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A06883 Summary:

BILL NOA06883
 
SAME ASSAME AS S05954
 
SPONSORGottfried
 
COSPNSRReyes, Barron, Colton
 
MLTSPNSR
 
Amd §§2807-k, 2807 & 2807-c, Pub Health L; amd §§211 & 212, Chap 474 of 1996
 
Relates to the general hospital indigent care pool and funding for safety net and enhanced safety net hospitals.
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A06883 Actions:

BILL NOA06883
 
04/13/2021referred to health
04/27/2021reported referred to ways and means
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A06883 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A6883
 
SPONSOR: Gottfried
  TITLE OF BILL: An act to amend the public health law, in relation to the general hospi- tal indigent care pool and funding for safety net and 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 additional payments for certain inpa- tient hospital services   PURPOSE OR GENERAL IDEA OF BILL: Redistribute indigent care pool (ICP) funding to better target support to safety net hospitals which provide services to persons who are unin- sured, under insured or insured by Medicaid.   SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends Public Health Law 2807-k, subdiv. 5-d, to reduce allo- cations to general hospitals other than major public general hospitals, or qualified safety net general hospitals by $275 million. This section also extends the removal of the transition collar enacted in 2020 and retains the reduction of the $25 million associated with this provision. These funds are distributed under other provisions of the bill. Section 2 of the bill adds a new Subdivision 22 to PHL 2807 to authorize adjustments to Medicaid rates for Enhanced Safety Net hospitals as defined in the PHL, and to a newly defined category of Qualified Safety Net hospitals. The new definition of Qualified Safety Net hospital is intended for hospitals that fall outside of the enhanced safety net definition, but provide significant indigent care, such as those that have received financial assistance through the existing VBPQIP/VAPAP programs and hospitals on the state's financial watch list. This section also requires the commissioner to increase Medicaid payments for inpa- tient and outpatient services by $34.1 million to major public general hospitals and $228 3 million to Enhanced Safety Net and Qualified Safety Net hospitals other than major public general hospitals. An additional $12 5 million is dedicated to federally designated critical access and sole community hospitals. This section increases rates/lump sum payments or using either VBP QIP or other supplemental programs to safety net hospitals (other than major public general hospitals) that lose funds compared to the current ICP distribution. Section 3 amends subdivision 1 of PHL 2807-c, which provides for hospi- tal inpatient Medicaid payment rates, to allow adjustments under the revised PHL 2807(22). Section 4 and 5 adds a new sub-paragraph (vi) to paragraph (a) of subdi- vision (1), and a new paragraph (d) to subdivision (34) of PHL 2807-c to make clear that payments to Enhanced Safety Net and Qualified Safety Net hospitals do not supplant other funding streams to Enhanced Safety Net hospitals. Sections 6 and 7 amend Chapter 474 of the Laws of 1996, to allow addi- tional $200 million in DSH payments to NYC Health + Hospitals, and addi- tional $100M DSH to all other major public hospitals, including those operated by the state, the State University of New York, or Erie, Nassau or Westchester counties.   JUSTIFICATION: This legislation will fix inequities in the distribution of ICP funds without hurting hospitals that provide services to low income and at risk communities, by increasing Medicaid rates for enhanced safety net and qualified safety net hospitals; optimizing new federal Medicaid funds; and retaining all existing federal DSH funds to support these essential services. This legislation will rebalance the distribution without additional financial impact to the State. The bill better targets ICP funds to uninsured patient care. To address the Medicaid rate issue, the bill would invest $275 million of ICP funds into Medi- caid increases for enhanced and qualified safety net hospitals. The investment by hospital ownership type is proportional to the current pool funding with public shares of ICP at 13% and voluntary shares of the ICP at 87%. The bill builds on the Enhanced Safety Net Hospitals statute, and reforms enacted in 2020. The bill also retains the reduction of $25 million related to the reforms enacted in 2020. It recognizes that addi- tional hospitals are providing essential services to safety net communi- ties and face serious financial jeopardy. Those hospitals are defined as qualified safety net hospitals and may be identified by criteria includ- ing having been awarded VAPAP or VBP QIP funds, or placed on the DOH Financially Distressed Watch List; the volume of Medicaid or uninsured patients served; or the importance of the hospital in the hospital's region in providing services to Medicaid and uninsured patients. The bill would retain all existing federal DSH by allowing public hospitals access to $300 million federal DSH formerly used for ICP. The bill would increase Medicaid reimbursement rates for safety net and qualified safety net hospitals; dedicate funding for critical access hospitals and sole community hospitals; expand existing programs for financially distressed hospitals to ensure no harm to safety net or qualified safety net hospitals.   PRIOR LEGISLATIVE HISTORY: New bill   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: Immediately
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A06883 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          6883
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                     April 13, 2021
                                       ___________
 
