New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter N - Professional Medical And Dental Services › Part 91 - Excess Liability Insurance Pool: Physicians And Dentists › Section 91.3 - Determination of cost and reimbursement of excess medical malpractice coverage

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Based on the
				  certification by general hospitals pursuant to section
				  91.2  of
				  this Part of physicians and dentists eligible for excess coverage or equivalent
				  excess coverage, the Superintendent of Insurance shall determine and certify to
				  each general hospital and to the Commissioner of Health, and may amend such
				  determination and certification as necessary, the cost of excess malpractice
				  insurance or equivalent excess insurance, including an allocable share of pool
				  administration costs, for medical and dental malpractice occurrences between
				  July 1, 1986 and June 30, 1987, July 1, 1987 through December 31, 1987, and
				  semi-annual periods beginning July 1st and January 1st, thereafter.
(b)
(1) The
				  Commissioner of Health or his designee shall adjust the established inpatient
				  rates of each general hospital (for rate periods during the periods July 1,
				  1986 through June 30, 1987, and annual periods beginning July 1st, thereafter,
				  excluding rates of payment for State governmental agencies for rate periods
				  during the period July 1, 1991 through June 30, 1992 and annual periods
				  beginning July 1st, thereafter) proportionally, based upon the allocation of
				  the general hospital's inpatient malpractice costs among rate payors and
				  general hospital charge payors used in determining inpatient rates of payment
				  and charges for 1986; and each annual period thereafter, for such general
				  hospital pursuant to Subpart 86-1 of this Title, to reflect the cost of excess
				  insurance coverage or equivalent excess coverage allocated to such general
				  hospital pursuant to subdivision (a) of this section for such rate periods, and
				  shall adjust the determination of the general hospital's maximum inpatient
				  charges. The Commissioner of Health shall further adjust such rates of payment
				  (excluding rates applicable to State governmental agencies as of July 1, 1991)
				  to reflect significant changes in volume of service. The adjustment shall be
				  made for the periods July 1, 1986 to June 30, 1987, and semi-annual periods
				  beginning July 1st and January 1st, thereafter, and shall not be carried
				  forward.
(2) In the event that
				  rates of payment for persons eligible for payment pursuant to title XVIII of
				  the Federal Social Security Act (Medicare) do not include the portion of such
				  cost allocable to such patients, such portion of the cost shall for purposes of
				  further adjustment be reallocated among payors whose rates of payment or
				  charges are determined in accordance with Subpart 86- 1 of this Title and rates
				  of payment for such payors (excluding rates applicable to State governmental
				  agencies as of July 1, 1991) shall be adjusted proportionally based upon the
				  allocation of general hospital malpractice costs among such payors used in
				  determining inpatient rates of payment and charges for 1986, and each
				  respective annual rate period thereafter, for such general hospital pursuant to
				  Subpart 86-1 of this Title and the determination of the general hospital's
				  maximum inpatient charges shall be adjusted so that the costs of such excess
				  insurance coverage or equivalent excess coverage excluding costs allocated or
				  reallocated to rates applicable to State governmental agencies for periods on
				  and after July 1, 1991, are fully reflected in hospital inpatient rates of
				  reimbursement and maximum charges; provided, however, that if a general
				  hospital's inpatient malpractice cost is allocated entirely to title XVIII of
				  the Federal Social Security Act (Medicare) in determining rates and charges for
				  1986, and each respective annual rate period thereafter, in accordance with
				  Subpart 86-1 of this Title, (excluding rates applicable to State governmental
				  agencies on and after July 1, 1991) for purposes of further adjustment the cost
				  of excess insurance coverage or equivalent excess coverage shall be reallocated
				  among payors whose rates of payment or charges are determined in accordance
				  with Subpart 86-1 of this Title based upon the statewide average general
				  hospital malpractice cost allocation among such payors in each rate period.
				  Such adjustments shall be made for the periods July 1, 1986 through June 30,
				  1987, and semi-annual periods beginning July 1st and January 1st, thereafter,
				  and shall not be carried forward.