N.Y. Social Services Law § 364-j-2: Transitional supplemental payments

§ 364-j-2. Transitional supplemental payments. 1. As used in this

section, "covered provider" shall mean a voluntary not-for-profit health

care provider that is any of the following:

(a) a freestanding diagnostic and treatment center licensed under

article twenty-eight of the public health law that qualifies for a

distribution pursuant to section twenty-eight hundred seven-p of such

article, or section seven of chapter four hundred thirty-three of the

laws of nineteen hundred ninety-seven, or receives funding under section

three hundred thirty-three of the federal public health services act for

health care for the homeless; or

(b) a freestanding diagnostic and treatment center which operates an

approved program under the prenatal care assistance program established

pursuant to article twenty-five of the public health law; or

(c) a facility licensed under article twenty-eight of the public

health law that is sponsored by a university or dental school which has

been granted an operating certificate pursuant to article twenty-eight

of the public health law to provide dental services; or

(d) a freestanding family planning clinic licensed under article

twenty-eight of the public health law.

2. (a) Notwithstanding paragraphs (b) and (h) of subdivision two of

section twenty-eight hundred seven of the public health law, the

commissioner of health shall make supplemental payments of nine million

eight hundred twenty-four thousand dollars ($9,824,000), to covered

providers described in subdivision one of this section who are qualified

providers as described in paragraph (a) of subdivision three of this

section, based on adjustments to fee-for-service rates for the period

February first through March thirty-first, two thousand two and nine

million eight hundred twenty-four thousand dollars ($9,824,000) for the

period October first through December thirty-first, two thousand two and

four million nine hundred twelve thousand dollars ($4,912,000) for the

period October first through December thirty-first, two thousand three

and an additional amount of four million nine hundred twelve thousand

dollars ($4,912,000) for the period October first through December

thirty-first, two thousand three and nine million eight hundred

twenty-four thousand dollars ($9,824,000) for the period April first

through June thirtieth, two thousand five, and nine million eight

hundred twenty-four thousand dollars ($9,824,000) for the period October

first through December thirty-first, two thousand six, and an additional

nine million eight hundred twenty-four thousand dollars ($9,824,000) for

the period October first through December thirty-first, two thousand

six, and nine million eight hundred twenty-four thousand dollars

($9,824,000) for the period October first through December thirty-first,

two thousand seven, as medical assistance payments for services provided

pursuant to this title for persons eligible for federal financial

participation under title XIX of the federal social security act to

reflect additional costs associated with the transition to a managed

care environment, and nine million eight hundred twenty-four thousand

dollars ($9,824,000) for the period October first through December

thirty-first, two thousand eight, and seven million three hundred

eighty-eight thousand dollars ($7,388,000) for the period October first

through December thirty-first, two thousand nine, as medical assistance

payments for services provided pursuant to this title for persons

eligible for federal financial participation under title XIX of the

federal social security act to reflect additional costs associated with

the operation of electronic health record systems that meet such

standards as may be established by the commissioner of health. There

shall be no local share in these payments. The director of the budget

shall allocate the non-federal share of such payments from an

appropriation for the miscellaneous special revenue fund - 339 community

service provider assistance program account for the two thousand

one--two thousand two state fiscal year for adjustments for the period

February first through March thirty-first, two thousand two. Adjustments

for the period October first, two thousand two through December

thirty-first, two thousand two shall be within amounts appropriated for

the two thousand two--two thousand three state fiscal year and

adjustments for the period October first, two thousand three through

December thirty-first, two thousand three shall be within amounts

appropriated for the two thousand three--two thousand four state fiscal

year and adjustments for the non-federal share of the additional amount

of four million nine hundred twelve thousand dollars ($4,912,000) for

such period shall be allocated by the director of the budget from an

appropriation for maintenance undistributed general fund community

projects fund - 007 account for the two thousand three--two thousand

four state fiscal year. The director of the budget shall allocate the

non-federal share of adjustments for the period April first, two

thousand five through June thirtieth, two thousand five from an

appropriation for the maintenance undistributed general fund community

projects fund - 007 - cc account for the two thousand four--two thousand

five state fiscal year. The director of the budget shall allocate the

non-federal share of adjustments for the period October first, two

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

appropriation for the maintenance undistributed, general fund, community

