§ 2807-S — Professional education pool funding

New York § 2807-S

• Jurisdiction: New York
• Law PBH: Public Health
• Art. 28: Hospitals

Text

* § 2807-s. Professional education pool funding. 1. (a) Payments to\ngeneral hospitals by all specified third-party payors, as defined in\nparagraph (b) of subdivision one-a of this section, making payments on a\nrate, charge, negotiated payment, or other basis for inpatient hospital\nservices provided to persons who are not eligible for payments as\nbeneficiaries of title XVIII of the federal social security act\n(medicare) or eligible for medical assistance pursuant to title eleven\nof article five of the social services law (including enrollees in\nmedicaid managed care programs) or eligible for the family health plus\nprogram pursuant to title eleven-D of article five of the social\nservices law, and related payments of patient deductible and coinsurance\namounts and of secondary third-party payors, shall include a surcharge\nfor a regional allowance on inpatient hospital net patient service\nrevenues in the percentage amount and for the periods specified in\nsubdivision two of this section. Any such allowance shall be submitted\nby general hospitals to the commissioner or the commissioner's designee\nin accordance with subdivision five of this section.\n (b) The allowance established pursuant to this section shall not be\napplicable to specified third-party payors filing an election and making\npayments to the commissioner or the commissioner's designee in\naccordance with section twenty-eight hundred-seven-t of this article and\npursuant to paragraph (a) of subdivision five of section twenty-eight\nhundred seven-j of this article, nor to related payments of patient\ndeductible and coinsurance amounts and of secondary third-party payors.\n 1-a. Definitions. (a) "Third-party coverage", for purposes of this\nsection and section twenty-eight hundred seven-t of this article, shall\ninclude payments by a specified third-party payor making payments on\nbehalf of a patient; whether made directly to a general hospital or\nindirectly as indemnity or similar payments made to the patient (or\npatient's representative such as parent or family member) for inpatient\nhospital services provided by a general hospital, or through the use of\npayments made payable to both the general hospital and the patient or\npatient's representative, or similar devices.\n (b) "Specified third-party payors", for purposes of this section and\nsections twenty-eight hundred seven-j and twenty-eight hundred seven-t\nof this article, shall include corporations organized and operating in\naccordance with article forty-three of the insurance law, organizations\noperating in accordance with the provisions of article forty-four of\nthis chapter, self-insured funds and administrators acting on behalf of\nself-insured funds, and commercial insurers authorized to write accident\nand health insurance and whose policy provides coverage on an expense\nincurred basis. Specified third-party payors, for purposes of this\nsection, shall not include governmental agencies or providers of\ncoverage pursuant to the comprehensive motor vehicle insurance\nreparations act, the workers' compensation law, the volunteer\nfirefighters' benefit law, or the volunteer ambulance workers' benefit\nlaw.\n (c) "Regions", for purposes of this section and section twenty-eight\nhundred seven-t of this article shall mean the regions as defined in\nparagraph (b) of subdivision sixteen of section twenty-eight hundred\nseven-c of this article as in effect on June thirtieth, nineteen hundred\nninety-six.\n 2. (a) The regional percentage allowance for any period during the\nperiod January first, nineteen hundred ninety-seven through December\nthirty-first, nineteen hundred ninety-nine for all general hospitals in\nthe region applicable to a specified third-party payor, and applicable\nto related patient coinsurance and deductible amounts and to secondary\nthird-party payors under coordination of benefits principles, shall be\nthe following, and shall be applied to inpatient hospital net patient\nservice revenues:\n (b) the result expressed as a percentage of:\n (i) for each region, the amount allocated to the region in accordance\nwith subdivision six of this section, divided by\n (ii) the total estimated nineteen hundred ninety-six general hospital\ninpatient revenue of all general hospitals in the region, excluding (A)\nan estimate of revenue from services provided to beneficiaries of title\nXVIII of the federal social security act (medicare), (B) an estimate of\nrevenue from services provided to patients eligible for payments by\ngovernmental agencies, patients eligible for payments pursuant to the\ncomprehensive motor vehicle insurance reparations act, the workers'\ncompensation law, the volunteer firefighters' benefit law, and the\nvolunteer ambulance workers' benefit law, and self-pay patients, (C)\nfrom general hospitals providing graduate medical education in the\naggregate an amount equal to the amount specified in subparagraph (i) of\nthis subdivision, other than the components of such amount allocable to\npayors specified in clause (B) of this subparagraph, and (D) an estimate\nof revenue reductions related to negotiated reimbursement in nineteen\nhundred ninety-seven with specified third-party payors which shall be a\nuniform statewide percentage estimated reduction.