NY Pub Health L § 2807 (2021)
2021 New York Laws PBH - Public Health Article 28 - Hospitals 2807 - Hospital Reimbursement Provisions; Generally.

§   2807.  Hospital  reimbursement  provisions;  generally.  1.  Valid operating  certificate  requirement.  No  government   agency   and   no corporation   organized   and   operating  in  accordance  with  article forty-three of the insurance law and no health maintenance  organization organized  and  operating  in accordance with article forty-four of this chapter, shall purchase, pay for or make reimbursement or  grants-in-aid for  any  hospital  or  health-related  service, unless, at the time the service  was  provided,  the  hospital  possessed  a   valid   operating certificate   authorizing  such  service.  No  government  agency  shall purchase, pay  for  or  make  reimbursement  or  grants-in-aid  for  any hospital  or  health-related  service  that  has  been determined by the commissioner of health to be unauthorized for payment under the  medical assistance  program  pursuant  to  section twenty-eight hundred three of this article.   2.  (a)  Rate   approvals.   Payments   for   hospital   service   and health-related  service  made  by  government  agencies  or for services provided prior  to  January  first,  nineteen  hundred  ninety-seven  by organizations  operating  in  accordance  with the provisions of article forty-four of this chapter shall be  at  rates  approved  by  the  state director  of  the budget in the case of government agencies and approved by the commissioner in the case of plans, organized and operating  under the  provisions  of article forty-four of this chapter, under which such payments  are  made  by  agencies  other  than  government  agencies  or corporations   organized   and  operating  in  accordance  with  article forty-three of the insurance law.   Payments for  hospital  service  and health-related  service  by  corporations  organized  and  operating  in accordance with article forty-three of the insurance  law  for  services provided  prior to January first, nineteen hundred ninety-seven shall be at rates approved by the commissioner of health.  (a-1) Notwithstanding any inconsistent  provision  of  law,  rates  of payment  by  governmental  agencies  for the operating cost component of general  hospital  out-patient  and  emergency  services,  and  for  the operating  cost  component  of  treatment  or diagnostic center services shall not require a certification by  the  commissioner  that  they  are reasonably related to the costs of efficient production of such services nor  that  they are reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities.  (b) During the period  October  first,  nineteen  hundred  ninety-four through  September  thirtieth, nineteen hundred ninety-five and for each twelve month rate period commencing on October first  thereafter,  rates of  payment by governmental agencies for the operating cost component of treatment or diagnostic center services  shall  be  based  on  operating costs in the base year cost report adjusted by a trend factor determined in  accordance  with  rules  and  regulations  promulgated  pursuant  to paragraph (b) of subdivision two of section twenty-eight  hundred  three of  this  article;  provided,  however,  that  prior to such adjustment, allowable operating costs shall be established by the commissioner after taking into account the cost of services provided in facilities offering similar services and regional economic factors, plus the addition of the capital cost per visit. The capital cost per visit shall be based on the base year cost report except that the capital  cost  per  visit  may  be adjusted  for major outpatient capital expenditures, incurred subsequent to  the  reporting  year,  when  such  expenditures  have  received  the requisite  approvals and the facility has provided the commissioner with a certified statement of expenditures. The base year for the rate period commencing on October  first,  nineteen  hundred  ninety-four  shall  be nineteen  hundred  ninety-two  and shall be advanced one year thereafter for each subsequent rate period.  (c) Notwithstanding any other provision of law to the contrary, for  a diagnostic  and  treatment center licensed pursuant to this article that provides,  as  its  principal  mission,  services  to  individuals  with developmental  disabilities,  the  commissioner  may  fully or partially waive  or  modify  recoupment  of  medical  assistance payments based on retroactive changes to the applicable formula for capital costs for  the period  of  September first, two thousand nine to December thirty-first, two thousand twelve.   * (e) Notwithstanding any inconsistent provisions of this  subdivision or  any other law, payments made by governmental agencies for ambulatory surgical services provided by a hospital,  including  general  hospitals and  diagnostic  and  treatment  centers,  during the period June first, nineteen hundred eighty-nine  through  December  thirty-first,  nineteen hundred  eighty-nine  and  the  period  January  first, nineteen hundred ninety through December thirty-first, nineteen hundred ninety and  every twelve  month  rate  period  thereafter  shall be at case based rates of reimbursement established by the commissioner and approved by the  state director of the budget. Ambulatory surgical services case based rates of payment  shall  be established prospectively and shall include operating costs and capital costs. Factors considered in  establishing  such  case based  rates  shall  include, but not be limited to: a classification of procedures with  individual  or  combined  rates  established  for  each services  classification;  operating  and  capital  costs  of ambulatory surgical services efficiently  and  economically  provided,  considering regional  economic factors, trended to the rate period; and the need for incentives to improve services and institute economies.   * NB Expired April 1, 2011   * (f) (i) During  the  period  July  first,  nineteen  hundred  ninety through  March  thirty-first,  nineteen  hundred  ninety-one,  the  rate periods during the  period  April  first,  nineteen  hundred  ninety-one through  September  thirtieth, nineteen hundred ninety-four and for each fiscal year period commencing on October first thereafter, comprehensive clinic  rates  of  payment  by  governmental  agencies  established   in accordance  with  paragraph  (b)  of  this  subdivision,  applicable for services  provided  to  individuals  eligible  for  medical   assistance pursuant  to title eleven of article five of the social services law for voluntary non-profit or  publicly  sponsored  diagnostic  and  treatment centers  providing a comprehensive range of primary health care services which can demonstrate, on forms provided  by  the  commissioner,  losses from a disproportionate share of bad debt and charity care during a base year   period   established  by  regulation  may  include  an  allowance determined in accordance with this paragraph to reflect the needs of the diagnostic and treatment center for the financing  of  losses  resulting from  bad  debt and the costs of charity care. Losses resulting from bad debt  and  the  costs  of  charity  care  shall  be  determined  by  the commissioner considering, but not limited to, such factors as the losses resulting  from  bad  debt and the costs of charity care provided by the diagnostic and treatment center and the availability of other  financial support, including state and local assistance public health aid, to meet the  losses resulting from bad debt and the costs of charity care of the diagnostic and treatment center. The bad debt and charity care allowance for a diagnostic and  treatment  center  for  a  rate  period  shall  be determined  by the commissioner in accordance with rules and regulations adopted by the council and approved by the commissioner,  and  shall  be consistent  with  the  purposes for which such allowances are authorized for general hospitals pursuant to the provisions of article twenty-eight of  this  chapter  and  rules  and  regulations   promulgated   by   the commissioner.  A diagnostic and treatment center applying for a bad debt  and charity care allowance pursuant  to  this  paragraph  shall  provide assurances  satisfactory  to  the  commissioner  that it shall undertake reasonable efforts to maintain  financial  support  from  community  and public  funding  sources  and reasonable efforts to collect payments for services from third party  insurance  payors,  governmental  payors  and self-paying  patients.  To be eligible for an allowance pursuant to this paragraph,  a  diagnostic  and   treatment   center   must   provide   a comprehensive range of primary health care services and must demonstrate that a minimum of fifteen percent of total clinic visits reported during the  applicable  base  year  period  were  to uninsured individuals. The commissioner may retrospectively reduce the bad debt  and  charity  care allowance  of a diagnostic and treatment center if it is determined that provider management actions  or  decisions  have  caused  a  significant reduction  for  the rate period in the delivery of comprehensive primary health care services to bad debt  and  charity  care  residents  of  the community.  (ii) The total amount of funds to be allocated and distributed for bad debt  and  charity  care  allowances to eligible voluntary and nonprofit diagnostic and treatment centers for a rate period  in  accordance  with this  paragraph  shall be limited to an annual aggregate amount of seven million three hundred thousand dollars. The total amount of funds to  be allocated  and  distributed  for bad debt and charity care allowances to eligible publicly sponsored diagnostic and treatment centers for a  rate period  in  accordance with this paragraph shall be limited to an annual aggregate amount  of  seven  million  seven  hundred  thousand  dollars; provided,  however, that twenty percent of the amount of funds allocated for distribution to eligible publicly sponsored diagnostic and treatment centers shall be available for clinics operating under the  auspices  of the  Health and Hospitals Corporation. Notwithstanding the foregoing and any other provision of this chapter municipalities which received  state aid,  pursuant  to article two of the public health law and prior to the effective date  of  this  chapter,  in  support  of  non-hospital  based free-standing  or  local  health  department  operated  general  medical clinics, shall receive a bad debt and charity care allowance of not less than the amount received in the nineteen  hundred  eighty-nine--nineteen hundred  ninety  state fiscal year for general medical clinics, plus the applicable local share for medical assistance expenditures  under  title XIX of the federal social security act. Funds to be distributed pursuant to  this  subparagraph  shall  be  based  on  losses associated with the delivery of bad debt and charity  care  excluding  the  amount  of  such losses determined in accordance with subparagraph (ix) of this paragraph as  the  incremental  loss  basis  for  a  supplemental  allowance for a diagnostic and treatment center designated as a preferred  primary  care provider.  (iii)  No  diagnostic  and treatment center may receive a bad debt and charity care allowance in accordance with this paragraph  in  an  amount which  exceeds  its need for the financing of losses associated with the delivery of bad debt and charity care.  (iv) A nominal payment amount for the financing of  losses  associated with  the  delivery of bad debt and charity care will be established for each eligible diagnostic  and  treatment  center.  The  nominal  payment amount shall be calculated as the sum of the dollars attributable to the application  of  an incrementally increasing nominal coverage percentage of base year period losses associated with the delivery of bad debt  and charity  care  for percentage increases in the relationship between base year period eligible bad debt and charity care clinic  visits  and  base year period total clinic visits according to the following scale:  % of eligible bad debt and charity care           % of nominal financial   clinic visits to total visits                     loss coverage               up to 15%                                   50%               15 - 30%                                    75%               30%+                                        100%  If  the  sum  of  the nominal payment amounts for all eligible voluntary non-profit diagnostic and treatment centers or for all  eligible  public diagnostic  and  treatment centers is less than the amount allocated for bad debt and charity care allowances pursuant to  subparagraph  (ii)  or (ix)  respectively  of  this paragraph for such diagnostic and treatment centers respectively, the nominal  coverage  percentages  of  base  year period  losses associated with the delivery of bad debt and charity care pursuant to this scale may be increased to not  more  than  one  hundred percent for voluntary non-profit diagnostic and treatment centers or for public  diagnostic  and  treatment  centers in accordance with rules and regulations adopted by the council and approved by the commissioner.  (v) The  bad  debt  and  charity  care  allowance  for  each  eligible voluntary  non-profit  diagnostic and treatment center shall be based on the dollar value of the result of the ratio of total funds allocated for bad debt and charity care allowances for voluntary non-profit diagnostic and treatment centers pursuant to subparagraph (ii) of this paragraph to the total statewide nominal payment amounts for all  eligible  voluntary non-profit  diagnostic  and  treatment  centers determined in accordance with subparagraph (iv) of this paragraph applied to the nominal  payment amount for each such diagnostic and treatment center.  (vi)  The bad debt and charity care allowance for each eligible public diagnostic and treatment center shall be based on the  dollar  value  of the  result  of  the  ratio  of  total  funds allocated for bad debt and charity care allowances for  public  diagnostic  and  treatment  centers pursuant  to  subparagraph (ii) of this paragraph to the total statewide nominal payment amounts for all eligible public diagnostic and treatment centers  determined  in  accordance  with  subparagraph  (iv)  of   this paragraph applied to the nominal payment amount for each such diagnostic and treatment center.  (vii) Diagnostic and treatment centers shall furnish to the department such  reports  and information as may be required by the commissioner to assess the cost, quality, access to, effectiveness and efficiency of bad debt and charity care  provided.  The  council  shall  adopt  rules  and regulations,  subject  to the approval of the commissioner, to establish uniform  reporting  and  accounting  principles   designed   to   enable diagnostic  and treatment centers to fairly and accurately determine and report bad debt and charity care visits and the costs of  bad  debt  and charity  care. In order to be eligible for an allowance pursuant to this paragraph, a diagnostic and treatment center must be in compliance  with bad debt and charity care reporting requirements.  (viii) Of the funds allocated and distributed for bad debt and charity care  allowances  to  eligible  voluntary  and non-profit diagnostic and treatment centers for a rate period in accordance with subparagraph (ii) of this paragraph, an  annual  aggregate  amount  not  to  exceed  three million  eight  hundred  thousand  dollars within a rate period shall be paid by or on behalf of diagnostic and treatment centers into a  primary care  initiative  pool established by the commissioner. Such funds shall be distributed to diagnostic and treatment centers  in  accordance  with the  provisions  of subdivisions one through six of section twenty-eight hundred seven-b of this article.  (ix) During the period January  first,  nineteen  hundred  ninety-four through  September  thirtieth, nineteen hundred ninety-four and for each  twelve month rate period commencing on October first thereafter, to  the extent  of  funds  available therefor, a diagnostic and treatment center which is approved as a  preferred  primary  care  provider  pursuant  to subdivision twelve of section twenty-eight hundred seven of this article and  meets  the  requirements  of  this  paragraph may be eligible for a supplemental allowance determined in accordance with this paragraph. The supplemental allowance shall be based  on  losses  associated  with  the delivery  of  bad  debt and charity care incurred by a preferred primary care provider to the extent such losses  exceed  any  losses  associated with  the  delivery  of  bad debt and charity care incurred for nineteen hundred ninety-three or, if later, the year  immediately  preceding  the year  in which the diagnostic and treatment center is first designated a preferred primary care provider.  (x) This paragraph shall be effective if,  and  as  long  as,  federal financial   participation   is   available  for  expenditures  made  for beneficiaries eligible for medical assistance under  title  XIX  of  the federal  social  security  act  based  upon the allowances determined in accordance with this paragraph.  (xi) Notwithstanding any inconsistent  provision  of  this  paragraph, adjustments  to  rates  of  payment for diagnostic and treatment centers determined in accordance with subparagraphs  (i)  through  (x)  of  this paragraph  shall  apply only for services provided on or before December thirty-first, nineteen hundred ninety-six.   * NB Expired December 31, 1996  (g)(i) During the period April  first,  nineteen  hundred  ninety-four through December thirty-first, nineteen hundred ninety-four and for each calendar  year rate period commencing on January first thereafter, rates of payment by governmental agencies for the operating cost component  of general  hospital  outpatient  services  shall be based on the operating costs reported in the base year cost report adjusted by the trend factor applicable to the general hospital in which the services were  provided; provided,  however,  that  the  maximum  payment  for the operating cost component of outpatient services shall be sixty-seven dollars and  fifty cents  plus the addition of the capital cost per visit. The capital cost per visit shall be based on the base year cost report  except  that  the capital  cost  per  visit  may  be adjusted for major outpatient capital expenditures incurred  subsequent  to  the  reporting  year,  when  such expenditures  have received the requisite approvals and the facility has provided  the  commissioner  with   a   certified   statement   of   the expenditures. The base year for the period April first, nineteen hundred ninety-four  through December thirty-first, nineteen hundred ninety-four shall be nineteen hundred ninety-two and  shall  be  advanced  one  year thereafter  for  each subsequent calendar year rate period. Further, the provisions of subdivision seven of this section  shall  not  apply.  The commissioner  may waive the maximum allowable payment and limitations on the  rate  of  payment  as  prescribed  herein  to   provide   for   the reimbursement  of  offering  and  arranging services eligible for ninety percent federal funds as set forth in section nineteen hundred three  of the federal social security act, and to provide for the reimbursement of specialized   services   having   separately   identifiable   costs  and statistics, including but  not  limited  to  hemodialysis  services  and surgical  services provided on an outpatient basis. Such waiver shall be granted only when the commissioner finds that  the  services  are  being provided  efficiently  and  at  minimum  cost.  The  commissioner  shall promptly promulgate rules and regulations  necessary  to  identify  such services.  Among  the  criteria which the commissioner shall consider in the case of specialized services are whether the services require highly specialized staff, equipment or facilities, thereby  generating  a  cost  that  substantially exceeds that of more routine diagnostic or treatment services; whether the facility in which the  services  are  provided  is presently providing the services to the population in need; and, whether the  services  may  be  provided safely and effectively on an outpatient basis at a lower cost than through inpatient admission. In addition  the commissioner shall provide for a waiver of the maximum allowable payment for those outpatient services medically necessary which include surgical procedures  where  delay  in  surgical  intervention would substantially increase the medical risk associated with  such  surgical  intervention. Where  the  commissioner  waives  the  maximum allowable payment for any specified service he may, in accordance with the foregoing criteria  and such  other  criteria  as  he  deems  appropriate,  establish  a maximum allowable payment for such specified service.  (ii) During the  period  April  first,  nineteen  hundred  ninety-four through December thirty-first, nineteen hundred ninety-four and for each calendar  year rate period commencing on January first thereafter, rates of payment by governmental agencies for the operating cost component  of general  hospital  emergency  services  shall  be based on the operating costs reported in the base year cost report adjusted by the trend factor applicable to the general hospital in which the services were  provided, and in addition shall include that portion of the reasonable incremental emergency service operating costs incurred by such hospital in excess of emergency  service  costs  reported in the nineteen hundred eighty-eight cost report, after application of  the  trend  factor,  attributable  to meeting additional quality of care standards for emergency services that became   effective   on   or   after  January  first,  nineteen  hundred eighty-nine;  provided,  however,  that  the  maximum  payment  for  the operating  component  shall  be  ninety-five  dollars, provided further, however, that for the period January first, two thousand  seven  through December  thirty-first,  two  thousand seven the maximum payment for the operating component shall be one hundred twenty-five dollars, and during the  period  January  first,  two  thousand   eight   through   December thirty-first,  two thousand eight, the maximum payment for the operating component shall be one hundred forty  dollars;  and  during  the  period January  first,  two  thousand  nine  through December thirty-first, two thousand nine and for each calendar year thereafter, the maximum payment for the operating component  shall  be  one  hundred  fifty  dollars.  