S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6677
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 15, 2019
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  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, hospital  reimbursements  and  adjustments  to
   medical  assistance  rates  to  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 extending the effectiveness of such rates
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 5-d of section 2807-k of the public health law,
 as  amended by section 2 of part A of chapter 57 of the laws of 2018, is
 amended to read as follows:
   5-d. (a) Notwithstanding any inconsistent provision of  this  section,
 section  twenty-eight  hundred  seven-w  of  this  article  or any other
 contrary provision of law, and subject to the  availability  of  federal
 financial participation, for periods [on and after January] APRIL first,
 two thousand [thirteen,] NINETEEN through [March] DECEMBER thirty-first,
 two  thousand  [twenty]  NINETEEN AND EACH CALENDAR YEAR THEREAFTER, all
 funds available for distribution pursuant to this  section,  except  for
 funds  distributed  pursuant  to  subparagraph  (v)  of paragraph (b) of
 subdivision five-b of this section, and all funds available for distrib-
 ution pursuant to section twenty-eight hundred seven-w of this  article,
 shall  be  reserved and set aside and distributed in accordance with the
 provisions of this subdivision.
   (b) The commissioner shall promulgate regulations, and may  promulgate
 emergency  regulations,  establishing methodologies for the distribution
 of funds as described in paragraph (a)  of  this  subdivision  and  such
 regulations shall include, but not be limited to, the following:
   (i)  Such  regulations  shall  establish methodologies for determining
 each facility's relative uncompensated care need amount based  on  unin-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10355-02-9

 A. 6677                             2
 
 sured  inpatient and outpatient units of service from the cost reporting
 year two years prior to the distribution year, multiplied by the  appli-
 cable  medicaid  rates in effect January first of the distribution year,
 as summed and adjusted by a statewide cost adjustment factor and reduced
 by  the  sum  of  all  payment  amounts  collected  from  such uninsured
 patients, and as further adjusted  by  application  of  a  nominal  need
 computation  that shall take into account each facility's medicaid inpa-
 tient share.
   (ii) Annual distributions pursuant to such regulations  [for  the  two
 thousand thirteen through two thousand nineteen calendar years] FOR EACH
 CALENDAR  YEAR  BEGINNING  WITH  THE TWO THOUSAND NINETEEN CALENDAR YEAR
 shall be in accord with the following:
   (A) [one hundred thirty-nine million four  hundred  thousand  dollars]
 ONE HUNDRED ONE MILLION SEVEN HUNDRED THOUSAND DOLLARS FOR EACH CALENDAR
 YEAR  (PRORATED,  AS MAY BE NECESSARY, TO REFLECT ANY PERIOD LESS THAN A
 YEAR) shall be distributed as Medicaid Disproportionate  Share  Hospital
 ("DSH") payments to major public general hospitals; and
   (B)  [nine  hundred ninety-four million nine hundred thousand dollars]
 SEVEN HUNDRED SEVEN MILLION SIX HUNDRED THOUSAND DOLLARS FOR EACH CALEN-
 DAR YEAR (PRORATED, AS MAY BE NECESSARY, TO REFLECT ANY PERIOD LESS THAN
 A YEAR) as Medicaid DSH payments to eligible  general  hospitals,  other
 than major public general hospitals.
   (iii)[(A)  Such  regulations shall establish transition adjustments to
 the distributions made pursuant to clauses (A) and (B)  of  subparagraph
 (ii)  of this paragraph such that no facility experiences a reduction in
 indigent care pool payments pursuant to this subdivision that is greater
 than the percentages, as specified in clause (C) of this subparagraph as
 compared to the average distribution that each  such  facility  received
 for  the three calendar years prior to two thousand thirteen pursuant to
 this section and section twenty-eight hundred seven-w of this article.
   (B) Such regulations shall also  establish  adjustments  limiting  the
 increases  in  indigent  care  pool  payments  experienced by facilities
 pursuant to this subdivision by an amount that will be, as determined by
 the commissioner and in conjunction with such other funding  as  may  be
 available  for  this  purpose, sufficient to ensure full funding for the
 transition adjustment payments authorized by clause (A) of this subpara-
 graph.
   (C) No facility shall experience a reduction  in  indigent  care  pool
 payments pursuant to this subdivision that: for the calendar year begin-
 ning  January first, two thousand thirteen, is greater than two and one-
 half percent; for the calendar year beginning January first,  two  thou-
 sand  fourteen, is greater than five percent; and, for the calendar year
 beginning on January first, two thousand fifteen; is greater than  seven
 and  one-half  percent,  and  for the calendar year beginning on January
 first, two thousand sixteen, is greater than ten percent;  and  for  the
 calendar  year  beginning  on  January first, two thousand seventeen, is
 greater than twelve and one-half percent;  and  for  the  calendar  year
 beginning  on  January  first,  two  thousand  eighteen, is greater than
 fifteen percent; and for the calendar year beginning on  January  first,
 two thousand nineteen, is greater than seventeen and one-half percent.
   (iv)]  Such  regulations shall reserve one percent of the funds avail-
 able for distribution in the two  thousand  fourteen  and  two  thousand
 fifteen  calendar  years, and for calendar years thereafter, pursuant to
 this subdivision, subdivision fourteen-f of section twenty-eight hundred
 seven-c of this article, and sections two hundred eleven and two hundred
 twelve of chapter four hundred seventy-four  of  the  laws  of  nineteen

