§ 364-J-2 — Transitional supplemental payments

New York § 364-J-2

• Jurisdiction: New York
• Law SOS: Social Services
• Title 11: Medical Assistance For Needy Persons
• Art. 5: Assistance and Care

Text

§ 364-j-2. Transitional supplemental payments. 1. As used in this\nsection, "covered provider" shall mean a voluntary not-for-profit health\ncare provider that is any of the following:\n (a) a freestanding diagnostic and treatment center licensed under\narticle twenty-eight of the public health law that qualifies for a\ndistribution pursuant to section twenty-eight hundred seven-p of such\narticle, or section seven of chapter four hundred thirty-three of the\nlaws of nineteen hundred ninety-seven, or receives funding under section\nthree hundred thirty-three of the federal public health services act for\nhealth care for the homeless; or\n (b) a freestanding diagnostic and treatment center which operates an\napproved program under the prenatal care assistance program established\npursuant to article twenty-five of the public health law; or\n (c) a facility licensed under article twenty-eight of the public\nhealth law that is sponsored by a university or dental school which has\nbeen granted an operating certificate pursuant to article twenty-eight\nof the public health law to provide dental services; or\n (d) a freestanding family planning clinic licensed under article\ntwenty-eight of the public health law.\n 2. (a) Notwithstanding paragraphs (b) and (h) of subdivision two of\nsection twenty-eight hundred seven of the public health law, the\ncommissioner of health shall make supplemental payments of nine million\neight hundred twenty-four thousand dollars ($9,824,000), to covered\nproviders described in subdivision one of this section who are qualified\nproviders as described in paragraph (a) of subdivision three of this\nsection, based on adjustments to fee-for-service rates for the period\nFebruary first through March thirty-first, two thousand two and nine\nmillion eight hundred twenty-four thousand dollars ($9,824,000) for the\nperiod October first through December thirty-first, two thousand two and\nfour million nine hundred twelve thousand dollars ($4,912,000) for the\nperiod October first through December thirty-first, two thousand three\nand an additional amount of four million nine hundred twelve thousand\ndollars ($4,912,000) for the period October first through December\nthirty-first, two thousand three and nine million eight hundred\ntwenty-four thousand dollars ($9,824,000) for the period April first\nthrough June thirtieth, two thousand five, and nine million eight\nhundred twenty-four thousand dollars ($9,824,000) for the period October\nfirst through December thirty-first, two thousand six, and an additional\nnine million eight hundred twenty-four thousand dollars ($9,824,000) for\nthe period October first through December thirty-first, two thousand\nsix, and nine million eight hundred twenty-four thousand dollars\n($9,824,000) for the period October first through December thirty-first,\ntwo thousand seven, as medical assistance payments for services provided\npursuant to this title for persons eligible for federal financial\nparticipation under title XIX of the federal social security act to\nreflect additional costs associated with the transition to a managed\ncare environment, and nine million eight hundred twenty-four thousand\ndollars ($9,824,000) for the period October first through December\nthirty-first, two thousand eight, and seven million three hundred\neighty-eight thousand dollars ($7,388,000) for the period October first\nthrough December thirty-first, two thousand nine, as medical assistance\npayments for services provided pursuant to this title for persons\neligible for federal financial participation under title XIX of the\nfederal social security act to reflect additional costs associated with\nthe operation of electronic health record systems that meet such\nstandards as may be established by the commissioner of health. There\nshall be no local share in these payments. The director of the budget\nshall allocate the non-federal share of such payments from an\nappropriation for the miscellaneous special revenue fund - 339 community\nservice provider assistance program account for the two thousand\none--two thousand two state fiscal year for adjustments for the period\nFebruary first through March thirty-first, two thousand two. Adjustments\nfor the period October first, two thousand two through December\nthirty-first, two thousand two shall be within amounts appropriated for\nthe two thousand two--two thousand three state fiscal year and\nadjustments for the period October first, two thousand three through\nDecember thirty-first, two thousand three shall be within amounts\nappropriated for the two thousand three--two thousand four state fiscal\nyear and adjustments for the non-federal share of the additional amount\nof four million nine hundred twelve thousand dollars ($4,912,000) for\nsuch period shall be allocated by the director of the budget from an\nappropriation for maintenance undistributed general fund community\nprojects fund - 007 account for the two thousand three--two thousand\nfour state fiscal year. The director of the budget shall allocate the\nnon-federal share of adjustments for the period April first, two\nthousand five through June thirtieth, two thousand five from an\nappropriation for the maintenance undistributed general fund community\nprojects fund - 007 - cc account for the two thousand four--two thousand\nfive state fiscal year. The director of the budget shall allocate