Bill Text: NY A06766 | 2023-2024 | General Assembly | Amended


Bill Title: Sets reimbursement rates for essential safety net hospitals at no less than regional average commercial rates for health care services provided by all hospitals in the same geographic region.

Spectrum: Partisan Bill (Democrat 9-0)

Status: (Introduced) 2024-01-03 - referred to health [A06766 Detail]

Download: New_York-2023-A06766-Amended.html



                STATE OF NEW YORK
        ________________________________________________________________________

                                         6766--A

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                       May 8, 2023
                                       ___________

        Introduced  by  M.  of  A.  PAULIN,  SEPTIMO,  McDONALD -- read once and
          referred to the Committee on  Health  --  committee  discharged,  bill
          amended,  ordered reprinted as amended and recommitted to said commit-
          tee

        AN ACT to amend the public health law, in relation to setting reimburse-
          ment rates for essential safety net hospitals

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Section  2807-c  of  the  public health law is amended by
     2  adding a new subdivision 34-a to read as follows:
     3    34-a. Health equity stabilization and transformation act.  (a) For the
     4  purposes of this subdivision,  "essential  safety  net  hospital"  shall
     5  mean:
     6    (i)  Any  hospital  eligible for participation in the directed payment
     7  template (DPT) preprint submitted by the state to the Centers for  Medi-
     8  caid and Medicare Services for fiscal year two thousand twenty-three;
     9    (ii)  Any non-state public hospital operated by a county, municipality
    10  or public benefit corporation; or
    11    (iii) is an acute  children's  hospital  licensed  by  the  department
    12  primarily for the provision of pediatric and neonatal services for which
    13  a  discrete  institutional  cost  report  was filed for the past   three
    14  calendar years, and which has medicaid   discharges in excess  of  fifty
    15  percent of it's total discharges.
    16    (iv)  Any  voluntary  hospital  certified under this article that is a
    17  general hospital, which, in any of the previous  three  calendar  years,
    18  has met the following criteria:
    19    (A)  at  least  thirty-six percent of inpatient volumes are associated
    20  with Medicaid and uninsured individuals;
    21    (B) at least thirty-six percent of outpatient volumes  are  associated
    22  with Medicaid and uninsured individuals; and

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10306-06-3

        A. 6766--A                          2

     1    (C)  no  more  than twenty percent of inpatient volumes are associated
     2  with commercially insured individuals.
     3    (b)  For purposes of this subdivision, "essential safety net hospital"
     4  shall not include hospitals that are (i) public  hospitals  operated  by
     5  the  state;  (ii)  federally  designated  as a critical access hospital;
     6  (iii) federally designated as a  sole  community  hospital;  or  (iv)  a
     7  specialty hospital.
     8    (c)  For  purposes  of  this subdivision, "health care services" shall
     9  include, but is not limited to, acute  inpatient  discharges,  inpatient
    10  psychiatric  days, ambulatory surgery visits, emergency room visits, and
    11  outpatient clinic services.
    12    (d) For essential safety net hospitals that qualify pursuant to  para-
    13  graph (a) of this subdivision, the commissioner shall, subject to feder-
    14  al  approval,  require  inpatient hospital rates and hospital outpatient
    15  rates paid by the medical assistance program for  services  provided  to
    16  patients enrolled in Medicaid managed care to reimburse the entire class
    17  of  essential  safety net hospitals in each geographic region at no less
    18  than regional average commercial rates for health care services provided
    19  by all hospitals in the same geographic region, as reported in a  bench-
    20  marking database maintained by a nonprofit organization specified by the
    21  commissioner.  Such  nonprofit organization shall not be affiliated with
    22  an insurer, a corporation subject to article forty-three of  the  insur-
    23  ance law, a municipal cooperative health benefit plan certified pursuant
    24  to article forty-seven of the insurance law, a health maintenance organ-
    25  ization  certified  pursuant to article forty-four of this chapter, or a
    26  provider licensed under this chapter.  For purposes of this paragraph:
    27    (i) The commissioner shall establish  geographic  regions  within  the
    28  state  for establishing the regional average commercial rate. One region
    29  shall consist of the average commercial rate for  services  provided  in
    30  the following counties: Bronx, Kings, New York, Queens, and Richmond.
    31    (ii)  The  regional  average  commercial rate for health care services
    32  shall reflect the most recent  twelve-month  period  in  which  data  on
    33  commercial  rates  is available, and shall be updated no less frequently
    34  than every two years, provided that the average commercial rate shall be
    35  trended forward to adjust for inflation on an annual basis between  such
    36  updates.  Such adjustment shall be made by a federally recognized metric
    37  as determined by the commissioner.
    38    (iii)  The  commissioner  shall  ensure  that all essential safety net
    39  hospitals shall receive the rates defined in this paragraph. The commis-
    40  sioner shall not exclude any qualifying essential safety net  hospitals,
    41  including public hospitals.
    42    (e)  Managed care organizations shall provide written certification to
    43  the commissioner on a quarterly basis that  all  payments  to  essential
    44  safety net hospitals are made in compliance with this subdivision and in
    45  accordance  with section three thousand two hundred twenty-four-a of the
    46  insurance law.
    47    (f) Any hospital qualifying  under  this  subdivision  shall  annually
    48  report  to the department demonstrating that it meets the criteria as an
    49  essential safety net hospital. The report shall also include information
    50  to demonstrate how increased reimbursement has been utilized to  improve
    51  patient  access,  patient  quality and patient experience.   Such report
    52  shall also include specific efforts made to improve maternal health.
    53    (g) The commissioner shall make any quality data reported by essential
    54  safety net hospitals pursuant  to  paragraph  (f)  of  this  subdivision
    55  publicly available in a manner that is useful for patients to make qual-

        A. 6766--A                          3

     1  ity  determinations.    Such  information shall be posted on the depart-
     2  ment's website.
     3    (h)  No  later  than  September  first, two thousand twenty-three, the
     4  commissioner shall provide the governor, the temporary president of  the
     5  senate  and the speaker of the assembly with a report on the feasibility
     6  of obtaining a state plan amendment to modify the Medicaid  fee-for-ser-
     7  vice  rates  for  health  care services in the manner prescribed in this
     8  subdivision.   The report shall  also  be  posted  on  the  department's
     9  website.
    10    §  2.  This  act shall take effect July 1, 2023. Effective immediately
    11  the commissioner of health shall make such rules  and  regulations,  and
    12  seek  any federal approvals necessary for the implementation of this act
    13  on its effective date.
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