        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 and funding for safety net and 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 additional payments for certain
          inpatient hospital services
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Subparagraph (ii) of paragraph  b  of  subdivision  5-d  of
     2  section 2807-k of the public health law, as amended by section 3 of part
     3  KK of chapter 56 of the laws of 2020, is amended to read as follows:
     4    (ii)  Annual distributions pursuant to such regulations for the calen-
     5  dar year two thousand [twenty through two thousand  twenty-two  calendar
     6  years]  twenty-one  and each year thereafter shall be in accord with the
     7  following:
     8    (A) one hundred thirty-nine  million  four  hundred  thousand  dollars
     9  shall be distributed as Medicaid Disproportionate Share Hospital ("DSH")
    10  payments to major public general hospitals; and
    11    (B)  nine  hundred sixty-nine million nine hundred thousand dollars as
    12  Medicaid DSH payments to eligible general hospitals,  other  than  major
    13  public general hospitals.
    14    For the calendar years two thousand twenty through two thousand [twen-
    15  ty-two,] twenty-one and each calendar year thereafter the total distrib-
    16  utions  to  eligible  general hospitals, other than major public general
    17  hospitals, shall be subject to an aggregate reduction  of  [one  hundred
    18  fifty]  two hundred seventy-five million dollars annually, provided that
    19  eligible general hospitals, other than major public  general  hospitals,
    20  that qualify as enhanced safety net hospitals under section two thousand

