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BILL NUMBER:S3362

TITLE OF BILL: An act to amend the public health law, in relation to inpatient reimbursement rates for general hospitals

PURPOSE: Ensure that general hospitals which are the most severely impacted by Medicaid rebasing receive an add-on to their reimbursement rates that is equivalent to the difference between uninsured units of service and cost based methodologies for the 2009 indigent care pool distributions divided 2005 Medicaid fee-for-service discharges.

SUMMARY OF SPECIFIC PROVISIONS: Section 1. This legislation provides for the inpatient reimbursement rate add-on for general hospitals whose total Medicaid revenues resulting from Medicaid rebasing place an institution among the top five (5) percent hardest hit hospitals in the State in terms of the percentage of their Medicaid revenue losses.

Section 2. effective date: April 1, 2011

JUSTIFICATION: The Medicaid Fee for Service revenues resulting from the December 1, 2009 Medicaid rebasing had the unintended consequence of dramatically reducing Medicaid revenues to certain general hospitals in New York State. As a result, eight general hospitals rank among the top five (5) percent hardest hit hospitals in the state, experiencing total Medicaid revenue losses ranging from a :reduction of 71.1 percent to a reduction of 54.1 percent. These losses are as much as nine times greater than the statewide average Medicaid loss of 7.8 percent. Five of the most impacted hospitals are located in Western New York; one is located in Central New York; one on Long Island; and one in the Rochester area. The five most impacted Western New York hospitals are located in the counties of Erie, Chautauqua and Niagara, which are among the lowest ranked counties in New York State in terms of morbidity rates, health behaviors and physical environment, according to a major study commissioned by the Robert Wood Johnson Foundation.

To provide relief and correct the extreme inequities of Medicaid rebasing, this legislation authorizes the use of an inpatient rate add-on to the top five (5) percent hardest hit hospitals. This legislation provides that, effective April 1, 2010, an add-on to those qualifying hospitals shall be equivalent to the difference between the uninsured units of service and cost based methodologies for 2009 indigent care pool distributions divided by 2005 Medicaid fee-for-service discharges. This legislation recognizes that higher Medicaid Fee for Service revenues needs to be authorized for hospitals with a significant share of Medicaid patients in .order to preserve access to Medicaid beneficiaries.

PRIOR LEGISLATIVE HISTORY:

 S. 7227 of 2010

FISCAL IMPLICATIONS: To be determined.

EFFECTIVE DATE: April 1, 2011

Text

STATE OF NEW YORK
________________________________________________________________________

3362

2011-2012 Regular Sessions

IN SENATE

February 17, 2011
___________

Introduced  by Sens. GRISANTI, KENNEDY, MAZIARZ, YOUNG -- read twice and
  ordered printed, and when printed to be committed to the Committee  on
  Health

AN  ACT  to  amend  the  public  health  law,  in  relation to inpatient
  reimbursement rates for general hospitals

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Paragraph  (g) of subdivision 35 of section 2807-c of the
public health law is amended by adding a new subparagraph (vi)  to  read
as follows:
  (VI)  (A) NOTWITHSTANDING ANY LAW, RULE OR REGULATION TO THE CONTRARY,
A GENERAL HOSPITAL WHOSE TOTAL  MEDICAID  REVENUES  RESULTING  FROM  THE
MEDICAID  RATES  THAT  TOOK  EFFECT ON DECEMBER FIRST, TWO THOUSAND NINE
PURSUANT TO THIS SUBDIVISION HAVE BEEN REDUCED TO SUCH  AN  EXTENT  THAT
THE  HOSPITAL  RANKS AMONG THE TOP FIVE PERCENT OF HOSPITALS IN NEW YORK
STATE IN TERMS OF THE PERCENTAGE REDUCTION IN THE HOSPITAL'S TOTAL MEDI-
CAID REVENUES, SHALL BE ENTITLED TO RECEIVE AN ADD-ON TO ITS RATES  THAT
IS  EQUIVALENT  TO THE INCREMENTAL DIFFERENCE BETWEEN UNINSURED UNITS OF
SERVICES AND COST BASED METHODOLOGIES FOR THE  YEAR  TWO  THOUSAND  NINE
INDIGENT  CARE  POOL.  SUCH  DIFFERENCE SHALL BE DIVIDED BY THE YEAR TWO
THOUSAND FIVE FEE-FOR-SERVICE DISCHARGES.
  (B) FUNDS IN AN AMOUNT TOTALING THREE MILLION SIXTY  THOUSAND  DOLLARS
SHALL  BE  ALLOCATED PURSUANT TO THIS SECTION AND SHALL BE OFFSET IN THE
BUDGET NEUTRALITY FACTOR FOR THE STATE-WIDE RATES. THE  COMMISSIONER  OF
HEALTH  IS HEREBY AUTHORIZED AND DIRECTED TO ADOPT RULES AND REGULATIONS
TO IMPLEMENT THE PROVISIONS OF THIS SECTION.
  S 2. This act shall take effect April 1, 2011, provided, however, that
the commissioner of health shall promulgate any  rules  and  regulations
necessary for the implementation of this act on or before such effective
date.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD08388-01-1