N.Y. Public Health Law § 2807-s: Professional education pool funding

* § 2807-s. Professional education pool funding. 1. (a) Payments to

general hospitals by all specified third-party payors, as defined in

paragraph (b) of subdivision one-a of this section, making payments on a

rate, charge, negotiated payment, or other basis for inpatient hospital

services provided to persons who are not eligible for payments as

beneficiaries of title XVIII of the federal social security act

(medicare) or eligible for medical assistance pursuant to title eleven

of article five of the social services law (including enrollees in

medicaid managed care programs) or eligible for the family health plus

program pursuant to title eleven-D of article five of the social

services law, and related payments of patient deductible and coinsurance

amounts and of secondary third-party payors, shall include a surcharge

for a regional allowance on inpatient hospital net patient service

revenues in the percentage amount and for the periods specified in

subdivision two of this section. Any such allowance shall be submitted

by general hospitals to the commissioner or the commissioner's designee

in accordance with subdivision five of this section.

(b) The allowance established pursuant to this section shall not be

applicable to specified third-party payors filing an election and making

payments to the commissioner or the commissioner's designee in

accordance with section twenty-eight hundred-seven-t of this article and

pursuant to paragraph (a) of subdivision five of section twenty-eight

hundred seven-j of this article, nor to related payments of patient

deductible and coinsurance amounts and of secondary third-party payors.

1-a. Definitions. (a) "Third-party coverage", for purposes of this

section and section twenty-eight hundred seven-t of this article, shall

include payments by a specified third-party payor making payments on

behalf of a patient; whether made directly to a general hospital or

indirectly as indemnity or similar payments made to the patient (or

patient's representative such as parent or family member) for inpatient

hospital services provided by a general hospital, or through the use of

payments made payable to both the general hospital and the patient or

patient's representative, or similar devices.

(b) "Specified third-party payors", for purposes of this section and

sections twenty-eight hundred seven-j and twenty-eight hundred seven-t

of this article, shall include corporations organized and operating in

accordance with article forty-three of the insurance law, organizations

operating in accordance with the provisions of article forty-four of

this chapter, self-insured funds and administrators acting on behalf of

self-insured funds, and commercial insurers authorized to write accident

and health insurance and whose policy provides coverage on an expense

incurred basis. Specified third-party payors, for purposes of this

section, shall not include governmental agencies or providers of

coverage pursuant to the comprehensive motor vehicle insurance

reparations act, the workers' compensation law, the volunteer

firefighters' benefit law, or the volunteer ambulance workers' benefit

law.

(c) "Regions", for purposes of this section and section twenty-eight

hundred seven-t of this article shall mean the regions as defined in

paragraph (b) of subdivision sixteen of section twenty-eight hundred

seven-c of this article as in effect on June thirtieth, nineteen hundred

ninety-six.

2. (a) The regional percentage allowance for any period during the

period January first, nineteen hundred ninety-seven through December

thirty-first, nineteen hundred ninety-nine for all general hospitals in

the region applicable to a specified third-party payor, and applicable

to related patient coinsurance and deductible amounts and to secondary

third-party payors under coordination of benefits principles, shall be

the following, and shall be applied to inpatient hospital net patient

service revenues:

(b) the result expressed as a percentage of:

(i) for each region, the amount allocated to the region in accordance

with subdivision six of this section, divided by

(ii) the total estimated nineteen hundred ninety-six general hospital

inpatient revenue of all general hospitals in the region, excluding (A)

an estimate of revenue from services provided to beneficiaries of title

XVIII of the federal social security act (medicare), (B) an estimate of

revenue from services provided to patients eligible for payments by

governmental agencies, patients eligible for payments pursuant to the

comprehensive motor vehicle insurance reparations act, the workers'

compensation law, the volunteer firefighters' benefit law, and the

volunteer ambulance workers' benefit law, and self-pay patients, (C)

from general hospitals providing graduate medical education in the

aggregate an amount equal to the amount specified in subparagraph (i) of

this subdivision, other than the components of such amount allocable to

payors specified in clause (B) of this subparagraph, and (D) an estimate

of revenue reductions related to negotiated reimbursement in nineteen

hundred ninety-seven with specified third-party payors which shall be a

uniform statewide percentage estimated reduction.

