New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter II - Administrative Rules and Regulations › Subchapter L - Hospitals and Related Facilities › Part 86 - Reporting and Rate Certifications for Facilities › Subpart 86-4 - Free-standing Ambulatory Care Facilities › Section 86-4.12 - Allowance for diagnostic and/or treatment centers providing a disproportionate share of bad debt and charity care

Current through Register Vol. 46, No. 28, July 10, 2024
(a) Basic rates of payment by governmental
					 agencies for voluntary nonprofit or publicly sponsored diagnostic and/or
					 treatment centers which provide a comprehensive range of primary health care
					 services and can demonstrate losses as a result of providing a disproportionate
					 share of bad debt and charity care shall include a bad debt and charity care
					 allowance. In addition, a diagnostic and/or treatment center which is approved
					 as a preferred primary care center may be eligible for a supplemental
					 allowance. 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 1993 or if later, the year
					 immediately preceding the year in which the diagnostic and/or treatment center
					 is first designated as a preferred primary care provider.
(b) The provisions of this section shall
					 apply to rates of payment for rate periods during the periods July 1, 1990
					 through March 31, 1991; April 1, 1991 through March 31, 1992, April 1, 1992
					 through March 31, 1993 and April 1, 1993 through September 30, 1994 and for
					 each fiscal year period commencing on October first thereafter for the
					 distribution of the bad debt and charity care allowance, ant to rates of
					 payment during the period January 1, 1994 through March 31, 1994 and each
					 fiscal year period commencing on April 1st thereafter for preferred primary
					 care providers who are eligible to receive a supplemental allowance.
(c) Eligibility shall be limited to voluntary
					 nonprofit and publicly sponsored diagnostic and/or treatment centers for the
					 initial distribution of bad debt and charity care allowance and to diagnostic
					 and/or treatment centers designated as preferred primary care providers for the
					 supplemental allowance which meet the following criteria:
(1) the facility must demonstrate that it is
					 licensed to provide primary medical care, must primarily provide a
					 comprehensive range of primary care and related support services;
(2) the facility must be able to demonstrate
					 on forms prescribed by the commissioner that a minimum of 15 percent of total
					 clinic threshold visits reported for the base year were eligible visits as
					 defined in paragraph (e)(2) of this section;
(3) the facility must be able to demonstrate
					 that it has made reasonable efforts to maintain financial support from
					 community and public funding sources;
(4) the facility must be able to demonstrate
					 that it has made reasonable efforts to collect payments for services from
					 third-party insurance payors, governmental payors and self-paying
					 patients;
(5) the facility must
					 receive an all-inclusive cost-based Medicaid reimbursement rate in accordance
					 with section
					 86-4.11  of this Subpart;
(6) the facility must have no petition for
					 bankruptcy filed under either chapter 7 or chapter 11 of title 11 of the U.S.
					 Code. The commissioner may waive this criteria if the facility demonstrates
					 that it is financially viable or a potentially financially viable organization
					 with a comprehensive plan to maintain fiscal integrity.