 A. 6677                             3
 
 hundred  ninety-six,  in  a  "financial  assistance compliance pool" and
 shall establish methodologies for the distribution of such pool funds to
 facilities based on their level of  compliance,  as  determined  by  the
 commissioner, with the provisions of subdivision nine-a of this section.
   (c)  The  commissioner  shall  annually report to the governor and the
 legislature on the distribution of funds under this subdivision  includ-
 ing, but not limited to:
   (i) the impact on safety net providers, including community providers,
 rural general hospitals and major public general hospitals;
   (ii)  the  provision  of  indigent care by units of services and funds
 distributed by general hospitals; and
   (iii) the extent to which access to care has been enhanced.
   § 2. Section 2807 of the public health law is amended by adding a  new
 subdivision 23 to read follows:
   23.  ADJUSTMENTS TO MEDICAID RATES. (A) THE COMMISSIONER IS AUTHORIZED
 TO MAKE ADJUSTMENTS TO MEDICAL ASSISTANCE RATES IN ACCORDANCE WITH  THIS
 SUBDIVISION  TO  ENHANCED  SAFETY NET HOSPITALS, AS DEFINED IN PARAGRAPH
 (A) OF SUBDIVISION THIRTY-FOUR OF SECTION TWENTY-EIGHT  HUNDRED  SEVEN-C
 OF  THIS  ARTICLE,  AND TO QUALIFIED SAFETY NET HOSPITALS, AS DEFINED IN
 PARAGRAPH (B) OF THIS SUBDIVISION, FOR THE PURPOSES OF SUPPORTING  CRIT-
 ICALLY  NEEDED  HEALTH CARE SERVICES AND TO ENSURE THE CONTINUED MAINTE-
 NANCE AND OPERATION OF SUCH HOSPITALS.
   (B) FOR THE PURPOSES OF THIS SUBDIVISION,  A  "QUALIFIED  SAFETY  NET"
 HOSPITAL SHALL MEAN A HOSPITAL, OTHER THAN AN ENHANCED SAFETY NET HOSPI-
 TAL, SO DESIGNATED BY THE COMMISSIONER PURSUANT TO CRITERIA DEVELOPED BY
 THE  COMMISSIONER  THAT  TAKE INTO ACCOUNT: (I) THE HOSPITAL'S FINANCIAL
 HARDSHIP, EVIDENCED BY THE OPERATING  LOSSES  OF  THE  HOSPITAL  OR  THE
 SYSTEM  OF  HOSPITALS TO WHICH THE HOSPITAL BELONGS AND/OR PARTICIPATION