(c) (i) The regional percentage allowance for the periods January

first, two thousand through June thirtieth, two thousand three, for all

general hospitals in the region applicable to specified third-party

payors, and applicable to related patient coinsurance and deductible

amounts, shall be the same regional percentage allowance calculated

pursuant to paragraph (b) of this subdivision for the period January

first, nineteen hundred ninety-nine through December thirty-first,

nineteen hundred ninety-nine.

(ii) The regional percentage allowance for the periods July first, two

thousand three through December thirty-first, two thousand five, for all

general hospitals in the region applicable to specified third-party

payors, and applicable to related patient coinsurance and deductible

amounts, shall be the same regional percentage allowance calculated

pursuant to paragraph (b) of this subdivision for the period January

first, nineteen hundred ninety-nine through December thirty-first,

nineteen hundred ninety-nine multiplied by one hundred eight and

nineteen hundredths percent.

(iii) The regional percentage allowance for the periods January first,

two thousand six through June thirtieth, two thousand seven, for all

general hospitals in the region applicable to specified third-party

payors, and applicable to related patient coinsurance and deductible

amounts, shall be the same regional percentage allowance calculated

pursuant to subparagraph (ii) of this paragraph for the period January

first, two thousand five through December thirty-first, two thousand

five multiplied by one hundred one and thirteen hundredths percent.

(iv) The regional percentage allowance for periods on and after July

first, two thousand seven, for all general hospitals in the region

applicable to specified third-party payors, and applicable to related

patient coinsurance and deductible amounts, shall be the same regional

percentage allowance calculated pursuant to subparagraph (iii) of this

paragraph for the period January first, two thousand six through June

thirtieth, two thousand seven.

3. Inpatient hospital net patient service revenues, for purposes of

this section, shall mean for general hospitals all moneys received for

or on account of inpatient hospital services provided to persons with

third-party coverage from a specified third-party payor, including

capitation payments allocable to inpatient hospital services, less

refunds, for patients discharged or contracted hospital inpatient

service obligations for periods on or after January first, nineteen

hundred ninety-seven excluding the following subject to the provisions

of subdivision eight of this section:

(a) revenue received from the allowances pursuant to section

twenty-eight hundred seven-j of this article and this section; and

(b) revenue received from physician practice or faculty practice plan

discrete billings for private practicing physician services.

4. (a) For periods prior to January first, two thousand five, the

commissioner is authorized to contract with the article forty-three

insurance law plans, or such other contractors as the commissioner shall

designate, to receive and distribute funds from the allowances

established pursuant to this section and funds from the assessments

established pursuant to section twenty-eight hundred seven-t of this

article. In the event contracts with the article forty-three insurance

law plans or other commissioner's designees are effectuated, the

commissioner shall conduct annual audits of the receipt and distribution

of the funds. The reasonable costs and expenses of an administrator as

approved by the commissioner, not to exceed for personnel services on an

annual basis eight hundred fifty thousand dollars for collection and

distribution of allowances established pursuant to this section and

assessments established pursuant to this section and assessments

established pursuant to section twenty-eight hundred seven-t of this

article shall be paid from the allowance and assessment funds.

(b) Notwithstanding any inconsistent provision of section one hundred

twelve or one hundred sixty-three of the state finance law or any other

law, at the discretion of the commissioner without a competitive bid or

request for proposal process, contracts in effect for administration of

bad debt and charity care pools for the period January first, nineteen

hundred ninety-six through June thirtieth, nineteen hundred ninety-six

pursuant to section twenty-eight hundred seven-c of this article may be

extended to provide for administration pursuant to this section, and

section twenty-eight hundred seven-t of this article and may be amended

as may be necessary.

5. Funds due by a general hospital to the commissioner or the

commissioner's designee from the allowance pursuant to this section

shall be due and shall be collected under the terms and conditions

provided for payment and collection of allowances pursuant to section

twenty-eight hundred seven-j of this article.