projects fund - 007-cc account for the two thousand five--two thousand

six state fiscal year. The director of the budget shall allocate the

non-federal share of the additional adjustments for the period October

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

from such funds as may be made available from an appropriation for the

maintenance undistributed, general fund, community projects fund -

007-cc account for the two thousand six--two thousand seven state fiscal

year. The director of the budget shall allocate the non-federal share of

the adjustments for the period October first, two thousand seven through

December thirty-first, two thousand seven from an appropriation for the

medical assistance program, general fund, local assistance account - 001

for the two thousand seven--two thousand eight state fiscal year. The

director of the budget shall allocate the non-federal share of the

adjustments for the period October first, two thousand eight through

December thirty-first, two thousand eight from an appropriation for the

medical assistance program, general fund, local assistance account - 001

for the two thousand eight--two thousand nine state fiscal year. The

director of the budget shall allocate the non-federal share of the

adjustments for the period October first, two thousand nine through

December thirty-first, two thousand nine from an appropriation for the

medical assistance program, general fund, local assistance account - 001

for the two thousand nine--two thousand ten state fiscal year. Such

adjustments to fee for service rates shall not be subject to subsequent

adjustment or reconciliation. Alternatively, such payments may be made

as aggregate payments to eligible providers.

(a-1) Notwithstanding the provisions of paragraph (a) of this

subdivision, for facilities licensed under article twenty-eight of the

public health law that are sponsored by a university or dental school

which has been granted an operating certificate pursuant to article

twenty-eight of the public health law and which provides dental services

as its principal mission, two hundred twenty-four thousand dollars

($224,000) in the aggregate for use pursuant to this section shall be

allocated for distribution to such facilities pursuant to the

methodology described in paragraph (b) of subdivision two and

subparagraph (i) of paragraph (b) of subdivision four of section two

thousand eight hundred seven-p of the public health law for services

provided for the period February first, two thousand two through March

thirty-first, two thousand two to persons eligible for federal financial

participation under title XIX of the federal social security act,

provided, however, that the amount paid pursuant to this paragraph for

each such facility shall equal the facility's proportional share of the

total nominal payment amounts calculated under this section of all such

facilities multiplied by the total funds allocated for such payments.

There shall be no local share in these payments. The director of the

budget shall allocate the non-federal share of such payments from an

appropriation for the miscellaneous special revenue fund - 339 community

service provider assistance program account for the two thousand

one--two thousand two state fiscal year. Such adjustments to fee for

service rates shall not be subject to subsequent adjustment or

reconciliation. Alternatively, such payments may be made as aggregate

payments to eligible providers.

(a-2) (i) Notwithstanding the provisions of paragraph (a) of this

subdivision, for facilities licensed under article twenty-eight of the

public health law that are sponsored by a university or dental school

which has been granted an operating certificate pursuant to article

twenty-eight of the public health law and which provides dental services

as its principal mission, two hundred twenty-four thousand dollars

($224,000) in the aggregate of the amount appropriated for the two

thousand two--two thousand three state fiscal year for use pursuant to

this section shall be allocated for the period October first through

December thirty-first, two thousand two and one hundred twelve thousand

dollars ($112,000) in the aggregate of the amount appropriated for the

two thousand three--two thousand four state fiscal year, and an

additional amount of one hundred twelve thousand dollars ($112,000) in

the aggregate for use pursuant to this section shall be allocated for

the period October first through December thirty-first, two thousand

three and two hundred twenty-four thousand dollars ($224,000) in the

aggregate of the amount appropriated for the two thousand four--two

thousand five state fiscal year shall be allocated for the period April

first, two thousand five through June thirtieth, two thousand five, and

two hundred twenty-four thousand dollars ($224,000) in the aggregate of

the amount appropriated for the two thousand five--two thousand six

state fiscal year shall be allocated for the period October first, two

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

additional two hundred twenty-four thousand dollars ($224,000) in the

aggregate of the amount appropriated for the two thousand six--two

thousand seven state fiscal year shall be allocated for the period

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

thousand six, and two hundred twenty-four thousand dollars ($224,000) in

the aggregate of the amount appropriated for the two thousand seven--two

thousand eight state fiscal year shall be allocated for the period

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

thousand seven, and two hundred twenty-four thousand dollars ($224,000)