 BY THE HOSPITAL IN PROGRAMS ESTABLISHED BY THE  COMMISSIONER  TO  ENABLE
 HOSPITALS  IN  FINANCIAL  DISTRESS  TO  MAINTAIN  OPERATIONS  AND  VITAL
 SERVICES;  (II)  THE  VOLUME  OF  MEDICAID  AND/OR  MEDICALLY  UNINSURED
 PATIENTS  SERVED  BY  THE  HOSPITAL  COMPARED  TO OTHER HOSPITALS IN THE
 HOSPITAL'S REGION; AND/OR (III) THE IMPORTANCE OF THE  HOSPITAL  IN  THE
 HOSPITAL'S  REGION  IN  ENABLING  MEDICAID  AND/OR  MEDICALLY  UNINSURED
 PATIENTS' ACCESS TO HEALTH CARE SERVICES IN  INPATIENT,  OUTPATIENT  AND
 COMMUNITY SETTINGS.
   (C)  FOR  THE  STATE  FISCAL YEAR COMMENCING APRIL FIRST, TWO THOUSAND
 NINETEEN, AND EACH STATE FISCAL YEAR THEREAFTER, THE COMMISSIONER  SHALL
 INCREASE  MEDICAL  ASSISTANCE  RATES  OF  PAYMENTS  FOR INPATIENT AND/OR
 OUTPATIENT SERVICES MADE BY EITHER STATE GOVERNMENTAL AGENCIES OR ORGAN-
 IZATIONS OPERATING IN ACCORDANCE WITH ARTICLE FORTY-THREE OF THE  INSUR-
 ANCE LAW OR ARTICLE FORTY-FOUR OF THIS CHAPTER BY AN AGGREGATE OF:
   (I)  THIRTY-SEVEN  MILLION SEVEN HUNDRED THOUSAND DOLLARS FOR ENHANCED
 SAFETY NET HOSPITALS THAT ARE MAJOR PUBLIC GENERAL HOSPITALS;
   (II) TWO HUNDRED SEVENTY-FOUR MILLION EIGHT HUNDRED  THOUSAND  DOLLARS
 FOR  QUALIFIED  SAFETY  NET  HOSPITALS AND ENHANCED SAFETY NET HOSPITALS
 OTHER THAN MAJOR PUBLIC GENERAL HOSPITALS,  OF  WHICH  AT  LEAST  TWELVE
 MILLION  FIVE  HUNDRED  THOUSAND  DOLLARS SHALL BE ALLOCATED TO ENHANCED
 SAFETY NET HOSPITALS THAT ARE FEDERALLY DESIGNATED AS CRITICAL ACCESS OR
 SOLE COMMUNITY HOSPITALS; AND
   (III) TWELVE MILLION FIVE HUNDRED THOUSAND DOLLARS FOR THOSE HOSPITALS
 ELIGIBLE UNDER  SUBPARAGRAPH  (II)  OF  THIS  PARAGRAPH  FOR  WHICH  THE
 COMBINED  PAYMENTS  MADE, OR TO BE MADE, UNDER SUBPARAGRAPH (II) OF THIS
 PARAGRAPH  AND  SUBDIVISION  FIVE-D  OF  SECTION  TWENTY-EIGHT  THOUSAND
 SEVEN-K  OF  THIS  ARTICLE  FOR CALENDAR YEAR TWO THOUSAND NINETEEN, AND
 EACH CALENDAR YEAR THEREAFTER, ARE PROJECTED BY THE COMMISSIONER  TO  BE