6. The amount allocated to each region for purposes of calculating the

regional allowance percentage pursuant to this section for each year

during the period January first, nineteen hundred ninety-seven through

December thirty-first, nineteen hundred ninety-nine and the regional

assessments pursuant to section twenty-eight hundred seven-t of this

article for each year during the period January first, nineteen hundred

ninety-seven through December thirty-first, nineteen hundred ninety-nine

and for each year on and after January first, two thousand, shall be the

sum of the factors computed in paragraphs (b), (d) and (f) of this

subdivision, if such factors are applicable to a given year, as follows:

(a) (i) A gross annual statewide amount for nineteen hundred

ninety-seven shall be five hundred eighty-nine million dollars.

(ii) A gross annual statewide amount for nineteen hundred ninety-eight

shall be five hundred eighty-nine million dollars.

(iii) A gross annual statewide amount for nineteen hundred ninety-nine

shall be five hundred eighty-nine million dollars.

(iv) A gross annual statewide amount for two thousand shall be five

hundred eighty-nine million dollars.

(v) A gross annual statewide amount for two thousand one shall be five

hundred sixty-nine million dollars.

(vi) A gross annual statewide amount for two thousand two shall be

five hundred eighty-nine million dollars.

(vii) A gross annual statewide amount for two thousand three shall be

five hundred eighty-nine million dollars.

(viii) A gross annual statewide amount for two thousand four and two

thousand five shall be six hundred twenty-four million dollars.

(ix) A gross annual statewide amount for two thousand six shall be six

hundred seventy-four million dollars.

(x) A gross statewide amount for the period January first, two

thousand seven through March thirty-first, two thousand seven shall be

one hundred sixty-eight million five hundred thousand dollars, and for

the period April first, two thousand seven through December

thirty-first, two thousand seven shall be five hundred sixty-one million

seven hundred fifty thousand dollars.

(xi) A gross statewide amount for the period January first, two

thousand eight through March thirty-first, two thousand eight, shall be

one hundred eighty-seven million two hundred fifty thousand dollars.

(xii) A gross statewide amount for the period April first, two

thousand eight through December thirty-first, two thousand eight, shall

be five hundred sixty-one million seven hundred fifty thousand dollars.

(xiii) A gross statewide amount for the period October first, two

thousand eight through March thirty-first, two thousand nine, shall be

one hundred seventy-four million two hundred thousand dollars. Such

amount shall be separately reported and paid in six monthly installments

by the tenth day of each month from October two thousand eight to March

two thousand nine. Such reports and payments must initially be based on

each payers' monthly enrollment count for the preceding month and shall

be reconciled on a month to month basis to reflect the actual monthly

enrollment counts for the applicable month.

(xiv) A gross annual statewide amount for the period January first,

two thousand nine through December thirty-first, two thousand fourteen,

shall be nine hundred forty-four million dollars.

(xv) A gross annual statewide amount for the period January first, two

thousand fifteen through December thirty-first, two thousand twenty-two,

shall be one billion forty-five million dollars.

(xvi) A gross annual statewide amount for the period January first,

two thousand twenty-three to December thirty-first, two thousand

twenty-six shall be one billion eighty-five million dollars, forty

million dollars annually of which shall be allocated under section

twenty-eight hundred seven-o of this article among the municipalities of

and the state of New York based on each municipality's share and the

state's share of early intervention program expenditures not

reimbursable by the medical assistance program for the latest twelve

month period for which such data is available.

(xvii) A gross annual statewide amount for the period January first,

two thousand twenty-seven to December thirty-first, two thousand

twenty-nine shall be one billion eighty-five million dollars, forty

million dollars annually of which shall be allocated under section

twenty-eight hundred seven-o of this article among the municipalities of

and the state of New York based on each municipality's share and the

state's share of early intervention program expenditures not

reimbursable by the medical assistance program for the latest twelve

month period for which such data is available.

(b) The amount specified in paragraph (a) of this subdivision shall be

allocated among the regions based on each region's proportional share of

the sum of the estimated revenue of all general hospitals in the region,

excluding revenue related to services provided to beneficiaries of title

XVIII of the federal social security act (medicare), related to one

hundred percent of the direct medical education expenses and fifty-nine

and five-tenths percent of indirect medical education expenses reflected

in general hospital inpatient revenue compared to the sum of such

amounts for all regions, based on estimated nineteen hundred ninety-six

data and statistics, excluding an estimate of revenue from services

provided to patients eligible for payments by governmental agencies,

patients eligible for payments pursuant to the comprehensive motor

vehicle insurance reparations act, the workers' compensation law, the

volunteer firefighters' benefit law, and the volunteer ambulance

workers' benefit law, and self-pay patients.