the\nnon-federal share of adjustments for the period October first, two\nthousand six through December thirty-first, two thousand six from an\nappropriation for the maintenance undistributed, general fund, community\nprojects fund - 007-cc account for the two thousand five--two thousand\nsix state fiscal year. The director of the budget shall allocate the\nnon-federal share of the additional adjustments for the period October\nfirst, two thousand six through December thirty-first, two thousand six\nfrom such funds as may be made available from an appropriation for the\nmaintenance undistributed, general fund, community projects fund -\n007-cc account for the two thousand six--two thousand seven state fiscal\nyear. The director of the budget shall allocate the non-federal share of\nthe adjustments for the period October first, two thousand seven through\nDecember thirty-first, two thousand seven from an appropriation for the\nmedical assistance program, general fund, local assistance account - 001\nfor the two thousand seven--two thousand eight state fiscal year. The\ndirector of the budget shall allocate the non-federal share of the\nadjustments for the period October first, two thousand eight through\nDecember thirty-first, two thousand eight from an appropriation for the\nmedical assistance program, general fund, local assistance account - 001\nfor the two thousand eight--two thousand nine state fiscal year. The\ndirector of the budget shall allocate the non-federal share of the\nadjustments for the period October first, two thousand nine through\nDecember thirty-first, two thousand nine from an appropriation for the\nmedical assistance program, general fund, local assistance account - 001\nfor the two thousand nine--two thousand ten state fiscal year. Such\nadjustments to fee for service rates shall not be subject to subsequent\nadjustment or reconciliation. Alternatively, such payments may be made\nas aggregate payments to eligible providers.\n (a-1) Notwithstanding the provisions of paragraph (a) of this\nsubdivision, for facilities licensed under article twenty-eight of the\npublic health law that are sponsored by a university or dental school\nwhich has been granted an operating certificate pursuant to article\ntwenty-eight of the public health law and which provides dental services\nas its principal mission, two hundred twenty-four thousand dollars\n($224,000) in the aggregate for use pursuant to this section shall be\nallocated for distribution to such facilities pursuant to the\nmethodology described in paragraph (b) of subdivision two and\nsubparagraph (i) of paragraph (b) of subdivision four of section two\nthousand eight hundred seven-p of the public health law for services\nprovided for the period February first, two thousand two through March\nthirty-first, two thousand two to persons eligible for federal financial\nparticipation under title XIX of the federal social security act,\nprovided, however, that the amount paid pursuant to this paragraph for\neach such facility shall equal the facility's proportional share of the\ntotal nominal payment amounts calculated under this section of all such\nfacilities multiplied by the total funds allocated for such payments.\nThere shall be no local share in these payments. The director of the\nbudget shall allocate the non-federal share of such payments from an\nappropriation for the miscellaneous special revenue fund - 339 community\nservice provider assistance program account for the two thousand\none--two thousand two state fiscal year. Such adjustments to fee for\nservice rates shall not be subject to subsequent adjustment or\nreconciliation. Alternatively, such payments may be made as aggregate\npayments to eligible providers.\n (a-2) (i) Notwithstanding the provisions of paragraph (a) of this\nsubdivision, for facilities licensed under article twenty-eight of the\npublic health law that are sponsored by a university or dental school\nwhich has been granted an operating certificate pursuant to article\ntwenty-eight of the public health law and which provides dental services\nas its principal mission, two hundred twenty-four thousand dollars\n($224,000) in the aggregate of the amount appropriated for the two\nthousand two--two thousand three state fiscal year for use pursuant to\nthis section shall be allocated for the period October first through\nDecember thirty-first, two thousand two and one hundred twelve thousand\ndollars ($112,000) in the aggregate of the amount appropriated for the\ntwo thousand three--two thousand four state fiscal year, and an\nadditional amount of one hundred twelve thousand dollars ($112,000) in\nthe aggregate for use pursuant to this section shall be allocated for\nthe period October first through December thirty-first, two thousand\nthree and two hundred twenty-four thousand dollars ($224,000) in the\naggregate of the amount appropriated for the two thousand four--two\nthousand five state fiscal year shall be allocated for the period April\nfirst, two thousand five through June thirtieth, two thousand five, and\ntwo hundred twenty-four thousand dollars ($224,000) in the aggregate of\nthe amount appropriated for the two thousand five--two thousand six\nstate fiscal year shall be allocated for the period October first, two\nthousand six through December thirty-first, two thousand six, and an\nadditional two hundred twenty-four thousand dollars ($224,000) in the\naggregate of the amount appropriated for the two thousand six--two\nthousand seven state fiscal year shall be allocated for the period\nOctober first, two thousand six through December