Health Services Medical Corp. of Central New York, Inc. v. Chassin

175 Misc. 2d 621, 668 N.Y.S.2d 1006, 1998 N.Y. Misc. LEXIS 30
CourtNew York Supreme Court
DecidedJanuary 27, 1998
StatusPublished
Cited by6 cases

This text of 175 Misc. 2d 621 (Health Services Medical Corp. of Central New York, Inc. v. Chassin) is published on Counsel Stack Legal Research, covering New York Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Health Services Medical Corp. of Central New York, Inc. v. Chassin, 175 Misc. 2d 621, 668 N.Y.S.2d 1006, 1998 N.Y. Misc. LEXIS 30 (N.Y. Super. Ct. 1998).

Opinion

OPINION OF THE COURT

Robert G. Hurlbutt, J.

In this declaratory judgment action, plaintiff seeks summary judgment declaring that an increase in the mandated rate of payment to hospitals for in-patient services provided to subscribers of health maintenance organizations (hereinafter HMOs), pursuant to Public Health Law § 2807-c (2-a), represents a tax, and that such tax, as applied to plaintiff, is unconstitutional. Plaintiff, incorporated as a not-for-profit corporation pursuant to the Not-For-Profit Corporation Law in 1975, is a health maintenance organization under article 44 of the Public Health Law and a health service corporation under article 43 of the Insurance Law. As a health maintenance organization, plaintiff arranges for the provision of health services to its enrolled subscribers for a set, prepaid fee.

In April 1992, the State Legislature amended the Public Health Law as part of the Omnibus Revenue Act of 1992 (L 1992, ch 55). Public Health Law § 2807-c (2-a)1 increased the amounts HMOs paid to hospitals for in-patient hospital ser[623]*623vices furnished to their non-Medicaid subscribers. Previously, the rate of payment to a hospital was based upon Diagnosis Related Groups (DRGs) which dictated the amount paid for a patient’s care based upon the diagnosis category rather than the actual cost of the care. Public Health Law § 2807-c (2-a) imposed an assessment upon the amounts paid by HMOs for in-patient hospital care, effective with patient discharges occurring on or after July 1, 1992, adding a factor of 9% over and above the DRG rate. The monies generated by the 9% assessment were not to be paid to the hospital, but were paid to an HMO pool and then were deposited to the State’s general fund.2 (Public Health Law § 2807-c [2-a] [c] [i].)

Pursuant to the legislation, the 9% increase was subject to reduction if the HMO met targeted enrollment goals for Medicaid recipients in each social services district in which it operated. Plaintiff sought and was granted reductions in assessment,3 but made payments to the HMO pool under Public Health Law § 2807-c (2-a) in the sum of $122,850 on August 14, 1992, $119,972 on September 10, 1992, and $241,884 on September 12, 1995. Plaintiff contends that these payments represent tax payments and that the HMO tax is improperly imposed upon it because it is exempt from taxation as a charitable institution pursuant to NY Constitution article XVI and Insurance Law article 43. Plaintiff seeks a declaration that the statute imposing this tax is unconstitutional as applied to it, and further seeks the return of all monies paid under the statute.

Defendants cross-move for summary judgment declaring that the assessment imposed by Public Health Law § 2807-c (2-a) is not a tax, and that even in the event that the court finds that it is a tax, plaintiff is not entitled to exemption. Defendants argue that the 9% assessment is a regulatory mechanism. They contend that payment differentials among hospital payers are rate-setting tools used historically to promote social goals relating to health care.4 Public Health Law § 2807-c (2-a) was enacted to give incentive to HMOs to enroll Medicaid recipients [624]*624under the belief that the health care needs of Medicaid patients would be more effectively and efficiently addressed in a “managed care” setting, and additionally, to generate revenue for the State.

Whether the Public Health Law § 2807-c (2-a) “differential” on rates paid to hospitals for in-patient care imposes a tax upon HMOs and, if so, whether plaintiff is exempt from payment of the tax, are questions of law which are appropriately determined on summary judgment. The question whether a provision imposes a tax or a regulatory fee turns on legislative intent. (American Sugar Ref. Co. v Waterfront Commn., 55 NY2d 11, appeal dismissed sub. nom. New York Shipping Assn. v Waterfront Commn., 458 US 1101.) Plaintiff provides some legislative materials with the moving papers, including a summary distributed to the Senate session describing the legislation and reporting that the HMO differential will raise $31 million for the State general fund. The expenses to administer the funds were not to exceed $200,000. The sum of $1 million was earmarked to aid managed care development, leaving revenue for the general fund far exceeding the associated expenses and the expenditure earmarked for the social goal. In August 1992, revisions to the legislation were proposed to insure that the assessment would generate sufficient revenue. (Tallon Bill mem.) It cannot be overlooked that the legislation imposing the assessment upon HMOs was a revenue act. The legislative materials thus emphasize the revenue-raising role of Public Health Law § 2807-c (2-a).

It is significant that the amount generated by the differential was not to be paid to the hospital to cover its expenses, but instead was to end up in the general fund of the State. Charges exacted for revenue purposes, or to offset the cost of general governmental functions are generally held to be taxes (New York Tel. Co. v City of Amsterdam, 200 AD2d 315, 317; Matter of Joslin v Regan, 63 AD2d 466, 470, affd 48 NY2d 746; Radio Common Carriers v State of New York, 158 Misc 2d 695), while fees are “enacted principally as an integral part of the regulation of an activity and to cover the cost of regulation.” (Radio Common Carriers v State of New York, supra, at 698, citing American Trucking Assns. v O’Neill, 522 F Supp 49.) “Taxes are imposed for the purpose of defraying the costs of government services generally * * * [while] [flees * * * have been [625]*625characterized as the Visitation of the costs of special services upon the one who derives a benefit from them’ ”, (Albany Area Bldrs. Assn. v Town of Guilderland, 141 AD2d 293, 298, affd 74 NY2d 372.) The amount of a regulatory fee “cannot be greater than a sum reasonably necessary to cover the costs of issuance, inspection and enforcement”. (Matter of Torsoe Bros. Constr. Corp. v Board of Trustees, 49 AD2d 461, 465.)

In holding that an exaction from employers was in the nature of a license fee rather than a tax, the Court in American Sugar Ref. Co. (supra, at 26-27) said “[a] license fee has for its primary purpose the regulation or restriction of a business deemed in need of public control, the cost of such regulation being imposed upon the business benefited or controlled, whereas the primary purpose of a tax is to raise money for support of the government generally”. In that case, the Court found that the fee was imposed for a purpose which brought benefits to’ the industry which would “in major part redound to the benefit of employers.” (Supra, at 27.)

Although the exaction from HMOs in the instant case is undoubtedly for the purpose of regulating the health care industry, it differs from that found to be a license fee in Amer-can Sugar Ref. Co. (supra) in that here the funds are directed to the general coffers to meet the cost of general governmental functions and are not utilized in a way that “redounds to the benefit of’ the payer. The revenue raised bears no relationship to the cost of regulation. The policy behind the legislation, which seeks to lower the cost of the Medicaid program by forcing enrollment in managed care, is one benefiting the wider community of State taxpayers, and there is no special benefit to HMOs.

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Cite This Page — Counsel Stack

Bluebook (online)
175 Misc. 2d 621, 668 N.Y.S.2d 1006, 1998 N.Y. Misc. LEXIS 30, Counsel Stack Legal Research, https://law.counselstack.com/opinion/health-services-medical-corp-of-central-new-york-inc-v-chassin-nysupct-1998.