A capital  cost  per  visit  shall  be  based on the base year cost report except that the capital cost per visit may be  adjusted  for  the  major outpatient  capital expenditures incurred subsequent to the report year, when such expenditures have received the  requisite  approvals  and  the facility  has  provided  the  commissioner with a certified statement of expenditures. The base year for the period April first, nineteen hundred ninety-four through December thirty-first, nineteen hundred  ninety-four shall  be  nineteen  hundred  ninety-two  and shall be advanced one year thereafter for each subsequent calendar year rate period.  Further,  the provisions of subdivision seven of this section shall not apply prior to January first, two thousand seven.  (h) Notwithstanding any inconsistent provisions of this subdivision or any other law, except as provided in section 43.02 of the mental hygiene law,  the  commissioner  may,  in  accordance with rules and regulations adopted by the council and approved by the commissioner, establish rates of reimbursement for payments made by governmental agencies, subject  to the  approval of the state director of the budget, for services provided on an outpatient basis by a general hospital or diagnostic and treatment center designated as a  preferred  primary  care  provider  pursuant  to subdivision  twelve  of  this  section  or  providing specialty services including hemo and peritoneal dialysis,  outpatient  rehabilitative  and  psychiatric   services,   methadone  maintenance,  and  other  organized outpatient or clinic services which are structured to address  extensive and  complex  medical  needs  for  patients  with  chronic or infectious medical  conditions  based  on  factors  other  than those prescribed by paragraph (b) or subparagraph (i) of paragraph (g) of  this  subdivision or  subdivision three of this section provided, however, that the use of such an alternative approach will not result in any  increase  to  other rates  of reimbursement established pursuant to this article. During the initial rate period such rates of payment  for  preferred  primary  care providers  shall  be  at  least equal to the average rate of payment per visit which would otherwise be provided pursuant to subparagraph (i)  of paragraph  (g)  or  paragraph  (b)  of this subdivision. Factors used to establish rates shall include a  reasonable  classification  of  medical procedures  with  individual  or  combined  rates  established  for each service classification group  which  will  be  prospectively  determined based  upon  an  estimate  of  the  costs  of  such  outpatient services efficiently  and  economically  provided  by   general   hospitals   and diagnostic  and treatment centers, considering regional economic factors and the need for incentives to improve services and institute economies. Notwithstanding any inconsistent provisions of law, rates of payment  by governmental  agencies  for  outpatient  services  provided by a general hospital or  diagnostic  and  treatment  center,  shall  not  require  a certification  by the commissioner that they are reasonable and adequate to meet the costs which must be incurred by efficiently and economically operated facilities.   2-a. Notwithstanding any provision of which is  inconsistent  with  or contrary   to   the   structure  established  by  this  subdivision  and subdivision thirty-three of section twenty-eight hundred seven-c of this article,  and  subject  to  the  availability   of   federal   financial participation,  rates  of  payment by governmental agencies, established pursuant to this article,  for  general  hospital  outpatient  services, general   hospital  emergency  services,  ambulatory  surgical  services provided by  a  hospital  as  defined  by  subdivision  one  of  section twenty-eight  hundred  one of this article, and diagnostic and treatment center services, but  excepting  any  facility  whose  reimbursement  is governed  by  subdivision  eight of this section or any payments made on behalf of persons enrolled in Medicaid managed care  or  in  the  family health plus program, shall be in accordance with the following:  (a)(i)  for  the  period  December  first,  two thousand eight through November thirtieth, two thousand  nine,  seventy-five  percent  of  such rates  of  payment for each general hospital's outpatient services shall reflect the average Medicaid payment per claim,  as  determined  by  the commissioner, for services provided by that facility in the two thousand seven  calendar year, but excluding any payments for services covered by the facility's licensure, if any, under  the  mental  hygiene  law,  and twenty-five  percent  of  such rates of payment shall, for the operating cost component, reflect the utilization of the ambulatory patient groups reimbursement  methodology  described   in   paragraph   (e)   of   this subdivision;  (ii) for the period December first, two thousand nine through December thirty-first,  two  thousand  ten,  fifty percent of such rates for each facility shall reflect  the  average  Medicaid  payment  per  claim,  as determined  by  the commissioner, for services provided by that facility in the two thousand seven calendar year, but excluding any payments  for services  covered  by the facility's licensure, if any, under the mental hygiene law, and fifty percent of such rates of payment shall,  for  the operating  cost  component,  reflect  the  utilization of the ambulatory  patient groups reimbursement methodology described in paragraph  (e)  of this subdivision;  (iii)  for  the  period  January  first,  two  thousand eleven through December thirty-first, two thousand eleven, twenty-five percent of  such rates   shall  reflect  the  average  Medicaid  payment  per  claim,  as determined by the commissioner, for services provided by  that  facility for the two thousand seven calendar year, but excluding any payments for services  covered  by the facility's licensure, if any, under the mental hygiene law, and seventy-five percent of such rates  of  payment  shall, for  the  operating  cost  component,  reflect  the  utilization  of the ambulatory  patient  groups  reimbursement  methodology   described   in paragraph (e) of this subdivision; and  (iv)  for periods on and after January first, two thousand twelve, one hundred percent of such rates of payment shall reflect  the  utilization of  the ambulatory patient groups reimbursement methodology described in paragraph (e) of this subdivision.  (v) This paragraph shall be  effective  the  later  of:  (i)  December first, two thousand eight, or (ii) after the commissioner receives final approval  of  federal  financial  participation  in  payments  made  for beneficiaries eligible for medical assistance under  title  XIX  of  the federal  social  security  act  for  the  rate  methodology  established pursuant  to  subparagraph  (i)  of   paragraph   (a)   of   subdivision thirty-three of section twenty-eight hundred seven-c of this article.  (b)  (i)  for  the  period  September first, two thousand nine through November thirtieth, two thousand  nine,  seventy-five  percent  of  such rates  of payment for services provided by each diagnostic and treatment center and each free-standing ambulatory surgery  center  shall  reflect the   average   Medicaid   payment  per  claim,  as  determined  by  the commissioner, for services provided by that facility in the two thousand seven calendar year, but excluding any payments for services covered  by the  facility's  licensure,  if  any,  under the mental hygiene law, and twenty-five percent of such rates of payment shall,  for  the  operating cost component, reflect the utilization of the ambulatory patient groups reimbursement   methodology   described   in   paragraph   (e)  of  this subdivision;  (ii) for the period December first, two thousand nine through December thirty-first, two thousand ten, fifty percent of  such  rates  for  each facility  shall  reflect  the  average  Medicaid  payment  per claim, as determined by the commissioner, for services provided by  that  facility in  the two thousand seven calendar year, but excluding any payments for services covered by the facility's licensure, if any, under  the  mental hygiene  law,  and fifty percent of such rates of payment shall, for the operating cost component, reflect  the  utilization  of  the  ambulatory patient  groups  reimbursement methodology described in paragraph (e) of this subdivision;  (iii) for the  period  January  first,  two  thousand  eleven  through December  thirty-first, two thousand eleven, twenty-five percent of such rates for each facility shall reflect the average Medicaid  payment  per claim,  as determined by the commissioner, for services provided by that facility in the two thousand seven  calendar  year,  but  excluding  any payments for services covered by the facility's licensure, if any, under the  mental  hygiene  law,  and  seventy-five  percent  of such rates of payment shall, for the operating cost component, reflect the utilization of the ambulatory patient groups reimbursement methodology described  in paragraph (e) of this subdivision; and  (iv)  for periods on and after January first, two thousand twelve, one hundred percent of such rates of payment shall reflect  the  utilization  of  the ambulatory patient groups reimbursement methodology described in paragraph (e) of this subdivision.  (c)  for periods on and after December first, two thousand eight, such rates of payment for ambulatory surgical services  provided  by  general hospitals shall reflect the utilization of the ambulatory patient groups reimbursement   methodology   described   in   paragraph   (e)  of  this subdivision, provided however, that the capital cost component for  such rates  shall  be  separately  computed  in  accordance  with regulations promulgated in accordance with paragraph (e) of this subdivision.  (d) for periods on and after January first,  two  thousand  nine,  the operating  cost  component of such rates of payment for general hospital emergency services shall  reflect  the  utilization  of  the  ambulatory patient  groups  reimbursement methodology described in paragraph (e) of this subdivision and shall not reflect any  maximum  payment  amount  as otherwise  provided  for  in  subparagraph  (ii)  of  paragraph  (g)  of subdivision two of this section.  (e)  (i)  notwithstanding  any   inconsistent   provisions   of   this subdivision, the commissioner shall promulgate regulations establishing, subject   to   the  approval  of  the  state  director  of  the  budget, methodologies  for  determining  rates  of  payment  for  the   services described   in   this   subdivision.   Such  regulations  shall  reflect utilization of the ambulatory patient group (APG) methodology, in  which patients  are  grouped  based  on  their diagnosis, the intensity of the services provided and the medical procedures performed,  and  with  each APG assigned a weight reflecting the projected utilization of resources. Such  regulations  shall provide for the development of one or more base rates and the multiplication of such base rates by the  assigned  weight for  each  APG  to establish the appropriate payment level for each such APG.    