thirty-first, two\nthousand six, and two hundred twenty-four thousand dollars ($224,000) in\nthe aggregate of the amount appropriated for the two thousand seven--two\nthousand eight state fiscal year shall be allocated for the period\nOctober first, two thousand seven through December thirty-first, two\nthousand seven, and two hundred twenty-four thousand dollars ($224,000)\nin the aggregate of the amount appropriated for the two thousand\neight--two thousand nine state fiscal year shall be allocated for the\nperiod October first, two thousand eight through December thirty-first,\ntwo thousand eight and two hundred twenty-four thousand dollars\n($224,000) in the aggregate of the amount appropriated for the two\nthousand nine--two thousand ten state fiscal year shall be allocated for\nthe period October first, two thousand nine through December\nthirty-first, two thousand nine for distribution to such facilities\npursuant to subparagraphs (ii) and (iii) of this paragraph. Adjustments\nfor the non-federal share of the additional amount of one hundred twelve\nthousand dollars ($112,000) for the period October first, two thousand\nthree through December thirty-first, two thousand three shall be\nallocated by the director of the budget from an appropriation for\nmaintenance undistributed general fund community projects fund - 007\naccount for the two thousand three--two thousand four state fiscal year.\nThe non-federal share of adjustments for the period April first, two\nthousand five through June thirtieth, two thousand five shall be\nallocated by the director of the budget from an appropriation for the\nmaintenance undistributed general fund community projects fund - 007\naccount for the two thousand four--two thousand five state fiscal year.\nThe non-federal share of adjustments for the period October first, two\nthousand six through December thirty-first, two thousand six shall be\nallocated by the director of the budget from an appropriation for the\nmaintenance undistributed, general fund, community projects fund -\n007-cc account for the two thousand five--two thousand six state fiscal\nyear. The non-federal share of the additional adjustments for the period\nOctober first, two thousand six through December thirty-first, two\nthousand six shall, subject to the availability of funds, be allocated\nby the director of the budget from the medical assistance local\nassistance appropriation for the two thousand six--two thousand seven\nstate fiscal year. The non-federal share of the adjustments for the\nperiod October first, two thousand seven through December thirty-first,\ntwo thousand seven shall be allocated by the director of the budget from\nan appropriation for the medical assistance program, general fund, local\nassistance account - 001 for the two thousand seven--two thousand eight\nstate fiscal year. The non-federal share of the adjustments for the\nperiod October first, two thousand eight through December thirty-first,\ntwo thousand eight shall be allocated by the director of the budget from\nan appropriation for the medical assistance program, general fund, local\nassistance account - 001 for the two thousand eight--two thousand nine\nstate fiscal year. The non-federal share of the adjustments for the\nperiod October first, two thousand nine through December thirty-first,\ntwo thousand nine shall be allocated by the director of the budget from\nan appropriation for the medical assistance program, general fund, local\nassistance account - 001 for the two thousand nine--two thousand ten\nstate fiscal year.\n (ii) Forty percent shall be allocated for equal distribution to such\nfacilities, reduced by the amount, if any, that a distribution exceeds\nforty percent of a facility's uncompensated care need as defined in\nparagraph (b) of subdivision two of section two thousand eight hundred\nseven-p of the public health law. Any funds allocated but not\ndistributed in accordance with this subparagraph shall be added to those\namounts distributed in accordance with subparagraph (iii) of this\nparagraph.\n (iii) Sixty percent, plus any funds allocated and not distributed in\naccordance with subparagraph (ii) of this paragraph, shall be allocated\nfor distribution to such facilities pursuant to the methodology\ndescribed in paragraph (b) of subdivision two and subparagraph (i) of\nparagraph (b) of subdivision four of section two thousand eight hundred\nseven-p of the public health law, provided, however, that the amount\npaid pursuant to this allocation for each such facility shall equal the\nfacility's proportional share of the total nominal payment amounts\ncalculated under this section of all such facilities multiplied by the\ntotal funds allocated for such payments.\n (iv) There shall be no local share in these payments.\n (b) Notwithstanding the provisions of subdivision one of section three\nhundred sixty-eight-a of this title, there shall be paid to each social\nservices district the full amount expended on behalf of the department\nof health for medical assistance furnished pursuant to the provisions of\nthis section, after first deducting therefrom any federal funds properly\nreceived or to be received on account thereof.