N.Y. PBH Law § 2807-W — New York Code / Act PBH / Article 28 / Section 2807-W
High need indigent care adjustment pool
Status: in_force

§ 2807-w. High need indigent care adjustment pool. Funds allocated\npursuant to paragraph (p) of subdivision one of section twenty-eight\nhundred seven-v of this article, shall be deposited as authorized and\nused for the purpose of making medicaid disproportionate share payments\nof up to eighty-two million dollars on an annualized basis pursuant to\nsubdivision twenty-one of section twenty-eight hundred seven-c of this\narticle, for the period January first, two thousand through March\nthirty-first, two thousand fourteen, in accordance with the following:\n  1. From the funds in the pool each year: (a) Each eligible rural\nhospital shall receive one hundred forty thousand dollars on an\nannualized basis for the periods January first, two thousand through\nDecember thirty-first, two thousand fourteen, provided as a\ndisproportionate share payment; provided, however, that if such payment\npursuant to this paragraph exceeds a hospital's applicable\ndisproportionate share limit, then the total amount in excess of such\nlimit shall be provided as a nondisproportionate share payment in the\nform of a grant directly from this pool without allocation to the\nspecial revenue funds - other, indigent care fund - 068, or any\nsuccessor fund or account, and provided further that payments for\nperiods on and after January first, two thousand nine shall be subject\nto the provisions of subdivision five-a of section twenty-eight hundred\nseven-k of this article;\n  (b) Each such hospital shall also receive an amount calculated by\nmultiplying the facility's uncompensated care need by the appropriate\npercentage from the following scale based on hospital rankings developed\nin accordance with each eligible rural hospital's weight as defined by\nthis section.\n               Rank                      Percentage Coverage of\n                                         Uncompensated Care Need\n                1-9                             60.0%\n               10-17                            52.5%\n               18-25                            45.0%\n               26-33                            37.5%\n               34-41                            30.0%\n               42-49                            22.5%\n               50-57                            15.0%\n                 58+                             7.5%\n  For purposes of calculating the distribution amount to an eligible\nrural hospital which has merged with another hospital on or after\nDecember thirty-first, nineteen hundred ninety-nine, and continues to be\nan eligible rural hospital in accordance with paragraph (c) of this\nsubdivision, such merged facility's uncompensated care need pursuant to\nthis paragraph shall be calculated from data provided in the eligible\nrural hospital's institutional cost report filed for the rate period two\nyears prior to the distribution period, or if such report is not\nrequired for such rural hospital, the distribution amount shall be based\nupon the last institutional cost report required to be filed by such\nrural hospital.\n  (c) "Eligible rural hospital", as used in this section, shall mean a\ngeneral hospital that as of December thirty-first, nineteen hundred\nninety-nine or thereafter, was classified as a rural hospital for\npurposes of determining payment for inpatient services provided to\nbeneficiaries of title XVIII of the federal social security act\n(medicare) or under state regulations, or a general hospital, which\nduring the same time period, had a service area which has an average\npopulation of less than one hundred seventy-five persons per square\nmile, or a general hospital which has a service area which has an\naverage population of less than two hundred persons per square mile\nmeasured as population density by zip code. The average population of\nthe service area is calculated by multiplying annual patient discharges\nby the population density per square mile of the county of origin or zip\ncode as applicable for each patient discharge and dividing by total\ndischarges. Annual patient discharges shall be determined using\ndischarge data for the nineteen hundred ninety-seven rate year, as\nreported to the commissioner by October first, nineteen hundred\nninety-eight. Population density shall be determined utilizing United\nStates census bureau data for nineteen hundred ninety-seven. If an\neligible rural hospital merges with another general hospital, on or\nafter December thirty-first, nineteen hundred ninety-nine, and the\nmerger results in separate facilities operating under a single facility\noperating certificate, such eligible rural hospital shall continue to be\na separate eligible rural hospital for purposes of this subdivision and\npayments provided in accordance with this section shall be made to the\nmerged entity; provided, however, that payments shall only be made to\nthe merged entity if such separate eligible rural hospital continues to\nprovide inpatient and/or outpatient hospital services at the same\nlocation at which it operated prior to the merger. If an eligible rural\nhospital merges with another general hospital on or after December\nthirty-first, nineteen hundred ninety-nine, and the merger results in\nsuch rural hospital continuing to operate under a separate facility\noperating certificate, such rural hospital will continue to be an\neligible rural hospital after the merger; provided, however, that\npayments shall only be made to such rural hospital if such eligible\nrural hospital continues to provide inpatient and/or outpatient hospital\nservices at the same location at which it is operated prior to the\nmerger.\n  (d) "Eligible rural hospital weight", as used in this section, shall\nmean the result of adding, for each eligible rural hospital:\n  (i) The eligible rural hospital's targeted need, as defined in section\ntwenty-eight hundred seven-k of this article, minus the mean targeted\nneed for all eligible rural hospitals, divided by the standard deviation\nof the targeted need of all eligible rural hospitals; and\n  (ii) The mean number of beds of all eligible rural hospitals minus the\nnumber of beds for an individual hospital, divided by the standard\ndeviation of the number of beds for all eligible rural hospitals.\n  2. From the funds in the pool each year, thirty-six million dollars on\nan annualized basis for the periods January first, two thousand through\nDecember thirty-first, two thousand fourteen, of the funds not\ndistributed in accordance with subdivision one of this section, shall be\ndistributed in accordance with the formula set forth in subdivision six\nof section twenty-eight hundred seven-k of this article, provided,\nhowever, that payments for periods on and after January first, two\nthousand nine shall be subject to the provisions of subdivision five-a\nof section twenty-eight hundred seven-k of this article.\n  3. From the funds in the pool each year, any funds not distributed in\naccordance with subdivision one or two of this section, shall be\ndistributed in accordance with the formula set forth in paragraph (b) of\nsubdivision four of section twenty-eight hundred seven-k of this\narticle.\n  4. In order for a general hospital to be eligible to participate in\nthe distribution of funds pursuant to this section, such general\nhospital must be in compliance with the provisions of subdivisions nine,\nten and twelve of section twenty-eight hundred seven-k of this article.\n  5. For each hospital receiving payments pursuant to paragraph (i) of\nsubdivision thirty-five of section twenty-eight hundred seven-c of this\narticle, the commissioner shall reduce the sum of any amounts paid\npursuant to this section and pursuant to section twenty-eight hundred\nseven-k of this article, as computed based on projected facility\nspecific disproportionate share hospital ceilings, by an amount equal to\nthe lower of such sum or each such hospital's payments pursuant to\nparagraph (i) of subdivision thirty-five of section twenty-eight hundred\nseven-c of this article, provided, however, that any additional\naggregate reductions enacted in a chapter of the laws of two thousand\nten to the aggregate amounts payable pursuant to this section and\npursuant to section twenty-eight hundred seven-k of this article shall\nbe applied subsequent to the adjustments otherwise provided for in this\nsubdivision.\n