S T A T E   O F   N E W   Y O R K
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                                  2844

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            January 18, 2013
                               ___________

Introduced  by  M.  of  A.  GOTTFRIED, BARRON, GALEF, PAULIN, ROSENTHAL,
  TITONE, ENGLEBRIGHT, MILLMAN, JAFFEE, ABINANTI,  STEVENSON  --  Multi-
  Sponsored  by  --  M.  of A. BRENNAN, CLARK, FARRELL, McDONALD -- read
  once and referred to the Committee on Health

AN ACT to amend the public health law, in relation to  the  distribution
  of  funds  to support the provision of general hospital indigent care;
  and to amend chapter 119 of the laws of 1997 relating  to  authorizing
  the  department  of  health  to  establish certain payments to general
  hospitals, in relation to the effectiveness thereof

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

  Section  1.  Section  2807-k  of  the  public health law is amended by
adding a new subdivision 5-d to read as follows:
  5-D. (A) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF  THIS  SECTION,
SECTION  TWENTY-EIGHT  HUNDRED  SEVEN-W  OF  THIS  ARTICLE  OR ANY OTHER
CONTRARY PROVISION OF LAW, AND SUBJECT TO THE  AVAILABILITY  OF  FEDERAL
FINANCIAL  PARTICIPATION,  FOR  PERIODS  ON AND AFTER JANUARY FIRST, TWO
THOUSAND THIRTEEN THROUGH DECEMBER THIRTY-FIRST, TWO  THOUSAND  FIFTEEN,
ALL  FUNDS  AVAILABLE  FOR  DISTRIBUTION  PURSUANT  TO  THIS SECTION AND
SECTION TWENTY-EIGHT HUNDRED SEVEN-W OF THIS ARTICLE, SHALL BE  RESERVED
AND  SET ASIDE AND DISTRIBUTED IN ACCORDANCE WITH THE PROVISIONS OF THIS
SUBDIVISION.
  (B) THE  COMMISSIONER  SHALL  MAKE  REGULATIONS  UNDER  THIS  SECTION,
INCLUDING  EMERGENCY  REGULATIONS,  ESTABLISHING  METHODOLOGIES  FOR THE
DISTRIBUTION OF FUNDS, IN  ACCORDANCE  WITH  FEDERAL  REQUIREMENTS.  THE
REGULATIONS SHALL INCLUDE, BUT NOT BE LIMITED TO, THE FOLLOWING:
  (I) THE REGULATIONS SHALL ESTABLISH METHODOLOGIES FOR DETERMINING EACH
FACILITY'S  RELATIVE  UNCOMPENSATED  CARE NEED AMOUNT BASED ON UNINSURED
INPATIENT AND OUTPATIENT UNITS OF SERVICE FROM THE COST  REPORTING  YEAR
TWO  YEARS  PRIOR TO THE DISTRIBUTION YEAR, MULTIPLIED BY THE APPLICABLE
MEDICAID RATES IN EFFECT JANUARY FIRST  OF  THE  DISTRIBUTION  YEAR,  AS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04591-01-3
              

