Bill Text: NY S05546 | 2019-2020 | General Assembly | Amended
Bill Title: Relates to general hospital and safety net hospital reimbursement rates and Medicaid adjustments.
Spectrum: Partisan Bill (Democrat 12-0)
Status: (Introduced - Dead) 2020-01-13 - PRINT NUMBER 5546A [S05546 Detail]
Download: New_York-2019-S05546-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 5546--A 2019-2020 Regular Sessions IN SENATE May 6, 2019 ___________ Introduced by Sens. RIVERA, BENJAMIN, LIU, GOUNARDES, MYRIE, PARKER, SALAZAR, STAVISKY -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- recommitted to the Committee on Health in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee 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,] twenty through [March] December thirty-first, 9 two thousand twenty and each calendar year thereafter, all funds avail- 10 able for distribution pursuant to this section, [except for funds11distributed pursuant to subparagraph (v) of paragraph (b) of subdivision12five-b of this section,] and all funds available for distribution pursu- 13 ant to section twenty-eight hundred seven-w of this article, shall be 14 reserved and set aside and distributed in accordance with the provisions 15 of this subdivision. 16 (b) The commissioner shall promulgate regulations, and may promulgate 17 emergency regulations, establishing methodologies for the distribution EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD10355-06-0S. 5546--A 2 1 of funds as described in paragraph (a) of this subdivision and such 2 regulations shall include, but not be limited to, the following: 3 (i) Such regulations shall establish methodologies for determining 4 each facility's relative uncompensated care need amount based on unin- 5 sured inpatient and outpatient units of service from the cost reporting 6 year two years prior to the distribution year, multiplied by the appli- 7 cable medicaid rates in effect January first of the distribution year, 8 as summed and adjusted by a statewide cost adjustment factor and reduced 9 by the sum of all payment amounts collected from such uninsured 10 patients, and as further adjusted by application of a nominal need 11 computation that shall take into account each facility's medicaid inpa- 12 tient share. 13 (ii) Annual distributions pursuant to such regulations for [the two14thousand thirteen through two thousand twenty calendar years] each 15 calendar year beginning with the two thousand twenty calendar year shall 16 be in accord with the following: 17 (A) [one hundred thirty-nine million four hundred thousand dollars] 18 one hundred one million seven hundred thousand dollars for each calendar 19 year (prorated, as may be necessary, to reflect any period less than a 20 year) shall be distributed as Medicaid Disproportionate Share Hospital 21 ("DSH") payments to major public general hospitals; and 22 (B) [nine hundred ninety-four million nine hundred thousand dollars] 23 seven hundred seven million six hundred thousand dollars for each calen- 24 dar year (prorated, as may be necessary, to reflect any period less than 25 a year) as Medicaid DSH payments to eligible general hospitals, other 26 than major public general hospitals. 27 (iii)[(A) Such regulations shall establish transition adjustments to28the distributions made pursuant to clauses (A) and (B) of subparagraph29(ii) of this paragraph such that no facility experiences a reduction in30indigent care pool payments pursuant to this subdivision that is greater31than the percentages, as specified in clause (C) of this subparagraph as32compared to the average distribution that each such facility received33for the three calendar years prior to two thousand thirteen pursuant to34this section and section twenty-eight hundred seven-w of this article.35(B) Such regulations shall also establish adjustments limiting the36increases in indigent care pool payments experienced by facilities37pursuant to this subdivision by an amount that will be, as determined by38the commissioner and in conjunction with such other funding as may be39available for this purpose, sufficient to ensure full funding for the40transition adjustment payments authorized by clause (A) of this subpara-41graph.42(C) No facility shall experience a reduction in indigent care pool43payments pursuant to this subdivision that: for the calendar year begin-44ning January first, two thousand thirteen, is greater than two and one-45half percent; for the calendar year beginning January first, two thou-46sand fourteen, is greater than five percent; and, for the calendar year47beginning on January first, two thousand fifteen; is greater than seven48and one-half percent, and for the calendar year beginning on January49first, two thousand sixteen, is greater than ten percent; and for the50calendar year beginning on January first, two thousand seventeen, is51greater than twelve and one-half percent; and for the calendar year52beginning on January first, two thousand eighteen, is greater than53fifteen percent; and for the calendar year beginning on January first,54two thousand nineteen, is greater