S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6883
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              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:
 
   Section 1. Subparagraph (ii) of paragraph  b  of  subdivision  5-d  of
 section 2807-k of the public health law, as amended by section 3 of part
 KK of chapter 56 of the laws of 2020, is amended to read as follows:
   (ii)  Annual distributions pursuant to such regulations for the CALEN-
 DAR YEAR two thousand [twenty through two thousand  twenty-two  calendar
 years]  TWENTY-ONE  AND EACH YEAR THEREAFTER shall be in accord with the
 following:
   (A) one hundred thirty-nine  million  four  hundred  thousand  dollars
 shall be distributed as Medicaid Disproportionate Share Hospital ("DSH")
 payments to major public general hospitals; and
   (B)  nine  hundred sixty-nine million nine hundred thousand dollars as
 Medicaid DSH payments to eligible general hospitals,  other  than  major
 public general hospitals.
   For the calendar years two thousand twenty through two thousand [twen-
 ty-two,] TWENTY-ONE AND EACH CALENDAR YEAR THEREAFTER the total distrib-
 utions  to  eligible  general hospitals, other than major public general
 hospitals, shall be subject to an aggregate reduction  of  [one  hundred
 fifty]  TWO HUNDRED SEVENTY-FIVE million dollars annually, provided that
 eligible general hospitals, other than major public  general  hospitals,
 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
 
 eight  hundred  seven-c  of  this  article  shall not be subject to such
 reduction.
   Such  reduction shall be determined by a methodology to be established
 by the commissioner. Such methodology may take into  account  the  payor
 mix  of  each  non-public  general hospital, including the percentage of
 inpatient days paid by Medicaid.
   § 2. Section 2807 of the public health law is amended by adding a  new
 subdivision 22 to read follows:
   22.  ADJUSTMENTS  TO  MEDICAID  RATES. (A) THE COMMISSIONER SHALL MAKE
 ADJUSTMENTS TO MEDICAL ASSISTANCE RATES IN ACCORDANCE WITH THIS SUBDIVI-
 SION TO ENHANCED SAFETY NET HOSPITALS, AS DEFINED IN  PARAGRAPH  (A)  OF
 SUBDIVISION  THIRTY-FOUR OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THIS
 ARTICLE, AND TO QUALIFIED SAFETY NET HOSPITALS, AS DEFINED IN  PARAGRAPH
 (B) OF THIS SUBDIVISION, FOR THE PURPOSES OF SUPPORTING CRITICALLY NEED-
 ED  HEALTH  CARE  SERVICES  AND  TO ENSURE THE CONTINUED MAINTENANCE AND
 OPERATION OF SUCH HOSPITALS.
   (B) FOR THE PURPOSES OF THIS  SUBDIVISION,  A  "QUALIFIED  SAFETY  NET
 HOSPITAL"  SHALL  MEAN A GENERAL HOSPITAL, OTHER THAN AN ENHANCED SAFETY
 NET HOSPITAL THAT IN ANY OF THE PREVIOUS THREE CALENDAR YEARS:
   (I) HAS MET FOUR OF THE FIVE CRITERIA LISTED UNDER SUBPARAGRAPH (I) OF
 PARAGRAPH (A) OF SUBDIVISION THIRTY-FOUR OF SECTION TWENTY-EIGHT HUNDRED
 SEVEN-C OF THIS ARTICLE; OR
   (II) HAS MET THE FOLLOWING CRITERIA:
   (A) NOT LESS THAN FORTY-FIVE PERCENT OF THE PATIENTS IT TREATS RECEIVE
 MEDICAL ASSISTANCE OR ARE MEDICALLY UNINSURED;