Such  regulations  may  also  utilize  bundling,  packaging  and discounting mechanisms.   If  the commissioner determines that the use of the APG methodology is not, or is not yet, appropriate or practical for specified services, the commissioner  may  utilize  existing  payment  methodologies  for   such services  or  may  promulgate  regulations, and may promulgate emergency regulations, establishing alternative  payment  methodologies  for  such services.  (ii) Notwithstanding this subdivision and any other contrary provision of  law, the commissioner may incorporate within the payment methodology described in subparagraph (i) of this  paragraph  payment  for  services provided  by  facilities  pursuant to licensure under the mental hygiene law, provided, however, that such APG payment methodology may be  phased into  effect  in  accordance  with  a  schedule  or schedules as jointly determined by the commissioner, the commissioner of mental  health,  the commissioner  of  alcoholism  and  substance  abuse  services,  and  the commissioner of the office for people with developmental disabilities.  (iii) Regulations issued pursuant to this  paragraph  may  incorporate quality  related measures limiting or excluding reimbursement related to potentially preventable conditions and complications; provided  however, such   quality  related  measures  shall  not  include  any  preventable conditions and complications not identified for Medicare  nonpayment  or limited payment.   * (iv)  Effective April first, two thousand twenty, regulations issued pursuant to this paragraph for public general hospitals or public health systems, other than those operated by the state of New York or the state university of New York, located in a city having  a  population  of  one million or more shall reflect additional reimbursement for costs, to the extent  permitted  under  42  CFR  447.321(b)(1)  and  based  on  actual utilization of services. Such  rate  add-on  shall  be  contingent  upon  federal  financial  participation and approval, and subject to the terms of a binding memorandum of understanding executed between the department of health and the  public  general  hospital  or  public  health  system receiving  the  rate add-on. If payment of such rate add-on is projected to cause Medicaid disbursements for such period to exceed the  projected department  of  health  Medicaid  state  funds  in  the  enacted  budget financial plan pursuant to subdivision three of section twenty-three  of the  state  finance law, as determined by the director of the budget, or the memorandum of understanding is not  executed  or  is  breached,  the commissioner,  in  consultation  with  the  director  of the budget, may either  cancel  or  reduce  payment  of  such  rate  add-on  to  achieve compliance with the enacted budget financial plan.   * NB Repealed March 31, 2023  (f)(i) The commissioner shall periodically measure the utilization and intensity  of  services  provided  to  medical  assistance recipients in ambulatory settings. Such analysis shall include, but not be limited to: measurement of the shift  of  surgical  procedures  from  the  inpatient hospital  setting to the ambulatory setting including measurement of the impact of any such shift on quality of care and outcomes; changes in the utilization  and  intensity  of  services  provided  in  the  outpatient hospital  department  and  in  diagnostic and treatment centers; and the change in the utilization and intensity  of  services  provided  in  the emergency department.  (ii)  notwithstanding the provisions of paragraphs (a) and (b) of this subdivision, for periods on and after January first, two thousand  nine, the   following   services   provided  by  general  hospital  outpatient departments and diagnostic and treatment  centers  shall  be  reimbursed with  rates  of payment based entirely upon the ambulatory patient group methodology as described in paragraph (e) of this subdivision, provided, however,  that   the   commissioner   may   utilize   existing   payment methodologies  or  may  promulgate  regulations establishing alternative payment methodologies for one or more of the services specified in  this subparagraph,  effective  for  periods  on  and  after  March first, two thousand nine:  (A) services provided in accordance with the provisions of  paragraphs (q)  and (r) of subdivision two of section three hundred sixty-five-a of the social services law; and  (B) all services, but only with regard to additional payment  amounts, as  determined  in accordance with regulations issued in accordance with paragraph (e) of this subdivision, for the provision  of  such  services during  times  outside  the  facility's  normal  hours  of operation, as determined in accordance with criteria set forth  in  such  regulations; and  (C)  individual  psychotherapy  services  provided  by licensed social workers, in accordance with licensing criteria set forth  in  applicable regulations,  to  persons  under  the  age  of twenty-one and to persons requiring such services as a result of or related to pregnancy or giving birth; and  (D) individual psychotherapy  services  provided  by  licensed  social workers,  in  accordance with licensing criteria set forth in applicable regulations, at diagnostic and treatment centers that  provided,  billed for,  and received payment for these services between January first, two thousand seven and December thirty-first, two thousand seven;  (E) services provided to pregnant women pursuant to paragraph  (s)  of subdivision  two  of  section  three  hundred sixty-five-a of the social services law and, for periods on and after January first,  two  thousand ten,  all  other  services  provided  pursuant to such paragraph (s) and  services provided pursuant  to  paragraph  (t)  of  subdivision  two  of section three hundred sixty-five-a of the social services law;  (F)  wheelchair  evaluation services and eyeglass dispensing services; and  (G) immunization services, effective  for  services  rendered  on  and after June tenth, two thousand nine.  (f-1)  Notwithstanding  any  inconsistent provision of this section or any other contrary provision of  law,  the  commissioner  may  with  the approval  of  the  director  of  the  budget,  for  periods prior to two thousand twelve,  establish  rates  of  payments  for  selected  patient service  categories  that are based entirely upon the ambulatory patient groups methodology as authorized  pursuant  to  paragraph  (e)  of  this subdivision.  (g)  for  the  purposes  set  forth  in paragraphs (a) and (b) of this subdivision, rates described as in effect for  the  two  thousand  seven calendar  year  shall mean those rates which are in effect for that year on the date this subdivision becomes effective and such rates shall  not thereafter,  for  the purposes set forth in such paragraphs (a) and (b), be subject to further adjustment.  (h)(i) To the degree that rates of payment computed in accordance with paragraphs (a) and (d) of this subdivision reflect  utilization  of  the ambulatory   patient   groups  reimbursement  methodology  described  in paragraph  (e)  of  this  subdivision  for  purposes  of  computing  the operating  component  of such rates, the computation of the capital cost component of such rates  shall  remain  subject  to  the  provisions  of subparagraphs  (i)  and (ii) of paragraph (g) of subdivision two of this section,  provided,  however,  that  this  subparagraph  shall  not   be understood  as  applying  to those portions of rates of payment computed pursuant to paragraph (a) of this subdivision which are based on average Medicaid payments per claim.  (ii) To the degree that rates of payment computed in  accordance  with paragraph  (b) of this subdivision reflect utilization of the ambulatory patient groups reimbursement methodology described in paragraph  (e)  of this  subdivision  for  purposes of computing the operating component of such rates, the computation of the capital cost component of such  rates shall,  for  diagnostic  and  treatment  centers,  remain subject to the provisions of paragraph (b) of  subdivision  two  of  this  section  and shall,  for  free-standing  ambulatory  surgery  centers,  be separately computed in accordance with regulations promulgated in  accordance  with paragraph   (e)  of  this  subdivision,  provided,  however,  that  this subparagraph shall not be understood as applying to  those  portions  of rates of payment which are based on average Medicaid payments per claim.  (i)  Notwithstanding  any  provision  of law to the contrary, rates of payment  by  governmental  agencies  for  general  hospital   outpatient services,  general  hospital  emergency services and ambulatory surgical services  provided  by  a  general  hospital  established  pursuant   to paragraphs  (a),  (c)  and  (d)  of  this subdivision shall result in an aggregate increase in such rates of payment of fifty-six million dollars for  the  period  December  first,  two  thousand  eight  through  March thirty-first,  two  thousand  nine and one hundred seventy-eight million dollars for periods after April first, two thousand nine, through  March thirty-first, two thousand thirteen, and one hundred fifty-three million dollars  for  state  fiscal  year  periods on and after April first, two thousand thirteen, provided, however, that  for  periods  on  and  after April  first, two thousand nine, such amounts may be adjusted to reflect projected decreases in fee-for-service Medicaid utilization and  changes in  case-mix  with  regard  to such services from the two thousand seven calendar year  to  the  applicable  rate  year,  and  provided  further,  however, that funds made available as a result of any such decreases may be  utilized  by  the  commissioner to increase capitation rates paid to Medicaid managed care plans  and  family  health  plus  plans  to  cover increased payments to health care providers for ambulatory care services and  to  increase  such  other  ambulatory  care  payment  rates  as the commissioner  determines  necessary  to  facilitate  access  to  quality ambulatory care services.   3.  Commissioner  rate  certification, governmental payments. Prior to the approval of such rates, as  provided  in  subdivision  two  of  this section,  the commissioner shall determine, and in the case of approvals by the state director of the budget, certify to such official  that  the proposed  rate  schedules  for  payments  to  hospitals for hospital and health-related services are reasonable and adequate to  meet  the  costs which   must  be  incurred  by  efficiently  and  economically  operated facilities. In making such certification, the  commissioner  shall  take into  consideration  the elements of cost, geographical differentials in the elements of cost considered, economic factors in the area  in  which the hospital is located, the rate of increase or decrease of the economy in  the  area  in  which  the hospital is located, costs of hospitals of comparable size, and the need for incentives  to  improve  services  and institute   economies.      