(c) (i) A further gross annual statewide amount for nineteen hundred

ninety-seven shall be sixty-four million dollars.

(ii) A further gross annual statewide amount for nineteen hundred

ninety-eight shall be sixty-four million dollars.

(iii) A further gross annual statewide amount for nineteen hundred

ninety-nine shall be eighty-nine million dollars.

(iv) A further gross annual statewide amount for two thousand, two

thousand one, two thousand two, two thousand three, two thousand four,

two thousand five, two thousand six, two thousand seven, two thousand

eight, two thousand nine, two thousand ten, two thousand eleven, two

thousand twelve and two thousand thirteen shall be eighty-nine million

dollars.

(v) A further gross annual statewide amount for the period January

first, two thousand fourteen through December thirty-first, two thousand

fourteen, shall be eighty-nine million dollars.

(d) For each year, the amount specified in paragraph (c) of this

subdivision shall be allocated among the regions based on the same

regional percentage allocations as determined in accordance with

paragraph (b) of this subdivision.

(e) A further gross annual statewide amount shall be twelve million

dollars for each period prior to January first, two thousand fifteen.

(f) For each year, the amount specified in paragraph (e) of this

subdivision shall be allocated among the regions based on each region's

allocated share of the AIDS drug assistance program expenditures for the

latest annual period for which such data are available.

(g) A further gross statewide amount for the state fiscal year two

thousand twenty-two shall be forty million dollars.

(h) The amount specified in paragraph (g) of this subdivision shall be

allocated under section twenty-eight hundred seven-o of this article

among the municipalities and the state of New York based on each

municipality's share and the state's share of early intervention program

expenditures not reimbursable by the medical assistance program for the

latest twelve month period for which such data is available.

7. Funds accumulated, including income from invested funds, from the

allowances specified in this section and the assessments pursuant to

section twenty-eight hundred seven-t of this article, including interest

and penalties, shall be deposited by the commissioner or the

commissioner's designee as follows:

(a) funds shall be accumulated in regional professional education

pools established by the commissioner or the healthcare reform act

(HCRA) resources fund established pursuant to section ninety-two-dd of

the state finance law, whichever is applicable, for distribution in

accordance with section twenty-eight hundred seven-m of this article, in

the following amounts:

(i) ninety-two and forty-five-hundredths percent of the funds

accumulated less seventy-six million dollars for the period January

first, nineteen hundred ninety-seven through December thirty-first,

nineteen hundred ninety-seven,

(ii) ninety-two and forty-five-hundredths percent of the funds

accumulated less seventy-six million dollars for the period January

first, nineteen hundred ninety-eight through December thirty-first,

nineteen hundred ninety-eight,

(iii) ninety-two and forty-five-hundredths percent of the funds

accumulated less one hundred one million dollars for the period January

first, nineteen hundred ninety-nine through December thirty-first,

nineteen hundred ninety-nine,

(iv) four hundred ninety-four million dollars on an annual basis for

the periods January first, two thousand through December thirty-first,

two thousand three,

(v) four hundred sixty-three million dollars for the period January

first, two thousand four through December thirty-first, two thousand

four,

(vi) four hundred eighty-eight million dollars for the period January

first, two thousand five through December thirty-first, two thousand

five,

(vii) four hundred ninety-four million dollars for the period January

first, two thousand six through December thirty-first, two thousand six,

(viii) four hundred seventy million dollars for the period January

first, two thousand seven through December thirty-first, two thousand

seven,

(ix) four hundred forty-six million six hundred thousand dollars for

the period January first, two thousand eight through December

thirty-first, two thousand eight,

(x) forty-seven million two hundred ten thousand dollars on an annual

basis for the periods January first, two thousand nine through December

thirty-first, two thousand ten;

(xi) eleven million eight hundred thousand dollars for the period

January first, two thousand eleven through March thirty-first, two

thousand eleven;

(xii) twenty-three million eight hundred thirty-six thousand dollars

for the period April first, two thousand eleven through March

thirty-first, two thousand twelve;

