2023 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.
* (iii) (A) For purposes of this subparagraph:
(1)  "Children with medical fragility" shall mean an individual who is
under twenty-one years of age and has a chronic  debilitating  condition
or  conditions, who may or may not be hospitalized or institutionalized,
and  who  meets  one  or  more  of  the  following  criteria:   (I)   is
technology-dependent  for  life  or  health  sustaining  functions; (II)
requires  complex  medication  regimens  or  medical  interventions   to
maintain  or  to  improve  their  health  status; or (III) is in need of
ongoing assessment or intervention to prevent serious  deterioration  of

their  health  status  or  medical  complications that place their life,
health or development at risk.
(2)   "Pediatric  residential  health  care  facility"  shall  mean  a
free-standing facility or discrete unit within a facility authorized  by
the  commissioner  to provide extensive nursing, medical, psychological,
and counseling support services solely to  children  under  the  age  of
twenty-one.
(3)   "Pediatric   diagnostic  and  treatment  center"  shall  mean  a
diagnostic and treatment center established pursuant  to  this  article,
which   as   of   April   first,  two  thousand  twenty-four,  has  been
participating in the demonstration program authorized under  subdivision
one  of  section twenty-eight hundred eight-e of this article, for which
at  least  eighty  percent  of  its   total   Medicaid   fee-for-service
reimbursements  derive  from the provision of services to children under
the age of twenty-one with medical fragility and is  affiliated  with  a
pediatric residential health care facility.
(B)  (1) Notwithstanding any law, rule, or regulation to the contrary,
the commissioner shall establish rates of  reimbursement  for  pediatric
diagnostic  and  treatment centers for all services provided on or after
April first, two thousand twenty-four, to children eligible for  medical
assistance that reflect the costs necessary to provide care and services
to  children  with  medical  fragility  being  treated at such pediatric
diagnostic and treatment center.
(2) For the period April first, two thousand twenty-four, to  December
thirty-first,  two  thousand  twenty-four,  and  until  such  time  as a
certified annual cost report for such period is received and verified by
the department, the operating  component  of  such  rate  shall  reflect
budgeted  costs  for the period January first, two thousand twenty-four,
through December thirty-first, two thousand twenty-four, as submitted to
the department and adjusted as the commissioner deems appropriate.  Upon
submission and subsequent verification of the cost report, the operating
component of the rate shall be reflective of actual costs for the period
January  first, two thousand twenty-four, through December thirty-first,
two  thousand  twenty-four,  subject  to  further  adjustments  as   the
commissioner  deems  appropriate.  Thereafter,  the base period reported
operating costs used to establish rates pursuant  to  this  subparagraph
shall be updated no less frequently than every two years. In addition to
required   annual  cost  reports,  pediatric  diagnostic  and  treatment
centers, as defined by this subparagraph, shall submit  additional  data
as the commissioner requires.
(3)  Notwithstanding  any  law,  rule,  or regulation to the contrary,
pediatric diagnostic and  treatment  centers  shall  be  reimbursed  for
services provided to children enrolled in Medicaid managed care plans at
the rates of reimbursement promulgated pursuant to this subparagraph.
(4)  The  capital component of the rate shall reflect actual base year
costs.
(5) All rates established under this subparagraph shall be subject  to
the availability of federal financial participation.
(6)  The  commissioner  may  promulgate  or  amend  regulations as the
commissioner determines appropriate and necessary to establish the rates
provided for in this subparagraph and/or exempt pediatric diagnostic and
treatment  centers  from  the  ambulatory  payment  group  reimbursement
methodology applicable to diagnostic and treatment centers.
* NB Repealed April 1, 2027
(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, 2026
(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),  (r),  and  (ll)  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) services provided by  licensed  social  workers,  licensed  mental
health  counselors,  and  licensed  marriage  and  family therapists, in
accordance with licensing criteria set forth in applicable  regulations;
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, 2026
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.