The   commissioner   shall  also  take  into consideration  the  economies  and  improvements  in   service   to   be anticipated  from  the  operation  of  joint  central  service or use of facilities or services which may serve as  alternatives  or  substitutes for  the  whole  or  any part of in-hospital service, including, but not limited to, obstetrical,  pediatric,  laboratory,  training,  radiology, pharmacy, laundry, purchasing, preadmission, nursing home, ambulatory or home  care  services.  The commissioner shall exclude costs for research and those  parts  of  the  costs  for  educational  salaries  which  the commissioner  shall  determine  to  be  not directly related to hospital service, and allowances for costs which are not specifically  identified except  for  allowances  authorized  under  section twenty-eight hundred seven-a or twenty-eight hundred seven-c of this article. In  determining and  certifying  to  the  state director of the budget rates of payment, including rates of payment for residential health care  facilities,  the commissioner  shall take into consideration the different levels of care authorized to be provided in such hospital or health-related service and determine and certify distinct rates of payment for each such  level  of care.  If  the  modification  of  an operating certificate of a hospital pursuant to subdivision six of section twenty-eight hundred six of  this article  requires the establishment of a rate for a level of service not previously provided in such hospital during the rate period existing  at the time of such modification, a new rate period for that portion of the hospital   reclassified   as  a  result  of  such  modification  may  be established upon sixty days' prior notice.   4.  Commissioner  rate  certifications,  payments  pursuant   to   the provisions of the workers' compensation law, the volunteer firefighters' benefit  law,  the  volunteer  ambulance  workers'  benefit  law and the comprehensive motor vehicle insurance  reparations  act.  For  the  rate years  commencing January first, nineteen hundred eighty-six and January first, nineteen hundred eighty-seven the commissioner  shall  submit  to the  chairman  of the workers' compensation board a schedule of hospital inpatient reimbursement rates computed in  accordance  with  subdivision two  of  section  twenty-eight  hundred  seven-a  of  this article or as revised  pursuant  to  subdivisions  eleven  and  fourteen  of   section twenty-eight  hundred  seven-a  of this article. Beginning with the rate period commencing  January  first,  nineteen  hundred  eighty-eight  the commissioner  shall  submit,  and beginning with the rate period January  first, nineteen hundred ninety-seven and certify, to the chairman of the workers' compensation board for an established rate period a schedule of hospital inpatient  reimbursement  rates  computed  in  accordance  with subdivision  one of section twenty-eight hundred seven-c of this article for payments pursuant to the workers' compensation  law,  the  volunteer firefighters'  benefit law and the comprehensive motor vehicle insurance reparations act and beginning with  the  rate  year  commencing  January first,  nineteen  hundred  ninety-one including payments pursuant to the volunteer ambulance workers' benefit law.   5. Audit authority. The  commissioner  shall  make  available  to  the commissioner  of social services, in a mutually satisfactory manner, all information necessary to conduct or have conducted, on  a  cost  sharing basis  among  payors,  an  appropriate review or audit of the fiscal and statistical records of a hospital necessary to implement the  provisions of this article.   6.  Consideration of economic status in certain cases. Notwithstanding the provisions of this section, the  commissioner,  in  determining  and certifying  rates  of  payment  for  services  provided  by a party to a contract entered into pursuant to the provisions of subdivision three of section twenty-eight hundred three of  this  article,  shall  take  into consideration  the  economic  status  of  the  patients  receiving  such services.   7. Reimbursement rate promulgation. The commissioner shall notify each residential health care  facility  and  health-related  service  of  its approved  rates  of  payment  which  shall  be  used  in reimbursing for services provided  to  persons  eligible  for  payments  made  by  state governmental  agencies  at least sixty days prior to the beginning of an established rate period for which the rate is to  become  effective  and for  general hospitals at least thirty days prior to the beginning of an established rate period for which  the  rate  is  to  become  effective. Notification  shall be made only after approval of rate schedules by the state  director  of  the  budget.  The  sixty  and  thirty  day   notice provisions,  herein,  shall not apply to rates issued following judicial annulment or invalidation of  any  previously  issued  rates,  or  rates issued  pursuant  to  changes  in  the methodology used to compute rates which changes  are  promulgated  following  the  judicial  annulment  or invalidation  of  previously issued rates. Notwithstanding any provision of law to the contrary, nothing in this subdivision shall  prohibit  the recalculation and payment of rates, including both positive and negative adjustments,  based  on  a reconciliation of amounts paid by residential health  care  facilities  beginning  April   first,   nineteen   hundred ninety-seven   for   additional   assessments   or   further  additional assessments pursuant to section twenty-eight  hundred  seven-d  of  this article   with  the  amounts  originally  recognized  for  reimbursement purposes.   7-a. Notwithstanding any inconsistent provision of law, with regard to a general hospital the provisions of subdivisions four and seven of this section and the provisions of section eighteen of  chapter  two  of  the laws  of  nineteen  hundred  eighty-eight relating to the requirement of prior notice and the time frames for notice, approval  or  certification of  rates  of payment, maximum rates of payment or maximum charges where not otherwise waived pursuant to law shall be applicable  only  to  such rates  of  payment  or  maximum charges prospectively established for an annual rate period and such provisions shall  not  be  applicable  to  a general hospital with regard to prospective adjustments or retrospective adjustments  of  established  rates of payment or maximum charges for or during an annual rate period based on correction of errors or  omissions of   data  or  in  computation,  rate  appeals,  audits  or  other  rate  adjustments authorized by law or regulations adopted pursuant to section twenty-eight hundred three of this article.   7-b.  Notification  of diagnostic and treatment center approved rates. (a) For rate periods or portions of rate periods beginning on  or  after October  first,  nineteen  hundred  ninety-four,  the commissioner shall notify each diagnostic and treatment center of  its  approved  rates  of payment,  which shall be used in the reimbursement for services provided to persons eligible for payments made by state governmental agencies  at least  thirty  days  prior to the beginning of the period for which such rates are to become effective.  (b) Notwithstanding any contrary provision of law, all diagnostic  and treatment  centers  certified  on  or  before September second, nineteen hundred ninety-seven shall, not later than  September  second,  nineteen hundred  ninety-seven,  notify  the  commissioner whether they intend to maintain all books and records utilized by the diagnostic and  treatment center  for cost reporting and reimbursement purposes on a calendar year basis or, commencing on July first, nineteen hundred  ninety-six,  on  a July  first  through June thirtieth basis, and shall thereafter maintain all books and records  on  such  basis.  All  diagnostic  and  treatment centers  certified after September second, nineteen hundred ninety-seven shall notify the commissioner at the time of certification whether  they intend  to maintain all books and records on a calendar year basis or on or a July first through  June  thirtieth  basis,  and  shall  thereafter maintain all books and records on such a basis.  (c) The books and records maintained pursuant to paragraph (b) of this subdivision  shall be utilized and made available to the commissioner in promulgating rates of payment for annual rate periods  beginning  on  or after October first, nineteen hundred ninety-seven.  (d) Notwithstanding any provision of the law to the contrary, rates of payment  established  in  accordance  with paragraph (b) as amended, and paragraph (f) of subdivision two of this section  for  the  rate  period beginning  April  first, nineteen hundred ninety-three shall continue in effect through September thirtieth, nineteen  hundred  ninety-four,  and applicable  trend factors shall be applied to that portion of such rates of payment for the  rate  period  which  begins  April  first,  nineteen hundred ninety-four.   8.  Rates  for  federally  qualified  health  centers and rural health centers. Notwithstanding section four of chapter eighty-one of the  laws of  nineteen  hundred ninety-five, as amended by section twenty-seven of chapter one of the laws of nineteen hundred ninety-nine, and  any  other law,  rule  or  regulation  to  the  contrary,  for periods on and after January first, two thousand one, rates of payment made  by  governmental agencies  for  services  provided by diagnostic and treatment centers or general hospital outpatient  clinics  licensed  under  this  article  to individuals  eligible for medical assistance pursuant to title eleven of article five of the social services law which are  also  designated,  in accordance  with  42  USC  §  1396a(aa),  as  federally qualified health centers or rural health centers shall be established in accordance  with the following:  (a)  For  periods  on  and  after January first, two thousand one, and prior to October first, two thousand one, such rates of payment shall be computed in accordance with paragraph (b) of  subdivision  two  of  this section,   provided,  however,  that  the  operating  and  capital  cost components of such  rates  and  the  applicable  ceilings  on  allowable operating costs shall reflect an average of nineteen hundred ninety-nine and two thousand base year costs as reported to the department.  (b)  For  each  twelve month period following September thirtieth, two thousand one, the operating cost component  of  such  rates  of  payment  shall  reflect  the  operating  cost  component  in  effect on September thirtieth of the prior period as increased by the percentage increase in the  Medicare  Economic  Index  as  computed  in  accordance  with   the requirements  of  42  USC  §  1396a(aa)(3)  and  as adjusted pursuant to applicable regulations to take into account any increase or decrease  in the scope of services furnished by the facility.  (c)  Rates  of payments to facilities which first qualify as federally qualified health centers or rural health centers  on  or  after  October first,  two thousand shall be computed in accordance with the provisions of paragraph (b) of subdivision two of this section, provided,  however, that the operating cost component of such rates shall reflect an average of  the  operating  cost  component of rates of payments issued to other facilities subject to this subdivision  during  the  same  rate  period, located  in the same geographic region and with a similar case load, and further provided that the capital cost component  of  such  rates  shall reflect the most recently available capital cost data as reported to the department.  