A 7220: Relates to the general hospital indigent care pool and funding for safety net and enhanced safety net hospitals.

  
  STATE OF NEW YORK ________________________________________________________________________ 7220 2025-2026 Regular Sessions  IN ASSEMBLY March 21, 2025 ___________ Introduced by M. of A. BICHOTTE HERMELYN, MAMDANI, JACOBSON, BORES, SHIMSKY, LEVENBERG, TAPIA, DAVILA, LUCAS, KELLES, RAGA -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to the general hospi- tal indigent care pool and funding for safety net and enhanced safety net hospitals; and to amend chapter 474 of the laws of 1996 amending the education law and other laws relating to rates for residential health care facilities, in relation to additional payments for certain inpatient hospital services The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subparagraph (ii) of paragraph b of subdivision 5-d of 2 section 2807-k of the public health law, as amended by section 1 of part 3 E of chapter 57 of the laws of 2023, is amended to read as follows: 4 (ii) Annual distributions pursuant to such regulations for the two 5 thousand twenty through two thousand twenty-five calendar years and each 6 calendar year thereafter shall be in accord with the following: 7 (A) one hundred thirty-nine million four hundred thousand dollars 8 shall be distributed as Medicaid Disproportionate Share Hospital ("DSH") 9 payments to major public general hospitals; and 10 (B) nine hundred sixty-nine million nine hundred thousand dollars as 11 Medicaid DSH payments to eligible general hospitals, other than major 12 public general hospitals. 13 For the calendar years two thousand twenty through two thousand twen- 14 ty-two, the total distributions to eligible general hospitals, other 15 than major public general hospitals, shall be subject to an aggregate 16 reduction of one hundred fifty million dollars annually, provided that 17 eligible general hospitals, other than major public general hospitals, 18 that qualify as enhanced safety net hospitals under section two thousand 19 eight hundred seven-c of this article shall not be subject to such 20 reduction. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD07026-01-5 
 A. 7220 2 1 For the calendar years two thousand twenty-three through two thousand 2 twenty-five and each calendar year thereafter, the total distributions 3 to eligible general hospitals, other than major public general hospi- 4 tals, shall be subject to an aggregate reduction of two hundred [thir- 5 ty-five] seventy-five million four hundred thousand dollars annually, 6 provided that eligible general hospitals, other than major public gener- 7 al hospitals that qualify as enhanced safety net hospitals under section 8 two thousand eight hundred seven-c of this article as of April first, 9 two thousand twenty, shall not be subject to such reduction. 10 Such reductions shall be determined by a methodology to be established 11 by the commissioner. Such methodologies may take into account the payor 12 mix of each non-public general hospital, including the percentage of 13 inpatient days paid by Medicaid. 14 § 2. Section 2807 of the public health law is amended by adding a new 15 subdivision 22 to read follows: 16 22. Adjustments to Medicaid rates. (a) The commissioner shall make 17 adjustments to medical assistance rates in accordance with this subdivi- 18 sion to enhanced safety net hospitals, as defined in paragraph (a) of 19 subdivision thirty-four of section twenty-eight hundred seven-c of this 20 article, and to qualified safety net hospitals, as defined in paragraph 21 (b) of this subdivision, for the purposes of supporting critically need- 22 ed health care services and to ensure the continued maintenance and 23 operation of such hospitals. 24 (b) For the purposes of this subdivision, a "qualified safety net 25 hospital" shall mean a general hospital, other than an enhanced safety 26 net hospital that in any of the previous three calendar years: 27 (i) has met four of the five criteria listed under subparagraph (i) of 28 paragraph (a) of subdivision thirty-four of section twenty-eight hundred 29 seven-c of this article; or 30 (ii) has met the following criteria: 31 (A) not less than forty-five percent of the patients it treats receive 32 medical assistance or are medically uninsured; 33 (B) not less than thirty-six percent of its inpatient discharges are 34 covered by Medicaid; 35 (C) twenty-eight percent or less of its discharged patients are 36 commercially insured; 37 (D) not less than two percent of the patients it provides services to 38 are attributed to the care of uninsured patients; and 39 (E) provides care to uninsured patients in its emergency room, hospi- 40 tal-based clinics and community based clinics, including the provision 41 of important community services, such as dental care and prenatal care; 42 or 43 (iii) is so designated by the commissioner pursuant to findings that 44 takes into account the following criteria: 45 (A) the hospital is operating under financial hardship, evidenced by 46 the operating losses of the hospital or the system of hospitals to which 47 the hospital belongs and/or participation by the hospital in programs 48 established by the commissioner to enable hospitals in financial 49 distress to maintain operations and vital services; 50 (B) the volume of Medicaid and/or medically uninsured patients served 51 by the hospital exceeds the average volume of such services provided by 52 other hospitals in the hospital's region; and 53 (C) the importance of the hospital in enabling Medicaid and/or 54 medically uninsured patients' access to health care services in inpa- 55 tient, outpatient and community settings within the hospital's region. 