\n (c) (i) The regional percentage allowance for the periods January\nfirst, two thousand through June thirtieth, two thousand three, for all\ngeneral hospitals in the region applicable to specified third-party\npayors, and applicable to related patient coinsurance and deductible\namounts, shall be the same regional percentage allowance calculated\npursuant to paragraph (b) of this subdivision for the period January\nfirst, nineteen hundred ninety-nine through December thirty-first,\nnineteen hundred ninety-nine.\n (ii) The regional percentage allowance for the periods July first, two\nthousand three through December thirty-first, two thousand five, for all\ngeneral hospitals in the region applicable to specified third-party\npayors, and applicable to related patient coinsurance and deductible\namounts, shall be the same regional percentage allowance calculated\npursuant to paragraph (b) of this subdivision for the period January\nfirst, nineteen hundred ninety-nine through December thirty-first,\nnineteen hundred ninety-nine multiplied by one hundred eight and\nnineteen hundredths percent.\n (iii) The regional percentage allowance for the periods January first,\ntwo thousand six through June thirtieth, two thousand seven, for all\ngeneral hospitals in the region applicable to specified third-party\npayors, and applicable to related patient coinsurance and deductible\namounts, shall be the same regional percentage allowance calculated\npursuant to subparagraph (ii) of this paragraph for the period January\nfirst, two thousand five through December thirty-first, two thousand\nfive multiplied by one hundred one and thirteen hundredths percent.\n (iv) The regional percentage allowance for periods on and after July\nfirst, two thousand seven, for all general hospitals in the region\napplicable to specified third-party payors, and applicable to related\npatient coinsurance and deductible amounts, shall be the same regional\npercentage allowance calculated pursuant to subparagraph (iii) of this\nparagraph for the period January first, two thousand six through June\nthirtieth, two thousand seven.\n 3. Inpatient hospital net patient service revenues, for purposes of\nthis section, shall mean for general hospitals all moneys received for\nor on account of inpatient hospital services provided to persons with\nthird-party coverage from a specified third-party payor, including\ncapitation payments allocable to inpatient hospital services, less\nrefunds, for patients discharged or contracted hospital inpatient\nservice obligations for periods on or after January first, nineteen\nhundred ninety-seven excluding the following subject to the provisions\nof subdivision eight of this section:\n (a) revenue received from the allowances pursuant to section\ntwenty-eight hundred seven-j of this article and this section; and\n (b) revenue received from physician practice or faculty practice plan\ndiscrete billings for private practicing physician services.\n 4. (a) For periods prior to January first, two thousand five, the\ncommissioner is authorized to contract with the article forty-three\ninsurance law plans, or such other contractors as the commissioner shall\ndesignate, to receive and distribute funds from the allowances\nestablished pursuant to this section and funds from the assessments\nestablished pursuant to section twenty-eight hundred seven-t of this\narticle. In the event contracts with the article forty-three insurance\nlaw plans or other commissioner's designees are effectuated, the\ncommissioner shall conduct annual audits of the receipt and distribution\nof the funds. The reasonable costs and expenses of an administrator as\napproved by the commissioner, not to exceed for personnel services on an\nannual basis eight hundred fifty thousand dollars for collection and\ndistribution of allowances established pursuant to this section and\nassessments established pursuant to this section and assessments\nestablished pursuant to section twenty-eight hundred seven-t of this\narticle shall be paid from the allowance and assessment funds.\n (b) Notwithstanding any inconsistent provision of section one hundred\ntwelve or one hundred sixty-three of the state finance law or any other\nlaw, at the discretion of the commissioner without a competitive bid or\nrequest for proposal process, contracts in effect for administration of\nbad debt and charity care pools for the period January first, nineteen\nhundred ninety-six through June thirtieth, nineteen hundred ninety-six\npursuant to section twenty-eight hundred seven-c of this article may be\nextended to provide for administration pursuant to this section, and\nsection twenty-eight hundred seven-t of this article and may be amended\nas may be necessary.\n 5. Funds due by a general hospital to the commissioner or the\ncommissioner's designee from the allowance pursuant to this section\nshall be due and shall be collected under the terms and conditions\nprovided for payment and collection of allowances pursuant to section\ntwenty-eight hundred seven-j of this article.