BILL NUMBER: S8554

SPONSOR: FERNANDEZ
 
TITLE OF BILL:

An act to amend the public health law, in relation to rates of hospital
reimbursement for facilities designated by the federal department of
health and human services as exempt extended neoplastic disease care
hospitals

 
PURPOSE OR GENERAL IDEA OF BILL:

The purpose of this bill is to update the operating component of the
base per diem Medicaid acute specialty rate for extended neoplastic
disease care hospitals in New York to more accurately reflect current
costs, and to ensure that such specialty rate is periodically rebased to
reflect actual costs, consistent with certain other designated specialty
acute hospitals in New York,

 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 of the bill revises the calculation of the operating component
              

of the base Medicaid acute rate for certain designated specialty acute
hospitals in New York to be to be rebased using 2021 cost report infor-
mation and continue to be rebased every two (2) years.

Section 2 addresses the effective date.

 
JUSTIFICATION:

Long- term care hospitals (LTCHs) are acute-care hospitals that focus on
patients who, on average, stay more than 25 days. Certain LTCHs are
designated by CMS as "Extended Neoplastic Disease Care Hospitals." In
New York, the only designated extended neoplastic disease care hospital
is singularly devoted to providing palliative and hospice care to adult
patients with advanced cancer and other terminal medical conditions,
providing compassionate care that relieves suffering and improves the
quality of life of mostly terminally ill in-patients and their families.

This hospital is vital to New York's health care continuum, as they
accept transfers for care of serious acute medical conditions and
  end-of-life  care,  decreasing costs to Medicaid and increasing system
acute capacity at Academic Medical Centers  (AMCs)  and  other  regional
acute  care  institutions.  Most  importantly,  they  provide a level of
compassionate care for patients, and  support  to  their  families  that
other hospitals are ill-equipped and unable to provide.

Currently,  the  Medicaid  per  diem  operating  base specialty rate for
specialty hospitals in New York is based  on  2005  allowable  operating
costs, which, unlike other acute care hospitals, has not been rebased in
13  years.  Cost  coverage  for inpatient services delivered to Medicaid
beneficiaries is no longer aligned with reimbursement, and the  Medicaid
rate is causing losses that are no longer sustainable.

It  is  necessary  to  sustain  the operations of hospitals that provide
essential services to New Yorkers with end-of-life  and  complex,  acute
care  needs.  The impact of a reduction or elimination of these services
would  constrain  the  health  care  delivery  system  by  limiting  the
discharge  of high-needs patients at end of life from acute institutions
across the New York City  area,  reduce  acute  hospital  capacity,  and
increase care delivery costs within the system.

 
PRIOR LEGISLATIVE HISTORY:

New Bill.

 
FISCAL IMPLICATIONS:

Based  on utilization trends for hospitals impacted by this legislation,
the legislation would result in an increase in Medicaid expenditures  of
$7.4  million  in  FY  2025  and FY 2026. However, the increased rate is
expected to partially, if not fully, offset through Medicaid savings  by
allowing  for  the  discharge  from  more  expensive acute hospitals for
patients with serious acute medical conditions for end-of-life care,  as
well as admission and readmission to nursing homes for end-of life care.

 
EFFECTIVE DATE:
This  act  shall  take  effect  April 1, 2024. Effective immediately the
commissioner of health or their designees  shall  make  such  rules  and
regulations,  and  seek any federal approvals necessary, to fully imple-
ment this act on or before such effective date.