 A. 7220 3 1 (c) For the state fiscal year commencing April first, two thousand 2 twenty-six and each state fiscal year thereafter, the commissioner shall 3 increase medical assistance rates of payments for inpatient and/or 4 outpatient services made by either state governmental agencies or organ- 5 izations operating in accordance with article forty-three of the insur- 6 ance law or article forty-four of this chapter by an aggregate of: 7 (i) thirty-four million one hundred twenty-five thousand dollars for 8 enhanced safety net hospitals that are major public general hospitals; 9 (ii) two hundred twenty-eight million three hundred seventy-five thou- 10 sand dollars for qualified safety net hospitals and enhanced safety net 11 hospitals other than major public general hospitals, of which at least 12 twelve million five hundred thousand dollars shall be allocated to 13 enhanced safety net hospitals that are federally designated as critical 14 access or sole community hospitals; and 15 (iii) twelve million five hundred thousand dollars for those hospitals 16 eligible under subparagraph (ii) of this paragraph for which the 17 combined payments made, or to be made, under subparagraph (ii) of this 18 paragraph and subdivision five-d of section twenty-eight hundred seven-k 19 of this article for calendar year two thousand twenty-six and each 20 calendar year thereafter, are projected by the commissioner to be less 21 than payments made to such hospitals pursuant to subdivision five-d of 22 section twenty-eight hundred seven-k of this article for calendar year 23 two thousand eighteen. 24 (d) Payments made pursuant to this subdivision may be added to rates 25 of payment, or made as aggregate payments of equal amounts on October 26 first and April first of each state fiscal year, to such enhanced safety 27 net hospitals and qualified safety net hospitals in accordance with a 28 methodology to be established by the commissioner; provided, however, 29 that, the commissioner may make the twelve million five hundred thousand 30 dollars in payments due to eligible hospitals under subparagraph (iii) 31 of paragraph (c) of this subdivision by instead increasing the amount 32 otherwise awarded to such eligible hospitals under programs established 33 by the commissioner to enable hospitals in financial distress to main- 34 tain operations and vital services while working to achieve longer-term 35 sustainability, including, but not limited to, the value based payment 36 quality improvement program. 37 § 3. Subparagraph (v) of paragraph (a) of subdivision 1 of section 38 2807-c of the public health law, as amended by chapter 639 of the laws 39 of 1996, is amended and a new subparagraph (vi) is added to read as 40 follows: 41 (v) adjustments for any modifications to the case payments determined 42 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of 43 this section[.]; and 44 (vi) adjustments for any modifications to the case payments determined 45 in accordance with subdivision twenty-two of section twenty-eight 46 hundred seven of this article. 47 § 4. Subparagraph (v) of paragraph (a) of subdivision 1 of section 48 2807-c of the public health law, as amended by chapter 731 of the laws 49 of 1993, is amended and a new subparagraph (vi) is added to read as 50 follows: 51 (v) adjustments for any modifications to the case payments determined 52 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of 53 this section[.]; and 54 (vi) adjustments for any modifications to the case payments determined 55 in accordance with subdivision twenty-two of section twenty-eight 56 hundred seven of this article. 
 A. 7220 4 1 § 5. Subdivision 34 of section 2807-c of the public health law is 2 amended by adding a new paragraph (d) to read as follows: 3 (d) Notwithstanding any inconsistent provision of law or regulation to 4 the contrary, adjustments made pursuant to this subdivision shall be in 5 addition to any adjustments made to medical assistance rates to enhanced 6 safety net hospitals authorized by subdivision twenty-two of section 7 twenty-eight hundred seven of this article. 8 § 6. Subdivision 1 of section 211 of chapter 474 of the laws of 1996 9 amending the education law and other laws relating to rates for residen- 10 tial health care facilities, is amended by adding a new paragraph (g) to 11 read as follows: 12 (g) Notwithstanding any inconsistent provision of law or regulation to 13 the contrary, effective for the state fiscal year beginning April 1, 14 2026, and annually thereafter, the department of health is authorized to 15 pay public general hospitals, other than those operated by the state of 16 New York or the state university of New York, as defined in subdivision 17 10 of section 2801 of the public health law, located in a city with a 18 population of over one million, additional payments for inpatient hospi- 19 tal services of 200 million dollars annually, as medical assistance 20 pursuant to title 11 of article 5 of the social services law for 21 patients eligible for federal financial participation under title XIX of 22 the federal social security act, pursuant to federal laws and regu- 23 lations governing disproportionate share payments to hospitals, based on 24 the relative share of each such non-state operated public general hospi- 25 tal medical assistance and uninsured patient losses. The payments may be 26 added to rates of payment or made as aggregate payments to an eligible 27 public general hospital. 28 § 7. Subdivision 1 of section 212 of chapter 474 of the laws of 1996 29 amending the education law and other laws relating to rates for residen- 30 tial health care facilities, is amended by adding a new paragraph (c) to 31 read as follows: 32 (c) Notwithstanding any inconsistent provision of law or regulation to 33 the contrary, effective for the state fiscal year beginning April 1, 34 2026, and annually thereafter, the department of health is authorized to 35 pay public general hospitals, as defined in subdivision 10 of section 36 2801 of the public health law, operated by the state of New York or the 37 state university of New York or by a county, which shall not include a 38 city with a population of over one million, of the state of New York, 39 and those public general hospitals located in the county of Westchester, 40 the county of Erie or the county of Nassau, additional payments for 41 inpatient hospital services of 100 million dollars annually, as medical 42 assistance payments pursuant to title 11 of article 5 of the social 43 services law for patients eligible for federal financial participation 44 under title XIX of the federal social security act, pursuant to federal 45 laws and regulations governing disproportionate share payments to hospi- 46 tals. The payments may be added to rates of payment or made as aggregate 47 payments to an eligible public general hospital. 48 § 8. This act shall take effect immediately; provided, however that 49 the amendments to paragraph (a) of subdivision 1 of section 2807-c of 50 the public health law made by section three of this act shall be subject 51 to the expiration and reversion of such paragraph when upon such date 52 the provisions of section four of this act shall take effect.