\n 6. The amount allocated to each region for purposes of calculating the\nregional allowance percentage pursuant to this section for each year\nduring the period January first, nineteen hundred ninety-seven through\nDecember thirty-first, nineteen hundred ninety-nine and the regional\nassessments pursuant to section twenty-eight hundred seven-t of this\narticle for each year during the period January first, nineteen hundred\nninety-seven through December thirty-first, nineteen hundred ninety-nine\nand for each year on and after January first, two thousand, shall be the\nsum of the factors computed in paragraphs (b), (d) and (f) of this\nsubdivision, if such factors are applicable to a given year, as follows:\n (a) (i) A gross annual statewide amount for nineteen hundred\nninety-seven shall be five hundred eighty-nine million dollars.\n (ii) A gross annual statewide amount for nineteen hundred ninety-eight\nshall be five hundred eighty-nine million dollars.\n (iii) A gross annual statewide amount for nineteen hundred ninety-nine\nshall be five hundred eighty-nine million dollars.\n (iv) A gross annual statewide amount for two thousand shall be five\nhundred eighty-nine million dollars.\n (v) A gross annual statewide amount for two thousand one shall be five\nhundred sixty-nine million dollars.\n (vi) A gross annual statewide amount for two thousand two shall be\nfive hundred eighty-nine million dollars.\n (vii) A gross annual statewide amount for two thousand three shall be\nfive hundred eighty-nine million dollars.\n (viii) A gross annual statewide amount for two thousand four and two\nthousand five shall be six hundred twenty-four million dollars.\n (ix) A gross annual statewide amount for two thousand six shall be six\nhundred seventy-four million dollars.\n (x) A gross statewide amount for the period January first, two\nthousand seven through March thirty-first, two thousand seven shall be\none hundred sixty-eight million five hundred thousand dollars, and for\nthe period April first, two thousand seven through December\nthirty-first, two thousand seven shall be five hundred sixty-one million\nseven hundred fifty thousand dollars.\n (xi) A gross statewide amount for the period January first, two\nthousand eight through March thirty-first, two thousand eight, shall be\none hundred eighty-seven million two hundred fifty thousand dollars.\n (xii) A gross statewide amount for the period April first, two\nthousand eight through December thirty-first, two thousand eight, shall\nbe five hundred sixty-one million seven hundred fifty thousand dollars.\n (xiii) A gross statewide amount for the period October first, two\nthousand eight through March thirty-first, two thousand nine, shall be\none hundred seventy-four million two hundred thousand dollars. Such\namount shall be separately reported and paid in six monthly installments\nby the tenth day of each month from October two thousand eight to March\ntwo thousand nine. Such reports and payments must initially be based on\neach payers' monthly enrollment count for the preceding month and shall\nbe reconciled on a month to month basis to reflect the actual monthly\nenrollment counts for the applicable month.\n (xiv) A gross annual statewide amount for the period January first,\ntwo thousand nine through December thirty-first, two thousand fourteen,\nshall be nine hundred forty-four million dollars.\n (xv) A gross annual statewide amount for the period January first, two\nthousand fifteen through December thirty-first, two thousand twenty-two,\nshall be one billion forty-five million dollars.\n (xvi) A gross annual statewide amount for the period January first,\ntwo thousand twenty-three to December thirty-first, two thousand\ntwenty-six shall be one billion eighty-five million dollars, forty\nmillion dollars annually of which shall be allocated under section\ntwenty-eight hundred seven-o of this article among the municipalities of\nand the state of New York based on each municipality's share and the\nstate's share of early intervention program expenditures not\nreimbursable by the medical assistance program for the latest twelve\nmonth period for which such data is available.\n (b) The amount specified in paragraph (a) of this subdivision shall be\nallocated among the regions based on each region's proportional share of\nthe sum of the estimated revenue of all general hospitals in the region,\nexcluding revenue related to services provided to beneficiaries of title\nXVIII of the federal social security act (medicare), related to one\nhundred percent of the direct medical education expenses and fifty-nine\nand five-tenths percent of indirect medical education expenses reflected\nin general hospital inpatient revenue compared to the sum of such\namounts for all regions, based on estimated nineteen hundred ninety-six\ndata and statistics, excluding an estimate of revenue from services\nprovided to patients eligible for payments by governmental agencies,\npatients eligible for payments pursuant to the comprehensive motor\nvehicle insurance reparations act, the workers' compensation law, the\nvolunteer firefighters' benefit law, and the volunteer ambulance\nworkers' benefit law, and self-pay patients.