S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7217
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 15, 2023
                                ___________
 
 Introduced  by  M.  of A. BICHOTTE HERMELYN -- 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 1 of part
 E of chapter 57 of the laws of 2023, is amended to read as follows:
   (ii)  Annual  distributions  pursuant  to such regulations for the two
 thousand twenty through two thousand twenty-five calendar years AND EACH
 CALENDAR 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, the total distributions to  eligible  general  hospitals,  other
 than  major  public  general hospitals, shall be subject to an aggregate
 reduction of one hundred fifty 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
 eight hundred seven-c of this article  shall  not  be  subject  to  such
 reduction.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08098-02-3
 A. 7217                             2
              

 
   For  the calendar years two thousand twenty-three through two thousand
 twenty-five AND EACH CALENDAR YEAR THEREAFTER, the  total  distributions
 to  eligible  general  hospitals, other than major public general hospi-
 tals, shall be subject to an aggregate reduction of two  hundred  [thir-
 ty-five]  SEVENTY-FIVE  million  four hundred thousand dollars annually,
 provided that eligible general hospitals, other than major public gener-
 al hospitals that qualify as enhanced safety net hospitals under section
 two thousand eight hundred seven-c of this article as  of  April  first,
 two thousand twenty, shall not be subject to such reduction.
   Such reductions shall be determined by a methodology to be established
 by  the commissioner. Such methodologies 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.
 A. 7217                             3
 
   (C)  FOR  THE  STATE  FISCAL YEAR COMMENCING APRIL FIRST, TWO THOUSAND
 TWENTY-FOUR 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;
   (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-FOUR 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.
 A. 7217                             4
 
   §  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.
   §  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,
 2024, 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,
 2024, 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 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.