senate Bill S5690

Vetoed By Governor
2013-2014 Legislative Session

Relates to diagnosis-related groups and service intensity weights for total hip joint replacement and total knee joint replacement inpatient cases for a general hospital

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Archive: Last Bill Status Via A403 - Vetoed by Governor


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Vetoed by Governor

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Actions

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Dec 18, 2013 tabled
vetoed memo.251
Dec 06, 2013 delivered to governor
Jun 20, 2013 returned to assembly
passed senate
3rd reading cal.1537
substituted for s5690
Jun 20, 2013 substituted by a403a
ordered to third reading cal.1537
committee discharged and committed to rules
Jun 10, 2013 reported and committed to finance
Jun 05, 2013 referred to health

Votes

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S5690 - Bill Details

See Assembly Version of this Bill:
A403A
Law Section:
Health

S5690 - Bill Texts

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Relates to diagnosis-related groups and service intensity weights for total hip joint replacement and total knee joint replacement inpatient cases for a general hospital.

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BILL NUMBER:S5690

TITLE OF BILL: An act in relation to diagnosis-related groups and
service intensity weights for total hip joint replacement and total
knee joint replacement inpatient cases for a general hospital

PURPOSE: To make financially viable an important Orthopedic/Sports
Medicine program at a small rural hospital that treats mainly patients
enrolled in commercial insurance plans,

SUMMARY OF PROVISIONS: This legislation would provide that for
reimbursement rates during the period January first, two thousand ten
through December thirty-first, two thousand thirteen, the commissioner
of health may determine that the diagnosis-related groups and service
intensity weights for total hip joint replacement and total knee joint
replacement inpatient cases for a general hospital shall be the
diagnosis-related groups and service intensity weights in effect on
December thirty-first, two thousand seven pursuant to subdivision
three of section 2807-c of the public health law.

The commissioner of health may make such a determination if the
majority of inpatient surgery cases for the general hospital are
orthopedic cases, the general hospital has developed a center of
excellence in orthopedic surgery and sports medicine, and the general
hospital incurred a significant reduction in non-governmental
reimbursement for such cases beginning in two thousand eight as a
result of revisions to the service intensity weights for these cases.
Such determination shall not affect the diagnosis related groups or
service intensity weights for any other cases or for any other general
hospital.

JUSTIFICATION: In 2008, the Department of Health began implementing
revised service intensity weights. Service intensity weights recognize
the typical resource consumption of a particular type of case, and
thus impact reimbursement for the case. Concerns were expressed that
the new weights did not properly include the cost of orthopedics and
prosthetics for hip and knee replacements, and that there may have
been a problem in the manner in which implants were reported on the
hospital cost reports. For most hospitals, orthopedics is not the
majority of their surgeries, and therefore this reporting problem was
not a major concern. However, Community Memorial Hospital in Hamilton
has developed orthopedics as a specialty service and this service
represents approximately 75% of its surgery cases.

In addition, most of such surgeries performed at Community Memorial
are paid for by commercial insurers, not Medicaid. While the weights
are set by the State for the specific purpose of Medicaid
reimbursement, many of the commercial insurers use the weights and the
diagnosis related groups established by the State for Medicaid
reimbursement. This legislation will only impact community Memorial
Hospital which, as a small rural hospital, is not able to negotiate
higher rates with these commercial insurers for these cases.

A safety net for the people of Central New York, Community Memorial
Hospital is dedicated to treating all patients regardless of ability
to pay. It has operated its Orthopedic Medicine program for more than
25 years and the program has won numerous national awards for quality,


serves as regional referral center. However, the financial jeopardy of
the hospital is threatened by the losses in this program. In order to
increase efficiency and reduce costs, Community Memorial is entering
into a passive parent relationship with Crouse Hospital, which will
produce more streamlined, cost-efficient care in Central New York.

Restoring the weights for these cases to their 2007 level will help
Community Memorial survive financially and help support its
relationship with Crouse Hospital.

LEGISLATIVE HISTORY: 2012: A.10701

FISCAL IMPLICATIONS: There would be no retroactive impact on State
Medicaid rates therefore the impact to the State would be minimal.

EFFECTIVE DATE: This act shall take effect immediately and, with the
exception of rates of payment made by state governmental agencies,
shall have been deemed to be in effect on and after January 1, 2010.

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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  5690

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                              June 5, 2013
                               ___________

Introduced  by  Sen. VALESKY -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

AN ACT in relation to diagnosis-related  groups  and  service  intensity
  weights  for total hip joint replacement and total knee joint replace-
  ment inpatient cases for a general hospital

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1.  Notwithstanding  any  contrary  provision of law or regu-
lation, for rate periods beginning January 1, 2010 and  ending  December
31,  2013,  the commissioner of health may determine that the diagnosis-
related groups  and  service  intensity  weights  for  total  hip  joint
replacement  and  total  knee  joint  replacement  inpatient cases for a
general hospital shall  be  the  diagnosis-related  groups  and  service
intensity weights in effect on December 31, 2007 pursuant to subdivision
3 of section 2807-c of the public health law. The commissioner of health
may make such a determination if the majority of inpatient surgery cases
for  the general hospital are orthopedic cases, the general hospital has
developed a center of excellence in orthopedic surgery and sports  medi-
cine,  and the general hospital incurred a significant reduction in non-
governmental reimbursement for such cases beginning in 2008 as a  result
of  revisions  to  the  service  intensity weights for these cases. Such
determination shall not affect the diagnosis-related groups  or  service
intensity weights for any other cases or for any other general hospital.
  S 2. This act shall take effect immediately and, with the exception of
rates of payment made by state governmental agencies, shall be deemed to
have been in full force and effect on and after January 1, 2010.


 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11371-01-3

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