   (B) NOT LESS THAN THIRTY-SIX PERCENT OF ITS INPATIENT  DISCHARGES  ARE
 COVERED BY MEDICAID;
   (C)  TWENTY-EIGHT  PERCENT  OR  LESS  OF  ITS  DISCHARGED PATIENTS ARE
 COMMERCIALLY INSURED;
   (D) NOT LESS THAN TWO PERCENT OF THE PATIENTS IT PROVIDES SERVICES  TO
 ARE ATTRIBUTED TO THE CARE OF UNINSURED PATIENTS; AND
   (E)  PROVIDES CARE TO UNINSURED PATIENTS IN ITS EMERGENCY ROOM, HOSPI-
 TAL-BASED CLINICS AND COMMUNITY BASED CLINICS, INCLUDING  THE  PROVISION
 OF  IMPORTANT COMMUNITY SERVICES, SUCH AS DENTAL CARE AND PRENATAL CARE;
 OR
   (III) IS SO DESIGNATED BY THE COMMISSIONER PURSUANT TO  FINDINGS  THAT
 TAKES INTO ACCOUNT THE FOLLOWING CRITERIA:
   (A)  THE  HOSPITAL IS OPERATING UNDER FINANCIAL HARDSHIP, EVIDENCED BY
 THE OPERATING LOSSES OF THE HOSPITAL OR THE SYSTEM OF HOSPITALS TO WHICH
 THE HOSPITAL BELONGS AND/OR PARTICIPATION BY THE  HOSPITAL  IN  PROGRAMS
 ESTABLISHED  BY  THE  COMMISSIONER  TO  ENABLE  HOSPITALS  IN  FINANCIAL
 DISTRESS TO MAINTAIN OPERATIONS AND VITAL SERVICES;
   (B) THE VOLUME OF MEDICAID AND/OR MEDICALLY UNINSURED PATIENTS  SERVED
 BY  THE HOSPITAL EXCEEDS THE AVERAGE VOLUME OF SUCH SERVICES PROVIDED BY
 OTHER HOSPITALS IN THE HOSPITAL'S REGION; AND
   (C) THE  IMPORTANCE  OF  THE  HOSPITAL  IN  ENABLING  MEDICAID  AND/OR
 MEDICALLY  UNINSURED  PATIENTS'  ACCESS TO HEALTH CARE SERVICES IN INPA-
 TIENT, OUTPATIENT AND COMMUNITY SETTINGS WITHIN THE HOSPITAL'S REGION.
   (C) FOR THE STATE FISCAL YEAR COMMENCING  APRIL  FIRST,  TWO  THOUSAND
 TWENTY-TWO AND EACH STATE FISCAL YEAR THEREAFTER, THE COMMISSIONER SHALL
 INCREASE  MEDICAL  ASSISTANCE  RATES  OF  PAYMENTS  FOR INPATIENT AND/OR
 OUTPATIENT SERVICES MADE BY EITHER STATE GOVERNMENTAL AGENCIES OR ORGAN-
 IZATIONS OPERATING IN ACCORDANCE WITH ARTICLE FORTY-THREE OF THE  INSUR-
 ANCE LAW OR ARTICLE FORTY-FOUR OF THIS CHAPTER BY AN AGGREGATE OF:
   (I)  THIRTY-FOUR  MILLION ONE HUNDRED TWENTY-FIVE THOUSAND DOLLARS FOR
 ENHANCED SAFETY NET HOSPITALS THAT ARE MAJOR PUBLIC GENERAL HOSPITALS;

 A. 6883                             3
 
   (II) TWO HUNDRED TWENTY-EIGHT MILLION THREE HUNDRED SEVENTY-FIVE THOU-
 SAND DOLLARS FOR QUALIFIED SAFETY NET HOSPITALS AND ENHANCED SAFETY  NET
 HOSPITALS  OTHER  THAN MAJOR PUBLIC GENERAL HOSPITALS, OF WHICH AT LEAST
 TWELVE MILLION FIVE HUNDRED  THOUSAND  DOLLARS  SHALL  BE  ALLOCATED  TO
 ENHANCED  SAFETY NET HOSPITALS THAT ARE FEDERALLY DESIGNATED AS CRITICAL
 ACCESS OR SOLE COMMUNITY HOSPITALS; AND
   (III) TWELVE MILLION FIVE HUNDRED THOUSAND DOLLARS FOR THOSE HOSPITALS
 ELIGIBLE UNDER  SUBPARAGRAPH  (II)  OF  THIS  PARAGRAPH  FOR  WHICH  THE
 COMBINED  PAYMENTS  MADE, OR TO BE MADE, UNDER SUBPARAGRAPH (II) OF THIS
 PARAGRAPH AND SUBDIVISION FIVE-D OF SECTION TWENTY-EIGHT HUNDRED SEVEN-K
 OF THIS ARTICLE FOR CALENDAR  YEAR  TWO  THOUSAND  TWENTY-TWO  AND  EACH
 CALENDAR  YEAR  THEREAFTER, ARE PROJECTED BY THE COMMISSIONER TO BE LESS
 THAN PAYMENTS MADE TO SUCH HOSPITALS PURSUANT TO SUBDIVISION  FIVE-D  OF
 SECTION  TWENTY-EIGHT  HUNDRED SEVEN-K OF THIS ARTICLE FOR CALENDAR YEAR
 TWO THOUSAND EIGHTEEN.