than seventeen and one-half percent;55and for the calendar year beginning on January first, two thousand twen-56ty, is greater than twenty percent.S. 5546--A 3 1(iv)] Such regulations shall reserve one percent of the funds avail- 2 able for distribution in the two thousand fourteen and two thousand 3 fifteen calendar years, and for calendar years thereafter, pursuant to 4 this subdivision, subdivision fourteen-f of section twenty-eight hundred 5 seven-c of this article, and sections two hundred eleven and two hundred 6 twelve of chapter four hundred seventy-four of the laws of nineteen 7 hundred ninety-six, in a "financial assistance compliance pool" and 8 shall establish methodologies for the distribution of such pool funds to 9 facilities based on their level of compliance, as determined by the 10 commissioner, with the provisions of subdivision nine-a of this section. 11 (c) The commissioner shall annually report to the governor and the 12 legislature on the distribution of funds under this subdivision includ- 13 ing, but not limited to: 14 (i) the impact on safety net providers, including community providers, 15 rural general hospitals and major public general hospitals; 16 (ii) the provision of indigent care by units of services and funds 17 distributed by general hospitals; and 18 (iii) the extent to which access to care has been enhanced. 19 § 2. Section 2807 of the public health law is amended by adding a new 20 subdivision 23 to read follows: 21 23. Adjustments to medicaid rates. (a) The commissioner is authorized 22 to make adjustments to medical assistance rates in accordance with this 23 subdivision to enhanced safety net hospitals, as defined in paragraph 24 (a) of subdivision thirty-four of section twenty-eight hundred seven-c 25 of this article, and to qualified safety net hospitals, as defined in 26 paragraph (b) of this subdivision, for the purposes of supporting crit- 27 ically needed health care services and to ensure the continued mainte- 28 nance and operation of such hospitals. 29 (b) For the purposes of this subdivision, a "qualified safety net" 30 hospital shall mean a hospital, other than an enhanced safety net hospi- 31 tal, so designated by the commissioner pursuant to criteria developed by 32 the commissioner that take into account: (i) the hospital's financial 33 hardship, evidenced by the operating losses of the hospital or the 34 system of hospitals to which the hospital belongs and/or participation 35 by the hospital in programs established by the commissioner to enable 36 hospitals in financial distress to maintain operations and vital 37 services; (ii) the volume of Medicaid and/or medically uninsured 38 patients served by the hospital compared to other hospitals in the 39 hospital's region; and/or (iii) the importance of the hospital in the 40 hospital's region in enabling Medicaid and/or medically uninsured 41 patients' access to health care services in inpatient, outpatient and 42 community settings. 43 (c) For the state fiscal year commencing April first, two thousand 44 twenty, and each state fiscal year thereafter, the commissioner shall 45 increase medical assistance rates of payments for inpatient and/or 46 outpatient services made by either state governmental agencies or organ- 47 izations operating in accordance with article forty-three of the insur- 48 ance law or article forty-four of this chapter by an aggregate of: 49 (i) thirty-seven million seven hundred thousand dollars for enhanced 50 safety net hospitals that are major public general hospitals; 51 (ii) two hundred seventy-four million eight hundred thousand dollars 52 for qualified safety net hospitals and enhanced safety net hospitals 53 other than major public general hospitals, of which at least twelve 54 million five hundred thousand dollars shall be allocated to enhanced 55 safety net hospitals that are federally designated as critical access or 56 sole community hospitals; andS. 5546--A 4 1 (iii) twelve million five hundred thousand dollars for those hospitals 2 eligible under subparagraph (ii) of this paragraph for which the 3 combined payments made, or to be made, under subparagraph (ii) of this 4 paragraph and subdivision five-d of section twenty-eight hundred seven-k 5 of this article for calendar year two thousand twenty, and each calendar 6 year thereafter, are projected by the commissioner to be less than 7 payments made to such hospitals pursuant to subdivision five-d of 8 section twenty-eight hundred seven-k of this article for calendar year 9 two thousand eighteen. 10 (d) Payments made pursuant to this subdivision may be added to rates 11 of payment, or made as aggregate payments of equal amounts on October 12 one and April one of each state fiscal year, to such enhanced safety net 13 hospitals and qualified safety net hospitals in accordance with a meth- 14 odology to be established by the commissioner; provided, however, that, 15 the commissioner may make the twelve million five hundred thousand 16 dollars in payments due to eligible hospitals under subparagraph (iii) 17 of paragraph (c) of this subdivision by instead increasing the amount 18 otherwise awarded to such eligible hospitals under programs established 19 by the commissioner to enable hospitals in financial distress to main- 20 tain operations and vital services while working to achieve longer-term 21 sustainability, including, but not limited to, the Value Based Payment 22 Quality Improvement Program. 