in the aggregate of the amount appropriated for the two thousand

eight--two thousand nine state fiscal year shall be allocated for the

period October first, two thousand eight through December thirty-first,

two thousand eight and two hundred twenty-four thousand dollars

($224,000) in the aggregate of the amount appropriated for the two

thousand nine--two thousand ten state fiscal year shall be allocated for

the period October first, two thousand nine through December

thirty-first, two thousand nine for distribution to such facilities

pursuant to subparagraphs (ii) and (iii) of this paragraph. Adjustments

for the non-federal share of the additional amount of one hundred twelve

thousand dollars ($112,000) for the period October first, two thousand

three through December thirty-first, two thousand three shall be

allocated by the director of the budget from an appropriation for

maintenance undistributed general fund community projects fund - 007

account for the two thousand three--two thousand four state fiscal year.

The non-federal share of adjustments for the period April first, two

thousand five through June thirtieth, two thousand five shall be

allocated by the director of the budget from an appropriation for the

maintenance undistributed general fund community projects fund - 007

account for the two thousand four--two thousand five state fiscal year.

The non-federal share of adjustments for the period October first, two

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

allocated by the director of the budget from an appropriation for the

maintenance undistributed, general fund, community projects fund -

007-cc account for the two thousand five--two thousand six state fiscal

year. The non-federal share of the additional adjustments for the period

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

thousand six shall, subject to the availability of funds, be allocated

by the director of the budget from the medical assistance local

assistance appropriation for the two thousand six--two thousand seven

state fiscal year. The non-federal share of the adjustments for the

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

two thousand seven shall be allocated by the director of the budget from

an appropriation for the medical assistance program, general fund, local

assistance account - 001 for the two thousand seven--two thousand eight

state fiscal year. The non-federal share of the adjustments for the

period October first, two thousand eight through December thirty-first,

two thousand eight shall be allocated by the director of the budget from

an appropriation for the medical assistance program, general fund, local

assistance account - 001 for the two thousand eight--two thousand nine

state fiscal year. The non-federal share of the adjustments for the

period October first, two thousand nine through December thirty-first,

two thousand nine shall be allocated by the director of the budget from

an appropriation for the medical assistance program, general fund, local

assistance account - 001 for the two thousand nine--two thousand ten

state fiscal year.

(ii) Forty percent shall be allocated for equal distribution to such

facilities, reduced by the amount, if any, that a distribution exceeds

forty percent of a facility's uncompensated care need as defined in

paragraph (b) of subdivision two of section two thousand eight hundred

seven-p of the public health law. Any funds allocated but not

distributed in accordance with this subparagraph shall be added to those

amounts distributed in accordance with subparagraph (iii) of this

paragraph.

(iii) Sixty percent, plus any funds allocated and not distributed in

accordance with subparagraph (ii) of this paragraph, shall be allocated

for distribution to such facilities pursuant to the methodology

described in paragraph (b) of subdivision two and subparagraph (i) of

paragraph (b) of subdivision four of section two thousand eight hundred

seven-p of the public health law, provided, however, that the amount

paid pursuant to this allocation for each such facility shall equal the

facility's proportional share of the total nominal payment amounts

calculated under this section of all such facilities multiplied by the

total funds allocated for such payments.

(iv) There shall be no local share in these payments.

(b) Notwithstanding the provisions of subdivision one of section three

hundred sixty-eight-a of this title, there shall be paid to each social

services district the full amount expended on behalf of the department

of health for medical assistance furnished pursuant to the provisions of

this section, after first deducting therefrom any federal funds properly

received or to be received on account thereof.