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10542-01-1

        A. 6883                             2
 
     1  eight  hundred  seven-c  of  this  article  shall not be subject to such
     2  reduction.
     3    Such  reduction shall be determined by a methodology to be established
     4  by the commissioner. Such methodology may take into  account  the  payor
     5  mix  of  each  non-public  general hospital, including the percentage of
     6  inpatient days paid by Medicaid.
     7    § 2. Section 2807 of the public health law is amended by adding a  new
     8  subdivision 22 to read follows:
     9    22.  Adjustments  to  Medicaid  rates. (a) The commissioner shall make
    10  adjustments to medical assistance rates in accordance with this subdivi-
    11  sion to enhanced safety net hospitals, as defined in  paragraph  (a)  of
    12  subdivision  thirty-four of section twenty-eight hundred seven-c of this
    13  article, and to qualified safety net hospitals, as defined in  paragraph
    14  (b) of this subdivision, for the purposes of supporting critically need-
    15  ed  health  care  services  and  to ensure the continued maintenance and
    16  operation of such hospitals.
    17    (b) For the purposes of this  subdivision,  a  "qualified  safety  net
    18  hospital"  shall  mean a general hospital, other than an enhanced safety
    19  net hospital that in any of the previous three calendar years:
    20    (i) has met four of the five criteria listed under subparagraph (i) of
    21  paragraph (a) of subdivision thirty-four of section twenty-eight hundred
    22  seven-c of this article; or
    23    (ii) has met the following criteria:
    24    (A) not less than forty-five percent of the patients it treats receive
    25  medical assistance or are medically uninsured;
    26    (B) not less than thirty-six percent of its inpatient  discharges  are
    27  covered by Medicaid;
    28    (C)  twenty-eight  percent  or  less  of  its  discharged patients are
    29  commercially insured;
    30    (D) not less than two percent of the patients it provides services  to
    31  are attributed to the care of uninsured patients; and
    32    (E)  provides care to uninsured patients in its emergency room, hospi-
    33  tal-based clinics and community based clinics, including  the  provision
    34  of  important community services, such as dental care and prenatal care;
    35  or
    36    (iii) is so designated by the commissioner pursuant to  findings  that
    37  takes into account the following criteria:
    38    (A)  the  hospital is operating under financial hardship, evidenced by
    39  the operating losses of the hospital or the system of hospitals to which
    40  the hospital belongs and/or participation by the  hospital  in  programs
    41  established  by  the  commissioner  to  enable  hospitals  in  financial
    42  distress to maintain operations and vital services;
    43    (B) the volume of Medicaid and/or medically uninsured patients  served
    44  by  the hospital exceeds the average volume of such services provided by
    45  other hospitals in the hospital's region; and
    46    (C) the  importance  of  the  hospital  in  enabling  Medicaid  and/or
    47  medically  uninsured  patients'  access to health care services in inpa-
    48  tient, outpatient and community settings within the hospital's region.
    49    (c) For the state fiscal year commencing  April  first,  two  thousand
    50  twenty-two and each state fiscal year thereafter, the commissioner shall
    51  increase  medical  assistance  rates  of  payments  for inpatient and/or
    52  outpatient services made by either state governmental agencies or organ-
    53  izations operating in accordance with article forty-three of the  insur-
    54  ance law or article forty-four of this chapter by an aggregate of:
    55    (i)  thirty-four  million one hundred twenty-five thousand dollars for
    56  enhanced safety net hospitals that are major public general hospitals;

        A. 6883                             3
 
     1    (ii) two hundred twenty-eight million three hundred seventy-five thou-
     2  sand dollars for qualified safety net hospitals and enhanced safety  net
     3  hospitals  other  than major public general hospitals, of which at least
     4  twelve million five hundred  thousand  dollars  shall  be  allocated  to
     5  enhanced  safety net hospitals that are federally designated as critical
     6  access or sole community hospitals; and
     7    (iii) twelve million five hundred thousand dollars for those hospitals
     8  eligible under  subparagraph  (ii)  of  this  paragraph  for  which  the
     9  combined  payments  made, or to be made, under subparagraph (ii) of this
    10  paragraph and subdivision five-d of section twenty-eight hundred seven-k
    11  of this article for calendar  year  two  thousand  twenty-two  and  each
    12  calendar  year  thereafter, are projected by the commissioner to be less
    13  than payments made to such hospitals pursuant to subdivision  five-d  of
    14  section  twenty-eight  hundred seven-k of this article for calendar year
    15  two thousand eighteen.
    16    (d) Payments made pursuant to this subdivision may be added  to  rates
    17  of  payment,  or  made as aggregate payments of equal amounts on October
    18  first and April first of each state fiscal year, to such enhanced safety
    19  net hospitals and qualified safety net hospitals in  accordance  with  a
    20  methodology  to  be  established by the commissioner; provided, however,
    21  that, the commissioner may make the twelve million five hundred thousand
    22  dollars in payments due to eligible hospitals under  subparagraph  (iii)
    23  of  paragraph  (c)  of this subdivision by instead increasing the amount
    24  otherwise awarded to such eligible hospitals under programs  established
    25  by  the  commissioner to enable hospitals in financial distress to main-
    26  tain operations and vital services while working to achieve  longer-term
    27  sustainability,  including,  but not limited to, the value based payment
    28  quality improvement program.
    29    § 3. Subparagraph (v) of paragraph (a) of  subdivision  1  of  section
    30  2807-c  of  the public health law, as amended by chapter 639 of the laws
    31  of 1996, 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-two  of  section  twenty-eight
    38  hundred seven of this article.
    39    §  4.  Subparagraph  (v)  of paragraph (a) of subdivision 1 of section
    40  2807-c of the public health law, as amended by chapter 731 of  the  laws
    41  of  1993,  is  amended  and  a new subparagraph (vi) is added to read as
    42  follows:
    43    (v) adjustments for any modifications to the case payments  determined
    44  in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
    45  this section[.]; and
    46    (vi) adjustments for any modifications to the case payments determined
    47  in  accordance  with  subdivision  twenty-two  of  section  twenty-eight
    48  hundred seven of this article.
    49    § 5. Subdivision 34 of section 2807-c of  the  public  health  law  is
    50  amended by adding a new paragraph (d) to read as follows:
    51    (d) Notwithstanding any inconsistent provision of law or regulation to
    52  the  contrary, adjustments made pursuant to this subdivision shall be in
    53  addition to any adjustments made to medical assistance rates to enhanced
    54  safety net hospitals authorized by  subdivision  twenty-two  of  section
    55  twenty-eight hundred seven of this article.