23 § 3. Subparagraph (v) of paragraph (a) of subdivision 1 of section 24 2807-c of the public health law, as amended by chapter 639 of the laws 25 of 1996, is amended and a new subparagraph (vi) is added to read as 26 follows: 27 (v) adjustments for any modifications to the case payments determined 28 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of 29 this section[.]; and 30 (vi) adjustments for any modifications to the case payments determined 31 in accordance with subdivision twenty-three of section twenty-eight 32 hundred seven of this article. 33 § 4. Subparagraph (v) of paragraph (a) of subdivision 1 of section 34 2807-c of the public health law, as amended by chapter 731 of the laws 35 of 1993, is amended and a new subparagraph (vi) is added to read as 36 follows: 37 (v) adjustments for any modifications to the case payments determined 38 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of 39 this section[.]; and 40 (vi) adjustments for any modifications to the case payments determined 41 in accordance with subdivision twenty-three of section twenty-eight 42 hundred seven of this article. 43 § 5. Subdivision 34 of section 2807-c of the public health law is 44 amended by adding a new paragraph (d) to read as follows: 45 (d) Notwithstanding any inconsistent provision of law or regulation to 46 the contrary, adjustments made pursuant to this subdivision shall be in 47 addition to any adjustments made to medical assistance rates to enhanced 48 safety net hospitals authorized by subdivision twenty-three of section 49 twenty-eight hundred seven of this article. 50 § 6. Subdivision 1 of section 211 of chapter 474 of the laws of 1996 51 amending the education law and other laws relating to rates for residen- 52 tial health care facilities is amended by adding a new paragraph (g) to 53 read as follows: 54 (g) Notwithstanding any inconsistent provision of law or regulation to 55 the contrary, effective for the state fiscal year beginning April 1, 56 2020, and annually thereafter, the department of health is authorized toS. 5546--A 5 1 pay public general hospitals, other than those operated by the state of 2 New York or the state university of New York, as defined in subdivision 3 10 of section 2801 of the public health law, located in a city with a 4 population of over one million, additional payments for inpatient hospi- 5 tal services of 200 million dollars annually, as medical assistance 6 pursuant to title 11 of article 5 of the social services law for 7 patients eligible for federal financial participation under title XIX of 8 the federal social security act, pursuant to federal laws and regu- 9 lations governing disproportionate share payments to hospitals, based on 10 the relative share of each such non-state operated public general hospi- 11 tal medical assistance and uninsured patient losses. The payments may be 12 added to rates of payment or made as aggregate payments to an eligible 13 public general hospital. 14 § 7. Subdivision 1 of section 212 of chapter 474 of the laws of 1996 15 amending the education law and other laws relating to rates for residen- 16 tial health care facilities, is amended by adding a new paragraph (c) to 17 read as follows: 18 (c) Notwithstanding any inconsistent provision of law or regulation to 19 the contrary, effective for the state fiscal year beginning April 1, 20 2020, and annually thereafter, the department of health is authorized to 21 pay public general hospitals, as defined in subdivision 10 of section 22 2801 of the public health law, operated by the state of New York or the 23 state university of New York or by a county, which shall not include a 24 city with a population of over one million, of the state of New York, 25 and those public general hospitals located in the county of Westchester, 26 the county of Erie or the county of Nassau, additional payments for 27 inpatient hospital services of 100 million dollars annually, as medical 28 assistance payments pursuant to title 11 of article 5 of the social 29 services law for patients eligible for federal financial participation 30 under title XIX of the federal social security act, pursuant to federal 31 laws and regulations governing disproportionate share payments to hospi- 32 tals. The payments may be added to rates of payment or made as aggregate 33 payments to an eligible public general hospital. 34 § 8. This act shall take effect immediately; provided however, that 35 the amendments made to paragraph (a) of subdivision 1 of section 2807-c 36 of the public health law made by section three of this act shall be 37 subject to the expiration and reversion of such paragraph when upon such 38 date the provisions of section four of this act shall take effect.
