N.Y. Public Health Law § 2807-w: High need indigent care adjustment pool

§ 2807-w. High need indigent care adjustment pool. Funds allocated

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

hundred seven-v of this article, shall be deposited as authorized and

used for the purpose of making medicaid disproportionate share payments

of up to eighty-two million dollars on an annualized basis pursuant to

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

article, for the period January first, two thousand through March

thirty-first, two thousand fourteen, in accordance with the following:

1. From the funds in the pool each year: (a) Each eligible rural

hospital shall receive one hundred forty thousand dollars on an

annualized basis for the periods January first, two thousand through

December thirty-first, two thousand fourteen, provided as a

disproportionate share payment; provided, however, that if such payment

pursuant to this paragraph exceeds a hospital's applicable

disproportionate share limit, then the total amount in excess of such

limit shall be provided as a nondisproportionate share payment in the

form of a grant directly from this pool without allocation to the

special revenue funds - other, indigent care fund - 068, or any

successor fund or account, and provided further that payments for

periods on and after January first, two thousand nine shall be subject

to the provisions of subdivision five-a of section twenty-eight hundred

seven-k of this article;

(b) Each such hospital shall also receive an amount calculated by

multiplying the facility's uncompensated care need by the appropriate

percentage from the following scale based on hospital rankings developed

in accordance with each eligible rural hospital's weight as defined by

this section.

Rank Percentage Coverage of

Uncompensated Care Need

1-9 60.0%

10-17 52.5%

18-25 45.0%

26-33 37.5%

34-41 30.0%

42-49 22.5%

50-57 15.0%

58+ 7.5%

For purposes of calculating the distribution amount to an eligible

rural hospital which has merged with another hospital on or after

December thirty-first, nineteen hundred ninety-nine, and continues to be

an eligible rural hospital in accordance with paragraph (c) of this

subdivision, such merged facility's uncompensated care need pursuant to

this paragraph shall be calculated from data provided in the eligible

rural hospital's institutional cost report filed for the rate period two

years prior to the distribution period, or if such report is not

required for such rural hospital, the distribution amount shall be based

upon the last institutional cost report required to be filed by such

rural hospital.

(c) "Eligible rural hospital", as used in this section, shall mean a

general hospital that as of December thirty-first, nineteen hundred

ninety-nine or thereafter, was classified as a rural hospital for

purposes of determining payment for inpatient services provided to

beneficiaries of title XVIII of the federal social security act

(medicare) or under state regulations, or a general hospital, which

during the same time period, had a service area which has an average

population of less than one hundred seventy-five persons per square

mile, or a general hospital which has a service area which has an

average population of less than two hundred persons per square mile

measured as population density by zip code. The average population of

the service area is calculated by multiplying annual patient discharges

by the population density per square mile of the county of origin or zip

code as applicable for each patient discharge and dividing by total

discharges. Annual patient discharges shall be determined using

discharge data for the nineteen hundred ninety-seven rate year, as

reported to the commissioner by October first, nineteen hundred

ninety-eight. Population density shall be determined utilizing United

States census bureau data for nineteen hundred ninety-seven. If an

eligible rural hospital merges with another general hospital, on or

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

merger results in separate facilities operating under a single facility

operating certificate, such eligible rural hospital shall continue to be

a separate eligible rural hospital for purposes of this subdivision and

payments provided in accordance with this section shall be made to the

merged entity; provided, however, that payments shall only be made to

the merged entity if such separate eligible rural hospital continues to

provide inpatient and/or outpatient hospital services at the same

location at which it operated prior to the merger. If an eligible rural

hospital merges with another general hospital on or after December

thirty-first, nineteen hundred ninety-nine, and the merger results in

such rural hospital continuing to operate under a separate facility

operating certificate, such rural hospital will continue to be an

eligible rural hospital after the merger; provided, however, that

payments shall only be made to such rural hospital if such eligible

rural hospital continues to provide inpatient and/or outpatient hospital

services at the same location at which it is operated prior to the

merger.

(d) "Eligible rural hospital weight", as used in this section, shall

mean the result of adding, for each eligible rural hospital:

(i) The eligible rural hospital's targeted need, as defined in section

twenty-eight hundred seven-k of this article, minus the mean targeted

need for all eligible rural hospitals, divided by the standard deviation

of the targeted need of all eligible rural hospitals; and

(ii) The mean number of beds of all eligible rural hospitals minus the

number of beds for an individual hospital, divided by the standard

deviation of the number of beds for all eligible rural hospitals.

2. From the funds in the pool each year, thirty-six million dollars on

an annualized basis for the periods January first, two thousand through

December thirty-first, two thousand fourteen, of the funds not

distributed in accordance with subdivision one of this section, shall be

distributed in accordance with the formula set forth in subdivision six

of section twenty-eight hundred seven-k of this article, provided,

however, that payments for periods on and after January first, two

thousand nine shall be subject to the provisions of subdivision five-a

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

3. From the funds in the pool each year, any funds not distributed in

accordance with subdivision one or two of this section, shall be

distributed in accordance with the formula set forth in paragraph (b) of

subdivision four of section twenty-eight hundred seven-k of this

article.

4. In order for a general hospital to be eligible to participate in

the distribution of funds pursuant to this section, such general

hospital must be in compliance with the provisions of subdivisions nine,

ten and twelve of section twenty-eight hundred seven-k of this article.

5. For each hospital receiving payments pursuant to paragraph (i) of

subdivision thirty-five of section twenty-eight hundred seven-c of this

article, the commissioner shall reduce the sum of any amounts paid

pursuant to this section and pursuant to section twenty-eight hundred

seven-k of this article, as computed based on projected facility

specific disproportionate share hospital ceilings, by an amount equal to

the lower of such sum or each such hospital's payments pursuant to

paragraph (i) of subdivision thirty-five of section twenty-eight hundred

seven-c of this article, provided, however, that any additional

aggregate reductions enacted in a chapter of the laws of two thousand

ten to the aggregate amounts payable pursuant to this section and

pursuant to section twenty-eight hundred seven-k of this article shall

be applied subsequent to the adjustments otherwise provided for in this

subdivision.