2023 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-two,
shall be one billion forty-five million dollars.
(xvi)  A  gross  annual statewide amount for the period January first,
two  thousand  twenty-three  to  December  thirty-first,  two   thousand
twenty-six  shall  be  one  billion  eighty-five  million dollars, forty
million dollars annually of  which  shall  be  allocated  under  section
twenty-eight hundred seven-o of this article among the municipalities of
and  the  state  of  New York based on each municipality's share and the
state's  share  of   early   intervention   program   expenditures   not
reimbursable  by  the  medical  assistance program for the latest twelve
month period for which such data is available.
(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.
(g) A further gross statewide amount for the  state  fiscal  year  two
thousand twenty-two shall be forty million dollars.
(h) The amount specified in paragraph (g) of this subdivision shall be
allocated  under  section  twenty-eight  hundred seven-o of this article
among the municipalities and  the  state  of  New  York  based  on  each
municipality's share and the state's share of early intervention program
expenditures  not reimbursable by the medical assistance program for the
latest twelve month period for which such data is 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-six;
(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.
(d)  funds  shall  be added to the funds collected by the commissioner
for distribution in accordance with section twenty-eight hundred seven-o
of this article, in the following amount: forty million dollars for  the
period  beginning  April  first, two thousand twenty-two, and continuing
each state fiscal year thereafter.
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, 2026