   (D) PAYMENTS MADE PURSUANT TO THIS SUBDIVISION MAY BE ADDED  TO  RATES
 OF  PAYMENT,  OR  MADE AS AGGREGATE PAYMENTS OF EQUAL AMOUNTS ON OCTOBER
 FIRST AND APRIL FIRST OF EACH STATE FISCAL YEAR, TO SUCH ENHANCED SAFETY
 NET HOSPITALS AND QUALIFIED SAFETY NET HOSPITALS IN  ACCORDANCE  WITH  A
 METHODOLOGY  TO  BE  ESTABLISHED BY THE COMMISSIONER; PROVIDED, HOWEVER,
 THAT, THE COMMISSIONER MAY MAKE THE TWELVE MILLION FIVE HUNDRED THOUSAND
 DOLLARS IN PAYMENTS DUE TO ELIGIBLE HOSPITALS UNDER  SUBPARAGRAPH  (III)
 OF  PARAGRAPH  (C)  OF THIS SUBDIVISION BY INSTEAD INCREASING THE AMOUNT
 OTHERWISE AWARDED TO SUCH ELIGIBLE HOSPITALS UNDER PROGRAMS  ESTABLISHED
 BY  THE  COMMISSIONER TO ENABLE HOSPITALS IN FINANCIAL DISTRESS TO MAIN-
 TAIN OPERATIONS AND VITAL SERVICES WHILE WORKING TO ACHIEVE  LONGER-TERM
 SUSTAINABILITY,  INCLUDING,  BUT NOT LIMITED TO, THE VALUE BASED PAYMENT
 QUALITY IMPROVEMENT PROGRAM.
   § 3. Subparagraph (v) of paragraph (a) of  subdivision  1  of  section
 2807-c  of  the public health law, as amended by chapter 639 of the laws
 of 1996, is amended and a new subparagraph (vi)  is  added  to  read  as
 follows:
   (v)  adjustments for any modifications to the case payments determined
 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
 this section[.]; AND
   (VI) ADJUSTMENTS FOR ANY MODIFICATIONS TO THE CASE PAYMENTS DETERMINED
 IN  ACCORDANCE  WITH  SUBDIVISION  TWENTY-TWO  OF  SECTION  TWENTY-EIGHT
 HUNDRED SEVEN OF THIS ARTICLE.
   §  4.  Subparagraph  (v)  of paragraph (a) of subdivision 1 of section
 2807-c of the public health law, as amended by chapter 731 of  the  laws
 of  1993,  is  amended  and  a new subparagraph (vi) is added to read as
 follows:
   (v) adjustments for any modifications to the case payments  determined
 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
 this section[.]; AND
   (VI) ADJUSTMENTS FOR ANY MODIFICATIONS TO THE CASE PAYMENTS DETERMINED
 IN  ACCORDANCE  WITH  SUBDIVISION  TWENTY-TWO  OF  SECTION  TWENTY-EIGHT
 HUNDRED SEVEN OF THIS ARTICLE.
   § 5. Subdivision 34 of section 2807-c of  the  public  health  law  is
 amended by adding a new paragraph (d) to read as follows:
   (D) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE  CONTRARY, ADJUSTMENTS MADE PURSUANT TO THIS SUBDIVISION SHALL BE IN
 ADDITION TO ANY ADJUSTMENTS MADE TO MEDICAL ASSISTANCE RATES TO ENHANCED
 SAFETY NET HOSPITALS AUTHORIZED BY  SUBDIVISION  TWENTY-TWO  OF  SECTION
 TWENTY-EIGHT HUNDRED SEVEN OF THIS ARTICLE.