3. (a) For periods prior to January first, two thousand eight, a

covered provider described in subdivision one of this section shall be

qualified to receive a supplemental payment only if its number of

medicaid visits for patient care services in the base year described in

subparagraph (ii) of paragraph (b) of this subdivision equals or exceeds

twenty-five percent of its total number of visits for patient care

services and its number of medicaid visits for patient care services for

medicaid managed care enrollees equals or exceeds three percent of its

total number of medicaid visits during the base year. For periods on and

after January first, two thousand eight, a covered provider described in

subdivision one of this section shall be qualified to receive a

supplemental payment only if it has in place during such period an

operational electronic health record system that meets such standards as

may be established by the commissioner of health and its number of

medicaid visits for patient care services in the base year described in

subparagraph (ii) of paragraph (b) of this subdivision equals or exceeds

twenty-five percent of its total number of visits for patient care

services during the base year or its number of medicaid visits combined

with its number of uninsured visits for patient care services in the

base year described in subparagraph (ii) of paragraph (b) of this

subdivision equals or exceeds thirty percent of its total number of

visits for patient care services during the base year.

(b) (i) For periods prior to January first, two thousand eight, each

qualified provider described in paragraph (a) of this subdivision shall

receive a supplemental payment equal to such provider's proportional

share of the total funds allocated pursuant to this section, based upon

the ratio of its visits from medical assistance recipients enrolled in

managed care during the base year to the total number of visits to all

such qualified providers by medical assistance recipients enrolled in

managed care during the base year. For periods on and after January

first, two thousand eight, each qualified provider described in

paragraph (a) of this subdivision shall receive a supplemental payment

equal to such provider's proportional share of the total funds allocated

pursuant to this section, based upon the ratio of its visits from

medical assistance recipients during the base year to the total number

of visits from medical assistance recipients to all such qualified

providers during the base year.

(ii) For periods prior to January first, two thousand eight, for

purposes of the calculation described in this subdivision, the base year

will be two thousand, and the commissioner of health shall utilize data

as reported on the 2000 AHCF-1 cost report initially submitted by

covered providers to the department of health on or about August

seventeenth, two thousand one. For periods on and after January first,

two thousand eight, for purposes of the calculation described in this

subdivision, the base year will be two years prior to the grant year,

and the commissioner of health shall utilize data as reported on AHCF-1

cost report submitted by covered providers to the department of health

for such base year.

4. Payments made pursuant to this section shall constitute additional

reimbursement to qualified providers and shall not be used to reduce

levels of other funding provided to qualified providers by governmental

agencies.

5. (a) The commissioner of health shall make medical assistance

payments to qualified providers from funds made available pursuant to

the provisions of this section contingent upon the receipt of all

federal approvals necessary and subject to the availability of federal

financial participation under title XIX of the federal social security

act for the transitional supplemental payments. In the event such

federal approval is not received prior to March thirty-first, two

thousand two, for adjustments for the period February first, two

thousand two through March thirty-first, two thousand two and prior to

October first, two thousand two for adjustments for the period October

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

and prior to October first, two thousand three for adjustments for the

period October first, two thousand three through December thirty-first,

two thousand three, and prior to October first, two thousand five for

adjustments for the period April first, two thousand five through June

thirtieth, two thousand five, and prior to October first, two thousand

six for adjustments for the period October first, two thousand six

through December thirty-first, two thousand six, and prior to October

first, two thousand seven for adjustments for the period October first,

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

and prior to October first, two thousand eight for adjustments for the

period October first, two thousand eight through December thirty-first,

two thousand eight, and prior to October first, two thousand nine for

adjustments for the period October first, two thousand nine through

December thirty-first, two thousand nine, the commissioner of health

shall make medical assistance payments to qualified providers consisting

of the state share amount available for purposes of this section and

apportioned in accordance with subdivisions two and three of this

section. In the event such federal approval is denied, such state share

amount payments shall be deemed to be grants to such qualified providers

and such qualified providers shall not be eligible to receive any other

payments pursuant to this section.

(b) The commissioner of health shall take all steps necessary and

shall use best efforts to secure federal financial participation under

title XIX of the social security act, for the purposes of this section,

including the prompt submission of appropriate amendments to the title

XIX state plan.