(xiii) twenty-three million eight hundred thirty-six thousand dollars

each state fiscal year for the period April first, two thousand twelve

through March thirty-first, two thousand twenty-nine;

(xiv) provided, however, for periods prior to January first, two

thousand nine, amounts set forth in this paragraph may be reduced by the

commissioner in an amount to be approved by the director of the budget

to reflect the amount received from the federal government under the

state's 1115 waiver which is directed under its terms and conditions to

the graduate medical education program established pursuant to section

twenty-eight hundred seven-m of this article;

(xv) provided further, however, for periods prior to July first, two

thousand nine, amounts set forth in this paragraph shall be reduced by

an amount equal to the total actual distribution reductions for all

facilities pursuant to paragraph (e) of subdivision three of section

twenty-eight hundred seven-m of this article; and

(xvi) provided further, however, for periods prior to July first, two

thousand nine, amounts set forth in this paragraph shall be reduced by

an amount equal to the actual distribution reductions for all facilities

pursuant to paragraph (s) of subdivision one of section twenty-eight

hundred seven-m of this article.

(b) funds shall be added to the funds collected by the commissioner

for distribution in accordance with section twenty-eight hundred seven-j

of this article, in the following amounts:

(i) seven and fifty-five-hundredths percent of the funds accumulated

less seventy-six million dollars for the period January first, nineteen

hundred ninety-seven through December thirty-first, nineteen hundred

ninety-seven,

(ii) seven and fifty-five-hundredths percent of the funds accumulated

less seventy-six million dollars for the period January first, nineteen

hundred ninety-eight through December thirty-first, nineteen hundred

ninety-eight,

(iii) seven and fifty-five-hundredths percent of the funds accumulated

less one hundred one million dollars for the period January first,

nineteen hundred ninety-nine through December thirty-first, nineteen

hundred ninety-nine,

(iv) the remaining balance of the funds accumulated for each period on

and after January first, two thousand; and

(c) further funds shall be added to the funds collected by the

commissioner for distribution in accordance with section twenty-eight

hundred seven-j of this article:

(i) for the nineteen hundred ninety-seven period, seventy-six million

dollars;

(ii) for the nineteen hundred ninety-eight period, seventy-six million

dollars; and

(iii) for the nineteen hundred ninety-nine period, one hundred one

million dollars.

(d) funds shall be added to the funds collected by the commissioner

for distribution in accordance with section twenty-eight hundred seven-o

of this article, in the following amount: forty million dollars for the

period beginning April first, two thousand twenty-two, and continuing

each state fiscal year thereafter.

8. Each exclusion from the allowances effective on or after January

first, nineteen hundred ninety-seven established pursuant to this

section shall be contingent upon either: (a) qualification of the

allowances for waiver pursuant to federal law and regulation; or (b)

consistent with federal law and regulation, not requiring a waiver by

the secretary of the department of health and human services related to

such exclusion; in order for the allowances under this section to be

qualified as a broad-based health care related tax for purposes of the

revenues received by the state pursuant to the allowances not reducing

the amount expended by the state as medical assistance for purposes of

federal financial participation. The commissioner shall collect the

allowances relying on such exclusions, pending any contrary action by

the secretary of the department of health and human services. In the

event the secretary of the department of health and human services

determines that the allowances do not so qualify based on any such

exclusion, then the exclusion shall be deemed to have been null and void

as of January first, nineteen hundred ninety-seven, and the commissioner

shall collect any retroactive amount due as a result, without interest

or penalty provided the general hospital pays the retroactive amount due

within ninety days of notice from the commissioner to the general

hospital that an exclusion is null and void. Interest and penalties

shall be measured from the due date of ninety days following notice from

the commissioner or the commissioner's designee to the general hospital.

9. Revenue from the allowances pursuant to this section shall not be

included in gross revenue received for purposes of the assessments

pursuant to subdivision eighteen of section twenty-eight hundred seven-c

of this article, subject to the provisions of paragraph (e) of

subdivision eighteen of section twenty-eight hundred seven-c of this

article, and shall not be included in gross revenue received for

purposes of the assessments pursuant to section twenty-eight hundred

seven-d of this article, subject to the provisions of subdivision twelve

of section twenty-eight hundred seven-d of this article.

* NB Expires December 31, 2029