 A. 6883                             4
 
   §  6.  Subdivision 1 of section 211 of chapter 474 of the laws of 1996
 amending the education law and other laws relating to rates for residen-
 tial health care facilities, is amended by adding a new paragraph (g) to
 read as follows:
   (G) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE  CONTRARY,  EFFECTIVE  FOR  THE STATE FISCAL YEAR BEGINNING APRIL 1,
 2022, AND ANNUALLY THEREAFTER, THE DEPARTMENT OF HEALTH IS AUTHORIZED TO
 PAY PUBLIC GENERAL HOSPITALS, OTHER THAN THOSE OPERATED BY THE STATE  OF
 NEW  YORK OR THE STATE UNIVERSITY OF NEW YORK, AS DEFINED IN SUBDIVISION
 10 OF SECTION 2801 OF THE PUBLIC HEALTH LAW, LOCATED IN A  CITY  WITH  A
 POPULATION OF OVER ONE MILLION, ADDITIONAL PAYMENTS FOR INPATIENT HOSPI-
 TAL  SERVICES  OF  200  MILLION  DOLLARS ANNUALLY, AS MEDICAL ASSISTANCE
 PURSUANT TO TITLE 11 OF  ARTICLE  5  OF  THE  SOCIAL  SERVICES  LAW  FOR
 PATIENTS ELIGIBLE FOR FEDERAL FINANCIAL PARTICIPATION UNDER TITLE XIX OF
 THE  FEDERAL  SOCIAL  SECURITY  ACT,  PURSUANT TO FEDERAL LAWS AND REGU-
 LATIONS GOVERNING DISPROPORTIONATE SHARE PAYMENTS TO HOSPITALS, BASED ON
 THE RELATIVE SHARE OF EACH SUCH NON-STATE OPERATED PUBLIC GENERAL HOSPI-
 TAL MEDICAL ASSISTANCE AND UNINSURED PATIENT LOSSES. THE PAYMENTS MAY BE
 ADDED TO RATES OF PAYMENT OR MADE AS AGGREGATE PAYMENTS TO  AN  ELIGIBLE
 PUBLIC GENERAL HOSPITAL.
   §  7.  Subdivision 1 of section 212 of chapter 474 of the laws of 1996
 amending the education law and other laws relating to rates for residen-
 tial health care facilities, is amended by adding a new paragraph (c) to
 read as follows:
   (C) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE CONTRARY, EFFECTIVE FOR THE STATE FISCAL  YEAR  BEGINNING  APRIL  1,
 2022, AND ANNUALLY THEREAFTER, THE DEPARTMENT OF HEALTH IS AUTHORIZED TO
 PAY  PUBLIC  GENERAL  HOSPITALS, AS DEFINED IN SUBDIVISION 10 OF SECTION
 2801 OF THE PUBLIC HEALTH LAW, OPERATED BY THE STATE OF NEW YORK OR  THE
 STATE  UNIVERSITY  OF NEW YORK OR BY A COUNTY, WHICH SHALL NOT INCLUDE A
 CITY WITH A POPULATION OF OVER ONE MILLION, OF THE STATE  OF  NEW  YORK,
 AND THOSE PUBLIC GENERAL HOSPITALS LOCATED IN THE COUNTY OF WESTCHESTER,
 THE  COUNTY  OF  ERIE  OR  THE COUNTY OF NASSAU, ADDITIONAL PAYMENTS FOR
 INPATIENT HOSPITAL SERVICES OF 100 MILLION DOLLARS ANNUALLY, AS  MEDICAL
 ASSISTANCE  PAYMENTS  PURSUANT  TO  TITLE  11 OF ARTICLE 5 OF THE SOCIAL
 SERVICES LAW FOR PATIENTS ELIGIBLE FOR FEDERAL  FINANCIAL  PARTICIPATION
 UNDER  TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT, PURSUANT TO FEDERAL
 LAWS AND REGULATIONS GOVERNING DISPROPORTIONATE SHARE PAYMENTS TO HOSPI-
 TALS. THE PAYMENTS MAY BE ADDED TO RATES OF PAYMENT OR MADE AS AGGREGATE
 PAYMENTS TO AN ELIGIBLE PUBLIC GENERAL HOSPITAL.
   § 8. This act shall take effect immediately;  provided,  however  that
 the amendments to subdivision 5-d of section 2807-k of the public health
 law  made  by section one of this act shall not affect the expiration of
 such subdivision and shall expire and be deemed repealed therewith;  and
 provided  further  that the amendments to paragraph (a) of subdivision 1
 of section 2807-c of the public health law made by section three of this
 act shall be subject to the expiration and reversion of  such  paragraph
 when  upon  such  date  the provisions of section four of this act shall
 take effect.