For  each  twelve month period following the rate period in which such facilities commence operation, the operating  cost  component of  rates of payment for such facilities shall be computed in accordance with paragraph (b) of this subdivision.  In  calculating  the  operating cost  component  of  such  rates  for  facilities which first qualify as federally qualified health care centers on or after October  first,  two thousand,  the  counties  comprising  the  geographic  region  known  as downstate shall be the same as the  counties  comprising  the  downstate region  for  purposes  of  reimbursing  diagnostic and treatment centers under ambulatory patient groups, which counties  are  specified  in  the regulations  adopted by the commissioner implementing section 18 of part C of chapter fifty-eight of the laws of two thousand eight.  (d) Subject to receipt of all necessary federal  approvals,  rates  of payment  computed  in  accordance  with  this subdivision may be further adjusted in accordance with the provisions of subdivision  seventeen  of this  section,  provided,  however,  that  such adjustments shall not be subject to trend adjustments  as  provided  in  paragraph  (b)  of  this subdivision.  (e)  Diagnostic  and  treatment  centers eligible for rates of payment computed pursuant to paragraphs (a) and (b) of this  subdivision,  which were, on December thirty-first, two thousand, receiving rates of payment as  preferred  primary care providers computed pursuant to paragraph (h) of subdivision two of this section, may elect  to  continue  to  receive rates  of  payment  computed  in  accordance  with  such  paragraph (h), provided that in no event shall such rates of payment be less  than  the rates  of  payment  computed  pursuant to paragraphs (a) and (b) of this subdivision.  (f) For any rate periods after March thirty-first, two thousand eight, subject to the availability  of  federal  financial  participation,  the commissioner  may  prospectively  adjust rates of payment for facilities otherwise  subject  to   this   subdivision   to   reflect   alternative rate-setting  methodologies,  provided,  however,  that such alternative rate-setting methodologies must: (i) be authorized by  applicable  state law,  (ii)  be  agreed to by the commissioner and each facility to which they are applied and (iii) in no event result  in  rates  that  are,  in aggregate, less than the rates of payment otherwise provided for in this subdivision.   9.  Payments under this section not to preclude other lawful payments. Any payments made  under  the  authority  of  this  section  or  section twenty-eight hundred seven-c of this article shall not preclude payments under any other section of law.    10.  Notwithstanding  the provisions of this article, the commissioner may waive, subject to the approval of the state director of the  budget, the requirements of any provisions of this section, section twenty-eight hundred  seven-a  or  twenty-eight  hundred  seven-c  of this article to permit   the   development   and/or   continuation   of   limited  pilot reimbursement programs to provide additional knowledge and experience in different types of reimbursement mechanisms for general hospitals.   * 11. Notwithstanding the provisions of this article, the commissioner may waive, subject to the approval of the state director of the  budget, the  requirements of any provision of this section, section twenty-eight hundred seven-a or twenty-eight  hundred  seven-c  of  this  article  to permit  the  development,  implementation and operation of limited pilot reimbursement programs for  general  hospital  outpatient  services  and diagnostic  and  treatment center services that would be prospective and associated to the resource use patterns  in  rendering  ambulatory  care services.   * NB Expired April 1, 2020   12.  (a) Notwithstanding any inconsistent provision of this article or any other law, for the purpose of improving access to  and  availability of  comprehensive  primary  health  care  to  persons  receiving medical assistance pursuant to title  eleven  of  article  five  of  the  social services  law,  the  commissioner,  upon  application  by  a health care provider, may designate  such  provider  as  a  preferred  primary  care provider in accordance with the provisions of this subdivision.  (b)  Health  care  providers  designated  as  preferred  primary  care providers pursuant to this subdivision shall meet such  requirements  as may be established by the commissioner in regulation, including, but not limited to:  (i)  access  by  the  medically  indigent  and  medicaid  eligible  to ambulatory services;  (ii) provision, to the maximum extent practicable,  of  continuity  of care;  (iii)   arrangements   for  specialty  physician  care  and  necessary ancillary services;  (iv) reasonably accessible hours of operation;  (v) services which are accessible to medically underserved populations and communities including, to the maximum extent feasible, offering such services within the medically underserved community; and  (vi) participation in local  social  services  district  managed  care programs  established  pursuant to section three hundred sixty-four-j of the social services law, provided that the commissioner, in consultation with the commissioner of social  services,  may  exempt  a  health  care provider  from  such  participation  for  good  cause.  Good cause shall include but not be limited to geographic inaccessibility to managed care programs, inability to coordinate services of managed care programs,  or that  participation  in  the  managed  care  program would significantly affect the provider's financial ability to provide services.  (c) For the purposes of  this  subdivision,  a  health  care  provider eligible  to  be  designated  as a preferred primary care provider shall mean a general hospital, a diagnostic and treatment  center,  a  private physician,  a  nurse practitioner, a midwife, a professional corporation or a group of physicians or nurse practitioners. The designation of  any general  hospital  or  a  diagnostic and treatment center as a preferred primary care provider shall apply only to the specific  site  where  the entity provides comprehensive primary health care services.   * 13.  Subject  to  the  availability of funds, the commissioner shall authorize health  occupation  development  and  workplace  demonstration programs  pursuant  to  the  provisions  of  section  two thousand eight  hundred seven-h of this article for diagnostic  and  treatment  centers, and  the  commissioner  is  hereby  directed to make rate adjustments to cover the cost of such programs.   * NB Expired July 1, 2017   * 14. Notwithstanding any inconsistent provision of law or regulation, for  purposes  of establishing rates of payment by governmental agencies for diagnostic and treatment centers for services provided on  or  after April  first,  nineteen  hundred ninety-five, the reimbursable base year administrative and general costs of a  provider,  excluding  a  provider reimbursed  on  an  initial budget basis, shall not exceed the statewide average of total reimbursable base year administrative and general costs of  diagnostic  and  treatment  centers.  For  the  purposes   of   this subdivision,  reimbursable  base  year  administrative and general costs shall mean those base year administrative and  general  costs  remaining after  application of all other efficiency standards, including, but not limited to, peer group cost ceilings or guidelines.  The  limitation  on reimbursement  for provider administrative and general expenses provided by this subdivision shall be expressed as a percentage reduction of  the operating cost component of the rate promulgated by the commissioner for each  diagnostic  and treatment center with base year administrative and general costs exceeding the average.   * NB Expired March 31, 2011   15. Notwithstanding  any  inconsistent  provision  of  law,  including subdivision  fourteen  of  this section, the facility-specific impact of eliminating the statewide cap on administrative and  general  costs,  as imposed pursuant to subdivision fourteen of this section, for the period April  first,  nineteen  hundred  ninety-nine  through  June  thirtieth, nineteen hundred ninety-nine pursuant  to  a  chapter  of  the  laws  of nineteen  hundred ninety-nine, shall be included in rates of payment for facilities affected by such elimination for the  period  October  first, nineteen  hundred  ninety-nine  through  December thirty-first, nineteen hundred ninety-nine. In addition, rates  for  diagnostic  and  treatment centers  for  the  period  October  first,  nineteen hundred ninety-nine through  December  thirty-first,  nineteen  hundred  ninety-nine   shall include,  in  the  aggregate,  the sum of fourteen million dollars which shall be added to  rates  of  payment  established  in  accordance  with paragraphs  (b)  and  (h) of subdivision two of this section based on an apportionment of such amount using a ratio of each individual provider's estimated medicaid expenditures to total estimated medicaid expenditures for diagnostic and treatment centers, as determined by the commissioner, for the October first, nineteen hundred  ninety-nine  through  September thirtieth, two thousand rate period.   16.  Notwithstanding  any  inconsistent  provision of law, payment for drugs which may not be dispensed without a prescription as  required  by section sixty-eight hundred ten of the education law provided to persons receiving medical assistance pursuant to title eleven of article five of the  social  services  law  by  any  non-hospital  based  diagnostic and treatment center  licensed  under  this  article  in  existence  on  the effective  date  of  this  subdivision  providing  comprehensive primary medical care services and registered by  the  state  board  of  pharmacy pursuant to section sixty-eight hundred eight of the education law shall be  on  a  fee-for-service  basis  and  shall  not  be  included  in any comprehensive clinic rate paid to such facility by governmental agencies established in accordance with paragraph (b) of subdivision two of  this section.   17.  (a)  Notwithstanding any contrary provision of law or regulation, the commissioner shall, subject to the availability of federal financial participation, adjust medical assistance rates  of  payment  established  pursuant  to  paragraph  (b)  of  subdivision  two  of  this section for free-standing diagnostic and treatment centers licensed pursuant to this article and which are: a "covered provider" as  defined  in  subdivision one  of  section  three  hundred sixty-four-j-two of the social services law; or eligible for an allocation under paragraph (a-1) of  subdivision two  of  section  three  hundred sixty-four-j-two of the social services law; or  which  provides  services  to  individuals  with  developmental disabilities  as  their principal mission, in accordance with paragraphs (b) and (c) of this subdivision for purposes  of  improving  recruitment and  retention  of  non-supervisory workers at health care facilities or any worker with direct patient  care  responsibility  in  the  following aggregate amounts for the following periods:  (i)  for  the  period  April  first, two thousand two through December thirty-first, two thousand two, thirteen million dollars;  (ii) for the period January first, two thousand three through December thirty-first, two thousand three, thirteen million dollars;  (iii) for the period January first, two thousand four through December thirty-first, two thousand four, thirteen million dollars;  (iv) for the period January first, two thousand five through  December thirty-first, two thousand five, thirteen million dollars;  (v)  for  the  period January first, two thousand six through December thirty-first, two thousand six, thirteen million dollars;  (vi) for the period January first, two  thousand  seven  through  June thirtieth,  two  thousand  seven,  six  million  five  hundred  thousand dollars;  (vii) for the period July first,  two  thousand  seven  through  March thirty-first,  two  thousand  eight,  nine  million  seven hundred fifty thousand dollars; and  (viii) thirteen million  dollars  for  the  period  April  first,  two thousand eight through March thirty-first, two thousand nine;  (ix) thirteen million dollars for the period April first, two thousand nine through March thirty-first, two thousand ten; and  (x)  thirteen million dollars for the period April first, two thousand ten through March thirty-first, two thousand eleven.  (b)  Such  adjustments  to  rates  of  payments  shall  be   allocated proportionally  based  on  each  diagnostic and treatment center's total annual gross salary and fringe benefit costs, as reported in  each  such diagnostic  and  treatment  center's  nineteen  hundred ninety-nine cost report as submitted to the  department  prior  to  November  first,  two thousand  one,  provided,  however,  that  for periods on and after July first, two thousand seven, such adjustments to rates of payment shall be allocated proportionally, based on each such  diagnostic  and  treatment center's  total  reported  medicaid  visits,  as  reported  in each such diagnostic and treatment center's  two  thousand  four  cost  report  as submitted  to the department prior to January thirty-first, two thousand seven, to the total of such  medicaid  visits  for  all  diagnostic  and treatment centers.  (c)  Rate  adjustments  made pursuant to this subdivision shall not be subject to subsequent adjustment or reconciliation.  (d) Diagnostic and treatment centers which have their  rates  adjusted pursuant  to  this  subdivision  shall use such funds for the purpose of recruitment and retention of  non-supervisory  workers  at  health  care facilities or any worker with direct patient care responsibility and are prohibited  from  using  such  funds  for  any  other purpose. Each such diagnostic and treatment center shall submit, at a time and in a  manner to  be determined by the commissioner, a written certification attesting that such funds will be used solely for the purpose of  recruitment  and retention  of  non-supervisory  workers at health care facilities or any  worker with direct patient  care  responsibility.  The  commissioner  is authorized  to audit each such diagnostic and treatment center to ensure compliance with the written certification required by this paragraph and shall  recoup  any funds determined to have been used for purposes other than recruitment and retention of non-supervisory workers at health care facilities or any worker with direct patient care  responsibility.  Such recoupment shall be in addition to any other penalties provided by law.   18.  (a)  Notwithstanding any contrary provision of law or regulation, the commissioner shall, subject to the provisions of  paragraph  (c)  of this   subdivision   and   to  the  availability  of  federal  financial participation, increase medical assistance rates of payment  established pursuant  to  paragraph  (b)  of  subdivision  two  of  this section for eligible diagnostic and treatment centers by three percent for  services provided  on  and after December first, two thousand two for purposes of improving recruitment and retention of non-supervisory  workers  or  any worker with direct patient care responsibility.  (b)  For  the  purposes  of this subdivision, "eligible diagnostic and treatment center" shall mean a voluntary, not-for-profit diagnostic  and treatment  center  licensed  under  this  article  that received medical assistance rates of payment reflecting  assignment  to  limited  primary care  or  drug  free  peer  groups as established pursuant to applicable rate-setting regulations and that provides primary health care  services to  a patient population primarily comprised of substance abuse patients and that is ineligible for an adjustment to medical assistance rates  of payment under subdivision seventeen of this section.  (c)  Diagnostic  and treatment centers which have their rates adjusted pursuant to this subdivision shall use such funds solely for the purpose of recruitment and retention of non-supervisory workers  or  any  worker with  direct  patient  care responsibility and are prohibited from using such funds for any other purpose. Each  such  diagnostic  and  treatment center  shall  submit, at a time and in a manner to be determined by the commissioner, a written certification attesting that such funds will  be used   solely   for   the   purpose  of  recruitment  and  retention  of non-supervisory  workers  or  any  worker  with  direct   patient   care responsibility.  The  commissioner  is  authorized  to  audit  each such diagnostic and treatment center to ensure compliance  with  the  written certification  required  by  this  paragraph  and shall recoup any funds determined to have been used for purposes  other  than  recruitment  and retention  of  non-supervisory workers or any worker with direct patient care responsibility. Such recoupment shall be in addition to  any  other penalties provided by law.   19.  (a)  Notwithstanding  any provision of law, rule or regulation to the contrary and subject to the provisions  of  paragraph  (b)  of  this subdivision  and to the availability of federal financial participation, the commissioner shall increase medical assistance rates of  payment  by three  percent  for  services  provided on and after December first, two thousand two by freestanding methadone maintenance service  and  program providers  issued  operating  certificates  pursuant to this article and section 32.09 of the mental hygiene law for the  purposes  of  improving recruitment and retention of methadone maintenance workers.  (b)  Freestanding methadone maintenance services and program providers which are eligible for rate adjustments pursuant to this subdivision and which are also eligible for rate  adjustments  pursuant  to  subdivision seventeen  of this section, shall, on or before July first, two thousand two, submit, in a  form  and  manner  determined  by  the  commissioner, amendments   to   designated   sections  of  their  AHCF-1  cost  report segregating wages and fringe benefit  costs  associated  with  methadone maintenance  services  from  all  other  services  for  the  purposes of  determining awards  made  pursuant  to  subdivision  seventeen  of  this section  for  rate  periods  ending  in  two  thousand  three and in two thousand four.  (c)  Freestanding  methadone maintenance service and program providers which have their rates adjusted pursuant to this subdivision  shall  use such  funds  solely  for  the  purpose  of  recruitment and retention of non-supervisory  workers  or  any  worker  with  direct   patient   care responsibility  and  are  prohibited from using such funds for any other purpose. Each such methadone maintenance service  and  program  provider shall  submit,  at  a  time  and  in  a  manner  to be determined by the commissioner, a written certification attesting that such funds will  be used   solely   for   the   purpose  of  recruitment  and  retention  of non-supervisory workers at such  programs  or  any  worker  with  direct patient  care  responsibility.  The  commissioner is authorized to audit each such methadone maintenance service and program provider  to  ensure compliance with the written certification required by this paragraph and shall  recoup  any funds determined to have been used for purposes other than recruitment and retention of non-supervisory workers or any  worker with  direct  patient  care  responsibility. Such recoupment shall be in addition to any other penalties provided by law.   20. (a) Notwithstanding any contrary provision of law and  subject  to the  receipt  of all necessary federal approvals and the availability of federal financial participation, the commissioner is authorized to enter into agreements with SUNY downstate medical center, other public general hospitals, and/or with the sponsoring local governments  of  such  other public  general hospitals, under which such facilities and/or such local government shall, by intergovernmental transfer,  fund  the  non-federal share  of  Medicaid  funds  made  available  for  Delivery System Reform Incentive Payments ("DSRIP") to such facilities. Such non-federal  share payments  shall be deemed voluntary and, further, such payments shall be excluded from computations made pursuant to section one  of  part  C  of chapter  fifty-eight  of  the  laws of two thousand five, as amended. In addition, the facilities, and/or the  sponsoring  local  governments  of such  facilities  or the state may, by written notification to the other parties to the agreement, cancel such agreement at any time prior to the payment of the DSRIP funds.  The  commissioner  shall,  to  the  maximum degree  practicable,  and to the extent permitted by the federal Centers for Medicare and  Medicaid  Services  ("CMS"),  ensure  that  the  DSRIP program is implemented throughout the entire state.  (b)  The  commissioner  shall  establish  an advisory panel to provide assistance with regard to the DSRIP program. The panel shall be  charged with  reviewing  recommendations  for  DSRIP funding made by the state's contracted DSRIP assessor and advising the  commissioner  regarding  the results  of such review. Such panel shall also review applications under paragraph  (b)  of  subdivision  two  of  section  twenty-eight  hundred twenty-five  of  this  article.  Panel  membership shall be comprised of individuals with significant health care system experience. Members  may not  be  elected  officials  or employed by providers that would benefit from DSRIP funding, and must not have  any  conflict  of  interest  that would  prevent them from providing an impartial review of DSRIP assessor recommendations. The panel shall consist of  members  appointed  by  the commissioner  and  shall  in addition consist of one member appointed by the majority leader of  the  New  York  state  senate,  and  one  member appointed by the speaker of the New York state assembly. The panel shall carry  out the review of DSRIP recommendations in strict accordance with all requirements set forth in the state's federal 1115  Medicaid  waiver standard   terms   and   conditions.   