NY Pub Health L § 2807-S (2021)
2021 New York Laws PBH - Public Health Article 28 - Hospitals 2807-S - Professional Education Pool Funding.

* §  2807-s.  Professional  education pool funding. 1. (a) Payments to general hospitals by all specified third-party  payors,  as  defined  in paragraph (b) of subdivision one-a of this section, making payments on a rate,  charge, negotiated payment, or other basis for inpatient hospital services provided to persons  who  are  not  eligible  for  payments  as beneficiaries  of  title  XVIII  of  the  federal  social  security  act (medicare) or eligible for medical assistance pursuant to  title  eleven of  article  five  of  the  social  services law (including enrollees in medicaid managed care programs) or eligible for the family  health  plus program  pursuant  to  title  eleven-D  of  article  five  of the social services law, and related payments of patient deductible and coinsurance amounts and of secondary third-party payors, shall include  a  surcharge for  a  regional  allowance  on  inpatient  hospital net patient service revenues in the percentage amount  and  for  the  periods  specified  in subdivision  two  of this section. Any such allowance shall be submitted by general hospitals to the commissioner or the commissioner's  designee in accordance with subdivision five of this section.  (b)  The  allowance  established pursuant to this section shall not be applicable to specified third-party payors filing an election and making payments  to  the  commissioner  or  the  commissioner's   designee   in accordance with section twenty-eight hundred-seven-t of this article and pursuant  to  paragraph  (a) of subdivision five of section twenty-eight hundred seven-j of this article, nor  to  related  payments  of  patient deductible and coinsurance amounts and of secondary third-party payors.   1-a.  Definitions.  (a)  "Third-party  coverage", for purposes of this section and section twenty-eight hundred seven-t of this article,  shall include  payments  by  a  specified third-party payor making payments on behalf of a patient; whether made directly  to  a  general  hospital  or indirectly  as  indemnity  or  similar  payments made to the patient (or patient's representative such as parent or family member) for  inpatient hospital  services provided by a general hospital, or through the use of payments made payable to both the general hospital and  the  patient  or patient's representative, or similar devices.  (b)  "Specified  third-party payors", for purposes of this section and sections twenty-eight hundred seven-j and twenty-eight  hundred  seven-t of  this  article, shall include corporations organized and operating in accordance with article forty-three of the insurance law,  organizations operating  in  accordance  with  the provisions of article forty-four of this chapter, self-insured funds and administrators acting on behalf  of self-insured funds, and commercial insurers authorized to write accident and  health  insurance  and whose policy provides coverage on an expense incurred basis. Specified  third-party  payors,  for  purposes  of  this section,  shall  not  include  governmental  agencies  or  providers  of coverage  pursuant  to  the  comprehensive   motor   vehicle   insurance reparations   act,   the   workers'   compensation  law,  the  volunteer firefighters' benefit law, or the volunteer ambulance  workers'  benefit law.  (c)  "Regions",  for purposes of this section and section twenty-eight hundred seven-t of this article shall mean the  regions  as  defined  in paragraph  (b)  of  subdivision  sixteen of section twenty-eight hundred seven-c of this article as in effect on June thirtieth, nineteen hundred ninety-six.   2. (a) The regional percentage allowance for  any  period  during  the period  January  first,  nineteen  hundred ninety-seven through December thirty-first, nineteen hundred ninety-nine for all general hospitals  in the  region  applicable to a specified third-party payor, and applicable to related patient coinsurance and deductible amounts and  to  secondary third-party  payors  under coordination of benefits principles, shall be  the following, and shall be applied to inpatient  hospital  net  patient service revenues:  (b) the result expressed as a percentage of:  (i)  for each region, the amount allocated to the region in accordance with subdivision six of this section, divided by  (ii) the total estimated nineteen hundred ninety-six general  hospital inpatient  revenue of all general hospitals in the region, excluding (A) an estimate of revenue from services provided to beneficiaries of  title XVIII  of the federal social security act (medicare), (B) an estimate of revenue from services provided to  patients  eligible  for  payments  by governmental  agencies,  patients  eligible for payments pursuant to the comprehensive motor vehicle  insurance  reparations  act,  the  workers' compensation  law,  the  volunteer  firefighters'  benefit  law, and the volunteer ambulance workers' benefit law,  and  self-pay  patients,  (C) from  general  hospitals  providing  graduate  medical  education in the aggregate an amount equal to the amount specified in subparagraph (i) of this subdivision, other than the components of such amount allocable  to payors specified in clause (B) of this subparagraph, and (D) an estimate of  revenue  reductions  related to negotiated reimbursement in nineteen hundred ninety-seven with specified third-party payors which shall be  a uniform statewide percentage estimated reduction.  (c)  (i)  The  regional  percentage  allowance for the periods January first, two thousand through June thirtieth, two thousand three, for  all general  hospitals  in  the  region  applicable to specified third-party payors, and applicable to related  patient  coinsurance  and  deductible amounts,  shall  be  the  same  regional percentage allowance calculated pursuant to paragraph (b) of this subdivision  for  the  period  January first,  nineteen  hundred  ninety-nine  through  December  thirty-first, nineteen hundred ninety-nine.  (ii) The regional percentage allowance for the periods July first, two thousand three through December thirty-first, two thousand five, for all general hospitals in the  region  applicable  to  specified  third-party payors,  and  applicable  to  related patient coinsurance and deductible amounts, shall be the  same  regional  percentage  allowance  calculated pursuant  to  paragraph  (b)  of this subdivision for the period January first,  nineteen  hundred  ninety-nine  through  December  thirty-first, nineteen  hundred  ninety-nine  multiplied  by  one  hundred  eight  and nineteen hundredths percent.  (iii) The regional percentage allowance for the periods January first, two thousand six through June thirtieth, two  thousand  seven,  for  all general  hospitals  in  the  region  applicable to specified third-party payors, and applicable to related  patient  coinsurance  and  deductible amounts,  shall  be  the  same  regional percentage allowance calculated pursuant to subparagraph (ii) of this paragraph for the  period  January first,  two  thousand  five  through December thirty-first, two thousand five multiplied by one hundred one and thirteen hundredths percent.  (iv) The regional percentage allowance for periods on and  after  July first,  two  thousand  seven,  for  all  general hospitals in the region applicable to specified third-party payors, and  applicable  to  related patient  coinsurance  and deductible amounts, shall be the same regional percentage allowance calculated pursuant to subparagraph (iii)  of  this paragraph  for  the  period January first, two thousand six through June thirtieth, two thousand seven.   3. Inpatient hospital net patient service revenues,  for  purposes  of this  section,  shall mean for general hospitals all moneys received for or on account of inpatient hospital services provided  to  persons  with third-party  coverage  from  a  specified  third-party  payor, including capitation payments  allocable  to  inpatient  hospital  services,  less  refunds,  for  patients  discharged  or  contracted  hospital  inpatient service obligations for periods on  or  after  January  first,  nineteen hundred  ninety-seven  excluding the following subject to the provisions of subdivision eight of this section:  (a)   revenue   received  from  the  allowances  pursuant  to  section twenty-eight hundred seven-j of this article and this section; and  (b) revenue received from physician practice or faculty practice  plan discrete billings for private practicing physician services.   4.  (a)  For  periods  prior  to January first, two thousand five, the commissioner is authorized to  contract  with  the  article  forty-three insurance law plans, or such other contractors as the commissioner shall designate,   to   receive  and  distribute  funds  from  the  allowances established pursuant to this section  and  funds  from  the  assessments established  pursuant  to  section  twenty-eight hundred seven-t of this article. In the event contracts with the article  forty-three  insurance law  plans  or  other  commissioner's  designees  are  effectuated,  the commissioner shall conduct annual audits of the receipt and distribution of the funds. The reasonable costs and expenses of an  administrator  as approved by the commissioner, not to exceed for personnel services on an annual  basis  eight  hundred  fifty thousand dollars for collection and distribution of allowances established  pursuant  to  this  section  and assessments   established  pursuant  to  this  section  and  assessments established pursuant to section twenty-eight  hundred  seven-t  of  this article shall be paid from the allowance and assessment funds.  (b)  Notwithstanding any inconsistent provision of section one hundred twelve or one hundred sixty-three of the state finance law or any  other law,  at the discretion of the commissioner without a competitive bid or request for proposal process, contracts in effect for administration  of bad  debt  and charity care pools for the period January first, nineteen hundred ninety-six through June thirtieth, nineteen  hundred  ninety-six pursuant  to section twenty-eight hundred seven-c of this article may be extended to provide for administration pursuant  to  this  section,  and section  twenty-eight hundred seven-t of this article and may be amended as may be necessary.   5. Funds due  by  a  general  hospital  to  the  commissioner  or  the commissioner's  designee  from  the  allowance  pursuant to this section shall be due and shall be  collected  under  the  terms  and  conditions provided  for  payment  and collection of allowances pursuant to section twenty-eight hundred seven-j of this article.   6. The amount allocated to each region for purposes of calculating the regional allowance percentage pursuant to this  section  for  each  year during  the  period January first, nineteen hundred ninety-seven through December thirty-first, nineteen hundred  ninety-nine  and  the  regional assessments  pursuant  to  section  twenty-eight hundred seven-t of this article for each year during the period January first, nineteen  hundred ninety-seven through December thirty-first, nineteen hundred ninety-nine and for each year on and after January first, two thousand, shall be the sum  of  the  factors  computed  in  paragraphs (b), (d) and (f) of this subdivision, if such factors are applicable to a given year, as follows:  (a)  (i)  A  gross  annual  statewide  amount  for  nineteen   hundred ninety-seven shall be five hundred eighty-nine million dollars.  (ii) A gross annual statewide amount for nineteen hundred ninety-eight shall be five hundred eighty-nine million dollars.  (iii) A gross annual statewide amount for nineteen hundred ninety-nine shall be five hundred eighty-nine million dollars.  (iv)  A  gross  annual statewide amount for two thousand shall be five hundred eighty-nine million dollars.  (v) A gross annual statewide amount for two thousand one shall be five hundred sixty-nine million dollars.  (vi)  A  gross  annual  statewide amount for two thousand two shall be five hundred eighty-nine million dollars.  (vii) A gross annual statewide amount for two thousand three shall  be five hundred eighty-nine million dollars.  (viii)  A  gross annual statewide amount for two thousand four and two thousand five shall be six hundred twenty-four million dollars.  (ix) A gross annual statewide amount for two thousand six shall be six hundred seventy-four million dollars.  (x) A gross  statewide  amount  for  the  period  January  first,  two thousand  seven  through March thirty-first, two thousand seven shall be one hundred sixty-eight million five hundred thousand dollars,  and  for the   period   April   first,   two   thousand  seven  through  December thirty-first, two thousand seven shall be five hundred sixty-one million seven hundred fifty thousand dollars.  (xi) A gross statewide  amount  for  the  period  January  first,  two thousand  eight through March thirty-first, two thousand eight, shall be one hundred eighty-seven million two hundred fifty thousand dollars.  (xii) A gross  statewide  amount  for  the  period  April  first,  two thousand  eight through December thirty-first, two thousand eight, shall be five hundred sixty-one million seven hundred fifty thousand dollars.  (xiii) A gross statewide amount for  the  period  October  first,  two thousand  eight  through March thirty-first, two thousand nine, shall be one hundred seventy-four million  two  hundred  thousand  dollars.  Such amount shall be separately reported and paid in six monthly installments by  the tenth day of each month from October two thousand eight to March two thousand nine. Such reports and payments must initially be based  on each  payers' monthly enrollment count for the preceding month and shall be reconciled on a month to month basis to reflect  the  actual  monthly enrollment counts for the applicable month.  (xiv)  A  gross  annual statewide amount for the period January first, two thousand nine through December thirty-first, two thousand  fourteen, shall be nine hundred forty-four million dollars.  (xv) A gross annual statewide amount for the period January first, two thousand   fifteen   through   December   thirty-first,   two   thousand twenty-three, shall be one billion forty-five million dollars.  (b) The amount specified in paragraph (a) of this subdivision shall be allocated among the regions based on each region's proportional share of the sum of the estimated revenue of all general hospitals in the region, excluding revenue related to services provided to beneficiaries of title XVIII of the federal social security  act  (medicare),  related  to  one hundred  percent of the direct medical education expenses and fifty-nine and five-tenths percent of indirect medical education expenses reflected in general hospital inpatient  revenue  compared  to  the  sum  of  such amounts  for all regions, based on estimated nineteen hundred ninety-six data and statistics, excluding an  estimate  of  revenue  from  services provided  to  patients  eligible  for payments by governmental agencies, patients eligible for  payments  pursuant  to  the  comprehensive  motor vehicle  insurance  reparations  act, the workers' compensation law, the volunteer  firefighters'  benefit  law,  and  the  volunteer   ambulance workers' benefit law, and self-pay patients.  (c)  (i)  A further gross annual statewide amount for nineteen hundred ninety-seven shall be sixty-four million dollars.  (ii) A further gross annual  statewide  amount  for  nineteen  hundred ninety-eight shall be sixty-four million dollars.  (iii)  A  further  gross  annual statewide amount for nineteen hundred ninety-nine shall be eighty-nine million dollars.  (iv) A further gross annual statewide amount  for  two  thousand,  two thousand  one,  two thousand two, two thousand three, two thousand four, two thousand five, two thousand six, two thousand  seven,  two  thousand eight,  two  thousand  nine,  two thousand ten, two thousand eleven, two thousand  twelve  and two thousand thirteen shall be eighty-nine million dollars.  (v) A further gross annual statewide amount  for  the  period  January first, two thousand fourteen through December thirty-first, two thousand fourteen, shall be eighty-nine million dollars.  (d)  For  each  year,  the  amount  specified in paragraph (c) of this subdivision shall be allocated among  the  regions  based  on  the  same regional   percentage  allocations  as  determined  in  accordance  with paragraph (b) of this subdivision.  (e) A further gross annual statewide amount shall  be  twelve  million dollars for each period prior to January first, two thousand fifteen.  (f)  For  each  year,  the  amount  specified in paragraph (e) of this subdivision shall be allocated among the regions based on each  region's allocated share of the AIDS drug assistance program expenditures for the latest annual period for which such data are available.   7.  Funds  accumulated, including income from invested funds, from the allowances specified in this section and  the  assessments  pursuant  to section twenty-eight hundred seven-t of this article, including interest and   penalties,   shall   be  deposited  by  the  commissioner  or  the commissioner's designee as follows:  (a) funds shall be  accumulated  in  regional  professional  education pools  established  by  the  commissioner  or  the healthcare reform act (HCRA) resources fund established pursuant to section  ninety-two-dd  of the  state  finance  law,  whichever  is applicable, for distribution in accordance with section twenty-eight hundred seven-m of this article, in the following amounts:  (i)  ninety-two  and  forty-five-hundredths  percent  of   the   funds accumulated  less  seventy-six  million  dollars  for the period January first, nineteen  hundred  ninety-seven  through  December  thirty-first, nineteen hundred ninety-seven,  (ii)   ninety-two  and  forty-five-hundredths  percent  of  the  funds accumulated less seventy-six million  dollars  for  the  period  January first,  nineteen  hundred  ninety-eight  through  December thirty-first, nineteen hundred ninety-eight,  (iii)  ninety-two  and  forty-five-hundredths  percent  of  the  funds accumulated  less one hundred one million dollars for the period January first,  nineteen  hundred  ninety-nine  through  December  thirty-first, nineteen hundred ninety-nine,  (iv)  four  hundred ninety-four million dollars on an annual basis for the periods January first, two thousand through  December  thirty-first, two thousand three,  (v)  four  hundred  sixty-three million dollars for the period January first, two thousand four through  December  thirty-first,  two  thousand four,  (vi)  four hundred eighty-eight million dollars for the period January first, two thousand five through  December  thirty-first,  two  thousand five,  (vii)  four hundred ninety-four million dollars for the period January first, two thousand six through December thirty-first, two thousand six,  (viii) four hundred seventy million dollars  for  the  period  January first,  two  thousand  seven through December thirty-first, two thousand seven,  (ix) four hundred forty-six million six hundred thousand  dollars  for the   period   January   first,  two  thousand  eight  through  December thirty-first, two thousand eight,  (x)  forty-seven million two hundred ten thousand dollars on an annual basis for the periods January first, two thousand nine through  December thirty-first, two thousand ten;  (xi)  eleven  million  eight  hundred  thousand dollars for the period January first, two  thousand  eleven  through  March  thirty-first,  two thousand eleven;  (xii)  twenty-three  million eight hundred thirty-six thousand dollars for  the  period  April  first,  two  thousand  eleven   through   March thirty-first, two thousand twelve;  (xiii)  twenty-three million eight hundred thirty-six thousand dollars each state fiscal