\n (c) (i) A further gross annual statewide amount for nineteen hundred\nninety-seven shall be sixty-four million dollars.\n (ii) A further gross annual statewide amount for nineteen hundred\nninety-eight shall be sixty-four million dollars.\n (iii) A further gross annual statewide amount for nineteen hundred\nninety-nine shall be eighty-nine million dollars.\n (iv) A further gross annual statewide amount for two thousand, two\nthousand one, two thousand two, two thousand three, two thousand four,\ntwo thousand five, two thousand six, two thousand seven, two thousand\neight, two thousand nine, two thousand ten, two thousand eleven, two\nthousand twelve and two thousand thirteen shall be eighty-nine million\ndollars.\n (v) A further gross annual statewide amount for the period January\nfirst, two thousand fourteen through December thirty-first, two thousand\nfourteen, shall be eighty-nine million dollars.\n (d) For each year, the amount specified in paragraph (c) of this\nsubdivision shall be allocated among the regions based on the same\nregional percentage allocations as determined in accordance with\nparagraph (b) of this subdivision.\n (e) A further gross annual statewide amount shall be twelve million\ndollars for each period prior to January first, two thousand fifteen.\n (f) For each year, the amount specified in paragraph (e) of this\nsubdivision shall be allocated among the regions based on each region's\nallocated share of the AIDS drug assistance program expenditures for the\nlatest annual period for which such data are available.\n (g) A further gross statewide amount for the state fiscal year two\nthousand twenty-two shall be forty million dollars.\n (h) The amount specified in paragraph (g) of this subdivision shall be\nallocated under section twenty-eight hundred seven-o of this article\namong the municipalities and the state of New York based on each\nmunicipality's share and the state's share of early intervention program\nexpenditures not reimbursable by the medical assistance program for the\nlatest twelve month period for which such data is available.\n 7. Funds accumulated, including income from invested funds, from the\nallowances specified in this section and the assessments pursuant to\nsection twenty-eight hundred seven-t of this article, including interest\nand penalties, shall be deposited by the commissioner or the\ncommissioner's designee as follows:\n (a) funds shall be accumulated in regional professional education\npools established by the commissioner or the healthcare reform act\n(HCRA) resources fund established pursuant to section ninety-two-dd of\nthe state finance law, whichever is applicable, for distribution in\naccordance with section twenty-eight hundred seven-m of this article, in\nthe following amounts:\n (i) ninety-two and forty-five-hundredths percent of the funds\naccumulated less seventy-six million dollars for the period January\nfirst, nineteen hundred ninety-seven through December thirty-first,\nnineteen hundred ninety-seven,\n (ii) ninety-two and forty-five-hundredths percent of the funds\naccumulated less seventy-six million dollars for the period January\nfirst, nineteen hundred ninety-eight through December thirty-first,\nnineteen hundred ninety-eight,\n (iii) ninety-two and forty-five-hundredths percent of the funds\naccumulated less one hundred one million dollars for the period January\nfirst, nineteen hundred ninety-nine through December thirty-first,\nnineteen hundred ninety-nine,\n (iv) four hundred ninety-four million dollars on an annual basis for\nthe periods January first, two thousand through December thirty-first,\ntwo thousand three,\n (v) four hundred sixty-three million dollars for the period January\nfirst, two thousand four through December thirty-first, two thousand\nfour,\n (vi) four hundred eighty-eight million dollars for the period January\nfirst, two thousand five through December thirty-first, two thousand\nfive,\n (vii) four hundred ninety-four million dollars for the period January\nfirst, two thousand six through December thirty-first, two thousand six,\n (viii) four hundred seventy million dollars for the period January\nfirst, two thousand seven through December thirty-first, two thousand\nseven,\n (ix) four hundred forty-six million six hundred thousand dollars for\nthe period January first, two thousand eight through December\nthirty-first, two thousand eight,\n (x) forty-seven million two hundred ten thousand dollars on an annual\nbasis for the periods January first, two thousand nine through December\nthirty-first, two thousand ten;\n (xi) eleven million eight hundred thousand dollars for the period\nJanuary first, two thousand eleven through March thirty-first, two\nthousand eleven;\n (xii) twenty-three million eight hundred thirty-six thousand dollars\nfor the period April first, two thousand eleven through March\nthirty-first, two thousand twelve;\n (xiii) twenty-three million eight hundred thirty-six thousand dollars\neach state fiscal year for the period April first, two thousand