\n 3. (a) For periods prior to January first, two thousand eight, a\ncovered provider described in subdivision one of this section shall be\nqualified to receive a supplemental payment only if its number of\nmedicaid visits for patient care services in the base year described in\nsubparagraph (ii) of paragraph (b) of this subdivision equals or exceeds\ntwenty-five percent of its total number of visits for patient care\nservices and its number of medicaid visits for patient care services for\nmedicaid managed care enrollees equals or exceeds three percent of its\ntotal number of medicaid visits during the base year. For periods on and\nafter January first, two thousand eight, a covered provider described in\nsubdivision one of this section shall be qualified to receive a\nsupplemental payment only if it has in place during such period an\noperational electronic health record system that meets such standards as\nmay be established by the commissioner of health and its number of\nmedicaid visits for patient care services in the base year described in\nsubparagraph (ii) of paragraph (b) of this subdivision equals or exceeds\ntwenty-five percent of its total number of visits for patient care\nservices during the base year or its number of medicaid visits combined\nwith its number of uninsured visits for patient care services in the\nbase year described in subparagraph (ii) of paragraph (b) of this\nsubdivision equals or exceeds thirty percent of its total number of\nvisits for patient care services during the base year.\n (b) (i) For periods prior to January first, two thousand eight, each\nqualified provider described in paragraph (a) of this subdivision shall\nreceive a supplemental payment equal to such provider's proportional\nshare of the total funds allocated pursuant to this section, based upon\nthe ratio of its visits from medical assistance recipients enrolled in\nmanaged care during the base year to the total number of visits to all\nsuch qualified providers by medical assistance recipients enrolled in\nmanaged care during the base year. For periods on and after January\nfirst, two thousand eight, each qualified provider described in\nparagraph (a) of this subdivision shall receive a supplemental payment\nequal to such provider's proportional share of the total funds allocated\npursuant to this section, based upon the ratio of its visits from\nmedical assistance recipients during the base year to the total number\nof visits from medical assistance recipients to all such qualified\nproviders during the base year.\n (ii) For periods prior to January first, two thousand eight, for\npurposes of the calculation described in this subdivision, the base year\nwill be two thousand, and the commissioner of health shall utilize data\nas reported on the 2000 AHCF-1 cost report initially submitted by\ncovered providers to the department of health on or about August\nseventeenth, two thousand one. For periods on and after January first,\ntwo thousand eight, for purposes of the calculation described in this\nsubdivision, the base year will be two years prior to the grant year,\nand the commissioner of health shall utilize data as reported on AHCF-1\ncost report submitted by covered providers to the department of health\nfor such base year.\n 4. Payments made pursuant to this section shall constitute additional\nreimbursement to qualified providers and shall not be used to reduce\nlevels of other funding provided to qualified providers by governmental\nagencies.\n 5. (a) The commissioner of health shall make medical assistance\npayments to qualified providers from funds made available pursuant to\nthe provisions of this section contingent upon the receipt of all\nfederal approvals necessary and subject to the availability of federal\nfinancial participation under title XIX of the federal social security\nact for the transitional supplemental payments. In the event such\nfederal approval is not received prior to March thirty-first, two\nthousand two, for adjustments for the period February first, two\nthousand two through March thirty-first, two thousand two and prior to\nOctober first, two thousand two for adjustments for the period October\nfirst, two thousand two through December thirty-first, two thousand two\nand prior to October first, two thousand three for adjustments for the\nperiod October first, two thousand three through December thirty-first,\ntwo thousand three, and prior to October first, two thousand five for\nadjustments for the period April first, two thousand five through June\nthirtieth, two thousand five, and prior to October first, two thousand\nsix for adjustments for the period October first, two thousand six\nthrough December thirty-first, two thousand six, and prior to October\nfirst, two thousand seven for adjustments for the period October first,\ntwo thousand seven through December thirty-first, two thousand seven,\nand prior to October first, two thousand eight for adjustments for the\nperiod October first, two thousand eight through December thirty-first,\ntwo thousand eight, and prior to October first, two thousand nine for\nadjustments for the period October first, two thousand nine through\nDecember thirty-first, two thousand nine, the commissioner of health\nshall make medical assistance payments to qualified providers consisting\nof the state share amount available for purposes of this section and\napportioned in accordance with subdivisions two and three of this\nsection. In the event such federal approval is denied, such state share\namount payments shall be deemed to be grants to such qualified providers\nand such qualified providers shall not be eligible to receive any other\npayments pursuant to this section.\n (b) The commissioner of health shall take all steps necessary and\nshall use best efforts to secure federal financial participation under\ntitle XIX of the social security act, for the purposes of this section,\nincluding the prompt submission of appropriate amendments to the title\nXIX state plan.\n