The   panel   shall   submit  its recommendations  to  the  commissioner  for  final   determination,   in  accordance  with  all requirements set forth in the state's federal 1115 Medicaid waiver standard terms  and  conditions.  The  commissioner  may modify  the  requirements  of  this  paragraph and paragraph (c) of this subdivision if such modifications are required by the federal CMS.  (c)(i)  Project  advisory  committees.  1.  Lead  entities  of systems established under the Medicaid delivery system reform incentive  payment ("DSRIP")  program  shall  establish  a  project advisory committee. The committee shall consider and advise the  entity  on  matters  concerning system  operations,  service delivery issues, elimination of health care disparities, measurement  of  project  outcomes,  the  degree  to  which project  goals  are  being  reached  and the development of any plans or programs. The entity may establish rules with  respect  to  its  project advisory committee.  (ii)  The  members  of  the  committee shall be representatives of the community, or geographic service areas, served by the system,  including Medicaid  consumers  attributed  to  that  system, and any other members required by the terms and conditions of  the  DSRIP  program.  The  lead entity  shall  file with the commissioner, and from time to time update, an up-to-date list of the members of the committee, which shall be  made available to the public by the department on its website.  (iii) Notwithstanding any inconsistent provision of law, no officer or employee  of the state or of any civil division thereof, shall be deemed to have forfeited or shall forfeit his or her office  or  employment  by reason  of  his  or  her  acceptance of membership on a project advisory committee. No member of  a  project  advisory  committee  shall  receive compensation  or  allowance  for  services  rendered  on  the committee, except, however, that members of a committee may be  reimbursed  by  the entity  or system for necessary expenses incurred in relation to service on a project advisory committee.  (d) For periods on and after April first, two thousand  fourteen,  the commissioner  shall  provide a report on a quarterly basis to the chairs of the senate finance,  assembly  ways  and  means,  senate  health  and assembly  health  committees  with  regard  to  the  status of the DSRIP program. Such reports shall be submitted no later than sixty days  after the close of the quarter, and shall include the most current information submitted  by  providers  to  the state and the federal CMS. The reports shall include:  (i) analysis of progress made toward DSRIP goals;  (ii) the impact on the state's health care delivery system;  (iii)  information  on  the  number  and  types   of   providers   who participate;  (iv)  plans  and  progress  for  monitoring  provider  compliance with requirements;  (v) a status update on project milestone progress;  (vi) information on project spending and budget;  (vii) analysis of impact on Medicaid beneficiaries served;  (viii) a summary of public engagement and public comments received;  (ix) a description of DSRIP funding applications that were denied;  (x) a  description  of  all  regulation  waivers  issued  pursuant  to paragraph (f) of this subdivision; and  (xi) a summary of the statewide geographic distribution of funds.  (e)  For  periods  on and after April first, two thousand fourteen the commissioner  shall  promptly  make  all  DSRIP   governing   documents, including   1115   waiver  standard  terms  and  conditions,  supporting attachments and detailed project descriptions, and  all  materials  made available   to  the  legislature  pursuant  to  paragraph  (d)  of  this subdivision, available on the  department's  website.  The  commissioner  shall  also  provide  a detailed overview on the department's website of the opportunities for public comment on the DSRIP program.  (f)  Notwithstanding  any  provision  of  law  to  the  contrary,  the commissioners of the department of health, the office of mental  health, the office for people with developmental disabilities, and the office of alcoholism  and  substance  abuse  services  are authorized to waive any regulatory requirements as are  necessary,  consistent  with  applicable law,  to  allow  applicants  under this subdivision and paragraph (a) of subdivision two of section  twenty-eight  hundred  twenty-five  of  this article  to avoid duplication of requirements and to allow the efficient implementation  of  the  proposed  project;  provided,   however,   that regulations  pertaining  to  patient safety may not be waived, nor shall any regulations be waived if such waiver would risk patient safety. Such waiver shall not exceed the life of the project  or  such  shorter  time periods  as  the  authorizing commissioner may determine. Any regulatory relief  granted  pursuant  to  this  subdivision  shall  be   described, including  each  regulation waived and the project it relates to, in the report provided pursuant to paragraph (d) of this subdivision.   * 20-a. Notwithstanding any provision of  law  to  the  contrary,  the commissioners  of the department of health, the office of mental health, the office of people with developmental disabilities, and the office  of alcoholism  and  substance  abuse  services  are authorized to waive any regulatory requirements as are  necessary,  consistent  with  applicable law,  to  allow  providers  that  are  involved  in  DSRIP  projects  or replication and scaling  activities,  as  approved  by  the  authorizing commissioner,  to  avoid  duplication  of  requirements and to allow the efficient scaling and  replication  of  DSRIP  promising  practices,  as determined  by  the  authorizing  commissioner;  provided  however, that regulations pertaining to  patient  safety,  patient  autonomy,  patient privacy,  patient  rights,  due process, scope of practice, professional licensure,    environmental    protections,    provider    reimbursement methodologies,  or occupational standards and employee rights may not be waived, nor shall any regulations be waived if such  waiver  would  risk patient  safety.  Any  regulatory action under this subdivision shall be published on the applicable website of the authorizing commissioner  and shall include a description of each waiver, including a citation of each regulation waived, and a description of the project of which such relief was granted.   * NB Expires April 1, 2022   21.  (a)  Notwithstanding any contrary provision of law and subject to the receipt of all necessary federal approvals and the  availability  of federal financial participation, the commissioner is authorized to enter into agreements with SUNY downstate medical center, other public general hospitals,  and/or  with  the sponsoring local governments of such other public general hospitals, under which such facilities and/or such  local government  shall,  by  intergovernmental transfer, fund the non-federal share of Medicaid funds made available for  implementation  of  Medicaid Redesign  Team  initiatives.  Such  non-federal  share payments shall be deemed voluntary and, further, such  payments  shall  be  excluded  from computations  made  pursuant  to  section  one  of  part  C  of  chapter fifty-eight of the laws of two thousand five, as amended.  In  addition, the   facilities,  and/or  the  sponsoring  local  governments  of  such facilities or the state  may,  by  written  notification  to  the  other parties to the agreement, cancel such agreement at any time prior to the payment of the Medicaid Redesign Team initiatives funds.  (b)  Applications  by  eligible  applicants for Medicaid Redesign Team initiatives funded by monies made available pursuant to paragraph (a) of this subdivision shall be submitted for review  to  the  advisory  panel  established  pursuant  to  paragraph  (b)  of subdivision twenty of this section and  such  panel  shall  submit  their  recommendations  to  the commissioner  for  final  determination.  For periods on and after April first, two thousand fourteen, the commissioner shall provide a report on a  quarterly  basis  to the majority leader of the New York state senate and to the speaker of the New York state assembly  with  regard  to  the status of such applications and approved projects. Such reports shall be submitted  no  later than sixty days after the close of the quarter, and shall include the most current information submitted  by  applicants  to the  state.  The reports shall be submitted in conjunction with and as a part of the reports submitted pursuant to paragraph (c)  of  subdivision twenty of this section and shall include:  (i) analysis of progress made toward project goals;  (ii) the impact on the state's health care delivery system;  (iii)   information   on   the  number  and  types  of  providers  who participate;  (iv) plans  and  progress  for  monitoring  provider  compliance  with requirements;  (v) a status update on project milestone progress;  (vi) information on project spending and budget;  (vii) analysis of impact on Medicaid beneficiaries served;  (viii) a summary of public engagement and public comments received;  (ix) a description of applications that were denied;  (x)  a  description  of  all  regulation  waivers  issued  pursuant to paragraph (e) of this subdivision; and  (xi) a summary of the statewide geographic distribution of funds.  (c) The commissioner shall  make  all  reports  prepared  pursuant  to paragraph  (b)  of  this  subdivision and all supporting attachments and materials available on the department's website.  (d) Notwithstanding any inconsistent law to the contrary, and  subject to  federal financial participation, and subject to amounts appropriated for purposes herein, the department may distribute funds  to  make  rate adjustments  for  health  home  providers  as described in section three hundred sixty-five-l of the social services law for  member  engagement, staff   training   and   retraining,   health   information   technology implementation, joint governance technical assistance,  and  other  such purposes  as the commissioner, in consultation with the commissioners of the office of mental health and the office of alcoholism  and  substance abuse services determines.  (e)  Notwithstanding  any  provisions  of  law  to  the  contrary, the commissioners of the department of health, the office of mental  health, the office for people with developmental disabilities, and the office of alcoholism  and  substance  abuse  services  are authorized to waive any regulatory requirements as are  necessary,  consistent  with  applicable law,  to  allow  applicants  under this subdivision and paragraph (a) of subdivision two of section  twenty-eight  hundred  twenty-five  of  this article  to avoid duplication of requirements and to allow the efficient implementation  of  the  proposed  project;  provided,   however,   that regulations  pertaining  to  patient safety may not be waived, not shall any regulation be waived if such waiver would risk patient safety.  Such waiver  shall  not  exceed  the life of the project or such shorter time period as the authorizing commissioner  any  determine.  Any  regulatory relief   granted  pursuant  to  this  subdivision  shall  be  described, including each regulation waived and the project it relates to,  in  the report provided pursuant to paragraph (b) of this subdivision.