twelve\nthrough March thirty-first, two thousand twenty-six;\n (xiv) provided, however, for periods prior to January first, two\nthousand nine, amounts set forth in this paragraph may be reduced by the\ncommissioner in an amount to be approved by the director of the budget\nto reflect the amount received from the federal government under the\nstate's 1115 waiver which is directed under its terms and conditions to\nthe graduate medical education program established pursuant to section\ntwenty-eight hundred seven-m of this article;\n (xv) provided further, however, for periods prior to July first, two\nthousand nine, amounts set forth in this paragraph shall be reduced by\nan amount equal to the total actual distribution reductions for all\nfacilities pursuant to paragraph (e) of subdivision three of section\ntwenty-eight hundred seven-m of this article; and\n (xvi) provided further, however, for periods prior to July first, two\nthousand nine, amounts set forth in this paragraph shall be reduced by\nan amount equal to the actual distribution reductions for all facilities\npursuant to paragraph (s) of subdivision one of section twenty-eight\nhundred seven-m of this article.\n (b) funds shall be added to the funds collected by the commissioner\nfor distribution in accordance with section twenty-eight hundred seven-j\nof this article, in the following amounts:\n (i) seven and fifty-five-hundredths percent of the funds accumulated\nless seventy-six million dollars for the period January first, nineteen\nhundred ninety-seven through December thirty-first, nineteen hundred\nninety-seven,\n (ii) seven and fifty-five-hundredths percent of the funds accumulated\nless seventy-six million dollars for the period January first, nineteen\nhundred ninety-eight through December thirty-first, nineteen hundred\nninety-eight,\n (iii) seven and fifty-five-hundredths percent of the funds accumulated\nless one hundred one million dollars for the period January first,\nnineteen hundred ninety-nine through December thirty-first, nineteen\nhundred ninety-nine,\n (iv) the remaining balance of the funds accumulated for each period on\nand after January first, two thousand; and\n (c) further funds shall be added to the funds collected by the\ncommissioner for distribution in accordance with section twenty-eight\nhundred seven-j of this article:\n (i) for the nineteen hundred ninety-seven period, seventy-six million\ndollars;\n (ii) for the nineteen hundred ninety-eight period, seventy-six million\ndollars; and\n (iii) for the nineteen hundred ninety-nine period, one hundred one\nmillion dollars.\n (d) funds shall be added to the funds collected by the commissioner\nfor distribution in accordance with section twenty-eight hundred seven-o\nof this article, in the following amount: forty million dollars for the\nperiod beginning April first, two thousand twenty-two, and continuing\neach state fiscal year thereafter.\n 8. Each exclusion from the allowances effective on or after January\nfirst, nineteen hundred ninety-seven established pursuant to this\nsection shall be contingent upon either: (a) qualification of the\nallowances for waiver pursuant to federal law and regulation; or (b)\nconsistent with federal law and regulation, not requiring a waiver by\nthe secretary of the department of health and human services related to\nsuch exclusion; in order for the allowances under this section to be\nqualified as a broad-based health care related tax for purposes of the\nrevenues received by the state pursuant to the allowances not reducing\nthe amount expended by the state as medical assistance for purposes of\nfederal financial participation. The commissioner shall collect the\nallowances relying on such exclusions, pending any contrary action by\nthe secretary of the department of health and human services. In the\nevent the secretary of the department of health and human services\ndetermines that the allowances do not so qualify based on any such\nexclusion, then the exclusion shall be deemed to have been null and void\nas of January first, nineteen hundred ninety-seven, and the commissioner\nshall collect any retroactive amount due as a result, without interest\nor penalty provided the general hospital pays the retroactive amount due\nwithin ninety days of notice from the commissioner to the general\nhospital that an exclusion is null and void. Interest and penalties\nshall be measured from the due date of ninety days following notice from\nthe commissioner or the commissioner's designee to the general hospital.\n 9. Revenue from the allowances pursuant to this section shall not be\nincluded in gross revenue received for purposes of the assessments\npursuant to subdivision eighteen of section twenty-eight hundred seven-c\nof this article, subject to the provisions of paragraph (e) of\nsubdivision eighteen of section twenty-eight hundred seven-c of this\narticle, and shall not be included in gross revenue received for\npurposes of the assessments pursuant to section twenty-eight hundred\nseven-d of this article, subject to the provisions of subdivision twelve\nof section twenty-eight hundred seven-d of this article.\n * NB Expires December 31, 2026\n