A. 2844                             2

SUMMED AND ADJUSTED BY A STATEWIDE COST ADJUSTMENT FACTOR AND REDUCED BY
THE  SUM  OF ALL PAYMENT AMOUNTS COLLECTED FROM SUCH UNINSURED PATIENTS,
AND AS FURTHER ADJUSTED BY  APPLICATION  OF  A  GRADUATED  NOMINAL  NEED
COMPUTATION  THAT SHALL TAKE INTO ACCOUNT EACH FACILITY'S MEDICAID INPA-
TIENT SHARE.
  (II) ANNUAL DISTRIBUTIONS UNDER THIS SUBDIVISION 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 NINETY-FOUR MILLION  NINE  HUNDRED  THOUSAND  DOLLARS
SHALL BE DISTRIBUTED AS MEDICAID DSH PAYMENTS TO ELIGIBLE GENERAL HOSPI-
TALS, OTHER THAN MAJOR PUBLIC GENERAL HOSPITALS.
  (III)  (A)  FOR  THE  TWO  THOUSAND THIRTEEN AND TWO THOUSAND FOURTEEN
CALENDAR YEARS, THE REGULATIONS SHALL ESTABLISH  TRANSITION  ADJUSTMENTS
TO  THE  DISTRIBUTIONS MADE UNDER SUBPARAGRAPH (II) OF THIS PARAGRAPH SO
THAT NO FACILITY EXPERIENCES A REDUCTION IN INDIGENT CARE POOL  PAYMENTS
UNDER  THIS  SUBDIVISION THAT IS GREATER THAN THE PERCENTAGES, AS SPECI-
FIED IN THE REGULATIONS, AS COMPARED TO THE  AVERAGE  DISTRIBUTION  THAT
EACH  SUCH  FACILITY  RECEIVED FOR THE THREE CALENDAR YEARS PRIOR TO TWO
THOUSAND THIRTEEN PURSUANT TO  THIS  SECTION  AND  SECTION  TWENTY-EIGHT
HUNDRED SEVEN-W OF THIS ARTICLE.
  (B)  THE  REGULATIONS  SHALL  ALSO  ESTABLISH ADJUSTMENTS LIMITING THE
INCREASES IN INDIGENT CARE POOL PAYMENTS EXPERIENCED BY FACILITIES UNDER
THIS SUBDIVISION BY AN AMOUNT THAT WILL BE, AS DETERMINED BY THE COMMIS-
SIONER AND IN CONJUNCTION WITH SUCH OTHER FUNDING AS  MAY  BE  AVAILABLE
FOR  THIS  PURPOSE, SUFFICIENT TO ENSURE FULL FUNDING FOR THE TRANSITION
ADJUSTMENT PAYMENTS AUTHORIZED BY CLAUSE (A) OF THIS SUBPARAGRAPH.
  (IV) THE REGULATIONS SHALL RESERVE ONE PERCENT OF THE FUNDS  AVAILABLE
FOR  DISTRIBUTION  IN  THE  TWO  THOUSAND  FOURTEEN THROUGH TWO THOUSAND
SEVENTEEN CALENDAR YEARS UNDER THIS SUBDIVISION, PARAGRAPH (I) OF SUBDI-
VISION THIRTY-FIVE OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C OF THIS ARTI-
CLE, AND SECTIONS TWO HUNDRED ELEVEN AND TWO HUNDRED TWELVE  OF  CHAPTER
FOUR HUNDRED SEVENTY-FOUR OF THE LAWS OF NINETEEN HUNDRED NINETY-SIX, IN
A  "FINANCIAL  ASSISTANCE COMPLIANCE POOL." THE REGULATIONS SHALL ESTAB-
LISH METHODOLOGIES AND STANDARDS UNDER WHICH SUCH POOL  FUNDS  SHALL  BE
DISTRIBUTED  TO FACILITIES BASED ON THEIR LEVEL OF COMPLIANCE, AS DETER-
MINED BY THE COMMISSIONER, WITH THE PROVISIONS OF SUBDIVISION NINE-A  OF
THIS SECTION.
  (C)  THE  COMMISSIONER  SHALL  ANNUALLY REPORT TO THE GOVERNOR AND THE
LEGISLATURE ON THE DISTRIBUTION OF FUNDS UNDER THIS SUBDIVISION  INCLUD-
ING, BUT NOT LIMITED TO:
  (I)  THE  IMPACT  ON  SAFETY  NET  PROVIDERS, INCLUDING SOLE COMMUNITY
PROVIDERS, RURAL GENERAL HOSPITALS AND MAJOR PUBLIC GENERAL HOSPITALS;
  (II) THE PROVISION OF INDIGENT CARE BY  UNITS  OF  SERVICE  AND  FUNDS
DISTRIBUTED BY GENERAL HOSPITALS; AND
  (III) THE EXTENT TO WHICH ACCESS TO CARE HAS BEEN ENHANCED.
  S  2. Section 3 of chapter 119 of the laws of 1997 relating to author-
izing the department of health to establish certain payments to  general
hospitals,  as  amended by section 1 of part N of chapter 58 of the laws
of 2009, is amended to read as follows:
  S 3. This act shall take effect immediately and  shall  be  deemed  to
have been in full force and effect on and after April 1, 1997.  This act
shall expire April 1, [2012] 2015.
  S  3.    The opening paragraph of subparagraph (i) of paragraph (i) of
subdivision 35 of section 2807-c of the public health law, as  added  by

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section  3-a of part B of chapter 109 of the laws of 2010, is amended to
read as follows:
  Notwithstanding  any inconsistent provision of this subdivision or any
other contrary provision of law  and  subject  to  the  availability  of
federal financial participation, for the period July first, two thousand
ten  through  March  thirty-first,  two  thousand eleven, and each state
fiscal year period thereafter, the commissioner  shall  make  additional
inpatient  hospital payments up to the aggregate upper payment limit for
inpatient hospital services after all other medical assistance payments,
but not to exceed two hundred thirty-five million five hundred  thousand
dollars  for the period July first, two thousand ten through March thir-
ty-first, two thousand eleven  [and],  three  hundred  fourteen  million
dollars  for  each state fiscal year BEGINNING APRIL FIRST, TWO THOUSAND
ELEVEN, THROUGH MARCH THIRTY-FIRST, TWO THOUSAND THIRTEEN, AND  NO  LESS
THAN  THREE  HUNDRED  THIRTY-NINE  MILLION DOLLARS FOR EACH STATE FISCAL
YEAR thereafter, to general hospitals, other than major  public  general
hospitals,  providing  emergency  room services and including safety net
hospitals, which shall, for the purpose of this paragraph, be defined as
having either: a Medicaid share of total inpatient  hospital  discharges
of  at  least  thirty-five  percent,  including both fee-for-service and
managed care discharges for acute and exempt  services;  or  a  Medicaid
share  of  total  discharges  of at least thirty percent, including both
fee-for-service  and  managed  care  discharges  for  acute  and  exempt
services,  and  also  providing  obstetrical  services.  Eligibility  to
receive such additional payments shall be based on data from the  period
two  years prior to the rate year, as reported on the institutional cost
report submitted to the department as of October first of the prior rate
year. Such payments shall be made as  medical  assistance  payments  for
fee-for-service  inpatient hospital services pursuant to title eleven of
article five of the social services law for patients eligible for feder-
al financial participation under title XIX of the federal social securi-
ty act and in accordance with the following:
  S 4.  This act shall take effect immediately; provided, however,  that
section  two  of this act shall be deemed to have been in full force and
effect on and after April 1, 2012.