by adding a new paragraph (d) to read as follows:
    41    (d) Notwithstanding any inconsistent provision of law or regulation to
    42  the contrary, adjustments made pursuant to this subdivision shall be  in
    43  addition to any adjustments made to medical assistance rates to enhanced
    44  safety  net  hospitals authorized by subdivision twenty-three of section
    45  twenty-eight hundred seven of this article.
    46    § 6. Subdivision 1 of section 211 of chapter 474 of the laws  of  1996
    47  amending the education law and other laws relating to rates for residen-
    48  tial  health care facilities is amended by adding a new paragraph (g) to
    49  read as follows:
    50    (g) Notwithstanding any inconsistent provision of law or regulation to
    51  the contrary, effective for the state fiscal  year  beginning  April  1,
    52  2019, and annually thereafter, the department of health is authorized to
    53  pay  public general hospitals, other than those operated by the state of
    54  New York or the state university of New York, as defined in  subdivision
    55  10  of  section  2801 of the public health law, located in a city with a
    56  population of over one million, additional payments for inpatient hospi-

        S. 5546                             5
     1  tal services of 200 million  dollars  annually,  as  medical  assistance
     2  pursuant  to  title  11  of  article  5  of  the social services law for
     3  patients eligible for federal financial participation under title XIX of
     4  the  federal  social  security  act,  pursuant to federal laws and regu-
     5  lations governing disproportionate share payments to hospitals, based on
     6  the relative share of each such non-state operated public general hospi-
     7  tal medical assistance and uninsured patient losses. The payments may be
     8  added to rates of payment or made as aggregate payments to  an  eligible
     9  public general hospital.
    10    §  7.  Subdivision 1 of section 212 of chapter 474 of the laws of 1996
    11  amending the education law and other laws relating to rates for residen-
    12  tial health care facilities, is amended by adding a new paragraph (c) to
    13  read as follows:
    14    (c) Notwithstanding any inconsistent provision of law or regulation to
    15  the contrary, effective for the state fiscal  year  beginning  April  1,
    16  2019, and annually thereafter, the department of health is authorized to
    17  pay  public  general  hospitals, as defined in subdivision 10 of section
    18  2801 of the public health law, operated by the state of New York or  the
    19  state  university  of New York or by a county, which shall not include a
    20  city with a population of over one million, of the state  of  New  York,
    21  and those public general hospitals located in the county of Westchester,
    22  the  county  of  Erie  or  the county of Nassau, additional payments for
    23  inpatient hospital services of 100 million dollars annually, as  medical
    24  assistance  payments  pursuant  to  title  11 of article 5 of the social
    25  services law for patients eligible for federal  financial  participation
    26  under  title XIX of the federal social security act, pursuant to federal
    27  laws and regulations governing disproportionate share payments to hospi-
    28  tals. The payments may be added to rates of payment or made as aggregate
    29  payments to an eligible public general hospital.
    30    § 8. This act shall take effect immediately;  provided  however,  that
    31  the  amendments made to paragraph (a) of subdivision 1 of section 2807-c
    32  of the public health law made by section three  of  this  act  shall  be
    33  subject to the expiration and reversion of such paragraph when upon such
    34  date the provisions of section four of this act shall take effect.
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