Amends the inpatient reimbursement rates for those general hospitals most significantly affected by revenue losses resulting from Medicaid rebasing that took effect 12/1/2009.
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
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