year for the period April first, two  thousand  twelve through March thirty-first, two thousand twenty-three;  (xiv)  provided,  however,  for  periods  prior  to January first, two thousand nine, amounts set forth in this paragraph may be reduced by the commissioner in an amount to be approved by the director of  the  budget to  reflect  the  amount  received from the federal government under the state's 1115 waiver which is directed under its terms and conditions  to the  graduate  medical education program established pursuant to section twenty-eight hundred seven-m of this article;  (xv) provided further, however, for periods prior to July  first,  two thousand  nine,  amounts set forth in this paragraph shall be reduced by an amount equal to the total  actual  distribution  reductions  for  all facilities  pursuant  to  paragraph  (e) of subdivision three of section twenty-eight hundred seven-m of this article; and  (xvi) provided further, however, for periods prior to July first,  two thousand  nine,  amounts set forth in this paragraph shall be reduced by an amount equal to the actual distribution reductions for all facilities pursuant to paragraph (s) of subdivision  one  of  section  twenty-eight hundred seven-m of this article.  (b)  funds  shall  be added to the funds collected by the commissioner for distribution in accordance with section twenty-eight hundred seven-j of this article, in the following amounts:  (i) seven and fifty-five-hundredths percent of the  funds  accumulated less  seventy-six million dollars for the period January first, nineteen hundred ninety-seven through  December  thirty-first,  nineteen  hundred ninety-seven,  (ii)  seven and fifty-five-hundredths percent of the funds accumulated less seventy-six million dollars for the period January first,  nineteen hundred  ninety-eight  through  December  thirty-first, nineteen hundred ninety-eight,  (iii) seven and fifty-five-hundredths percent of the funds accumulated less one hundred one million  dollars  for  the  period  January  first, nineteen  hundred  ninety-nine  through  December thirty-first, nineteen hundred ninety-nine,  (iv) the remaining balance of the funds accumulated for each period on and after January first, two thousand; and  (c) further funds shall  be  added  to  the  funds  collected  by  the commissioner  for  distribution  in accordance with section twenty-eight hundred seven-j of this article:  (i) for the nineteen hundred ninety-seven period, seventy-six  million dollars;  (ii) for the nineteen hundred ninety-eight period, seventy-six million dollars; and  (iii)  for  the  nineteen  hundred ninety-nine period, one hundred one million dollars.    8. Each exclusion from the allowances effective on  or  after  January first,  nineteen  hundred  ninety-seven  established  pursuant  to  this section shall be  contingent  upon  either:  (a)  qualification  of  the allowances  for  waiver  pursuant  to federal law and regulation; or (b) consistent  with  federal  law and regulation, not requiring a waiver by the secretary of the department of health and human services related  to such  exclusion;  in  order  for the allowances under this section to be qualified as a broad-based health care related tax for purposes  of  the revenues  received  by the state pursuant to the allowances not reducing the amount expended by the state as medical assistance for  purposes  of federal  financial  participation.  The  commissioner  shall collect the allowances relying on such exclusions, pending any  contrary  action  by the  secretary  of  the  department of health and human services. In the event the secretary of the  department  of  health  and  human  services determines  that  the  allowances  do  not  so qualify based on any such exclusion, then the exclusion shall be deemed to have been null and void as of January first, nineteen hundred ninety-seven, and the commissioner shall collect any retroactive amount due as a result,  without  interest or penalty provided the general hospital pays the retroactive amount due within  ninety  days  of  notice  from  the  commissioner to the general hospital that an exclusion is null  and  void.  Interest  and  penalties shall be measured from the due date of ninety days following notice from the commissioner or the commissioner's designee to the general hospital.   9.  Revenue  from the allowances pursuant to this section shall not be included in gross revenue  received  for  purposes  of  the  assessments pursuant to subdivision eighteen of section twenty-eight hundred seven-c of  this  article,  subject  to  the  provisions  of  paragraph  (e)  of subdivision eighteen of section twenty-eight  hundred  seven-c  of  this article,  and  shall  not  be  included  in  gross  revenue received for purposes of the assessments pursuant  to  section  twenty-eight  hundred seven-d of this article, subject to the provisions of subdivision twelve of section twenty-eight hundred seven-d of this article.   * NB Expires December 31, 2023