        A. 6883                             4
 
     1    §  6.  Subdivision 1 of section 211 of chapter 474 of the laws of 1996
     2  amending the education law and other laws relating to rates for residen-
     3  tial health care facilities, is amended by adding a new paragraph (g) to
     4  read as follows:
     5    (g) Notwithstanding any inconsistent provision of law or regulation to
     6  the  contrary,  effective  for  the state fiscal year beginning April 1,
     7  2022, and annually thereafter, the department of health is authorized to
     8  pay public general hospitals, other than those operated by the state  of
     9  New  York or the state university of New York, as defined in subdivision
    10  10 of section 2801 of the public health law, located in a  city  with  a
    11  population of over one million, additional payments for inpatient hospi-
    12  tal  services  of  200  million  dollars annually, as medical assistance
    13  pursuant to title 11 of  article  5  of  the  social  services  law  for
    14  patients eligible for federal financial participation under title XIX of
    15  the  federal  social  security  act,  pursuant to federal laws and regu-
    16  lations governing disproportionate share payments to hospitals, based on
    17  the relative share of each such non-state operated public general hospi-
    18  tal medical assistance and uninsured patient losses. The payments may be
    19  added to rates of payment or made as aggregate payments to  an  eligible
    20  public general hospital.
    21    §  7.  Subdivision 1 of section 212 of chapter 474 of the laws of 1996
    22  amending the education law and other laws relating to rates for residen-
    23  tial health care facilities, is amended by adding a new paragraph (c) to
    24  read as follows:
    25    (c) Notwithstanding any inconsistent provision of law or regulation to
    26  the contrary, effective for the state fiscal  year  beginning  April  1,
    27  2022, and annually thereafter, the department of health is authorized to
    28  pay  public  general  hospitals, as defined in subdivision 10 of section
    29  2801 of the public health law, operated by the state of New York or  the
    30  state  university  of New York or by a county, which shall not include a
    31  city with a population of over one million, of the state  of  New  York,
    32  and those public general hospitals located in the county of Westchester,
    33  the  county  of  Erie  or  the county of Nassau, additional payments for
    34  inpatient hospital services of 100 million dollars annually, as  medical
    35  assistance  payments  pursuant  to  title  11 of article 5 of the social
    36  services law for patients eligible for federal  financial  participation
    37  under  title XIX of the federal social security act, pursuant to federal
    38  laws and regulations governing disproportionate share payments to hospi-
    39  tals. The payments may be added to rates of payment or made as aggregate
    40  payments to an eligible public general hospital.
    41    § 8. This act shall take effect immediately;  provided,  however  that
    42  the amendments to subdivision 5-d of section 2807-k of the public health
    43  law  made  by section one of this act shall not affect the expiration of
    44  such subdivision and shall expire and be deemed repealed therewith;  and
    45  provided  further  that the amendments to paragraph (a) of subdivision 1
    46  of section 2807-c of the public health law made by section three of this
    47  act shall be subject to the expiration and reversion of  such  paragraph
    48  when  upon  such  date  the provisions of section four of this act shall
    49  take effect.
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