 A. 6677                             4
 
 LESS THAN PAYMENTS MADE TO SUCH HOSPITALS PURSUANT TO SUBDIVISION FIVE-D
 OF  SECTION  TWENTY-EIGHT  THOUSAND SEVEN-K OF THIS ARTICLE FOR CALENDAR
 YEAR TWO THOUSAND EIGHTEEN.
   (D)  PAYMENTS  MADE PURSUANT TO THIS SUBDIVISION MAY BE ADDED TO RATES
 OF PAYMENT, OR MADE AS AGGREGATE PAYMENTS OF EQUAL  AMOUNTS  ON  OCTOBER
 ONE AND APRIL ONE OF EACH STATE FISCAL YEAR, TO SUCH ENHANCED SAFETY NET
 HOSPITALS  AND QUALIFIED SAFETY NET HOSPITALS IN ACCORDANCE WITH A METH-
 ODOLOGY TO BE ESTABLISHED BY THE COMMISSIONER; PROVIDED, HOWEVER,  THAT,
 THE  COMMISSIONER  MAY  MAKE  THE  TWELVE  MILLION FIVE HUNDRED THOUSAND
 DOLLARS IN PAYMENTS DUE TO ELIGIBLE HOSPITALS UNDER  SUBPARAGRAPH  (III)
 OF  PARAGRAPH  (C)  OF THIS SUBDIVISION BY INSTEAD INCREASING THE AMOUNT
 OTHERWISE AWARDED TO SUCH ELIGIBLE HOSPITALS UNDER PROGRAMS  ESTABLISHED
 BY  THE  COMMISSIONER TO ENABLE HOSPITALS IN FINANCIAL DISTRESS TO MAIN-
 TAIN OPERATIONS AND VITAL SERVICES WHILE WORKING TO ACHIEVE  LONGER-TERM
 SUSTAINABILITY,  INCLUDING,  BUT NOT LIMITED TO, THE VALUE BASED PAYMENT
 QUALITY IMPROVEMENT PROGRAM.
   § 3. Subparagraph (v) of paragraph (a) of  subdivision  1  of  section
 2807-c  of  the public health law, as amended by chapter 639 of the laws
 of 1996, is amended and a new subparagraph (vi)  is  added  to  read  as
 follows:
   (v)  adjustments for any modifications to the case payments determined
 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
 this section[.]; AND
   (VI) ADJUSTMENTS FOR ANY MODIFICATIONS TO THE CASE PAYMENTS DETERMINED
 IN ACCORDANCE WITH  SUBDIVISION  TWENTY-THREE  OF  SECTION  TWENTY-EIGHT
 HUNDRED SEVEN OF THIS ARTICLE.
   §  4.  Subparagraph  (v)  of paragraph (a) of subdivision 1 of section
 2807-c of the public health law, as amended by chapter 731 of  the  laws
 of  1993,  is  amended  and  a new subparagraph (vi) is added to read as
 follows:
   (v) adjustments for any modifications to the case payments  determined
 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
 this section[.]; AND
   (VI) ADJUSTMENTS FOR ANY MODIFICATIONS TO THE CASE PAYMENTS DETERMINED
 IN  ACCORDANCE  WITH  SUBDIVISION  TWENTY-THREE  OF SECTION TWENTY-EIGHT
 HUNDRED SEVEN OF THIS ARTICLE.
   § 5. Subdivision 34 of section 2807-c of  the  public  health  law  is
 amended by adding a new paragraph (d) to read as follows:
   (D) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE  CONTRARY, ADJUSTMENTS MADE PURSUANT TO THIS SUBDIVISION SHALL BE IN
 ADDITION TO ANY ADJUSTMENTS MADE TO MEDICAL ASSISTANCE RATES TO ENHANCED
 SAFETY NET HOSPITALS AUTHORIZED BY SUBDIVISION TWENTY-THREE  OF  SECTION
 TWENTY-EIGHT HUNDRED SEVEN OF THIS ARTICLE.
   §  6.  Subdivision 1 of section 211 of chapter 474 of the laws of 1996
 amending the education law and other laws relating to rates for residen-
 tial health care facilities is amended by adding a new paragraph (g)  to
 read as follows:
   (G) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE  CONTRARY,  EFFECTIVE  FOR  THE STATE FISCAL YEAR BEGINNING APRIL 1,
 2019, AND ANNUALLY THEREAFTER, THE DEPARTMENT OF HEALTH IS AUTHORIZED TO
 PAY PUBLIC GENERAL HOSPITALS, OTHER THAN THOSE OPERATED BY THE STATE  OF
 NEW  YORK OR THE STATE UNIVERSITY OF NEW YORK, AS DEFINED IN SUBDIVISION
 10 OF SECTION 2801 OF THE PUBLIC HEALTH LAW, LOCATED IN A  CITY  WITH  A
 POPULATION OF OVER ONE MILLION, ADDITIONAL PAYMENTS FOR INPATIENT HOSPI-
 TAL  SERVICES  OF  200  MILLION  DOLLARS ANNUALLY, AS MEDICAL ASSISTANCE
 PURSUANT TO TITLE 11 OF  ARTICLE  5  OF  THE  SOCIAL  SERVICES  LAW  FOR

 A. 6677                             5
 
 PATIENTS ELIGIBLE FOR FEDERAL FINANCIAL PARTICIPATION UNDER TITLE XIX OF
 THE  FEDERAL  SOCIAL  SECURITY  ACT,  PURSUANT TO FEDERAL LAWS AND REGU-
 LATIONS GOVERNING DISPROPORTIONATE SHARE PAYMENTS TO HOSPITALS, BASED ON
 THE RELATIVE SHARE OF EACH SUCH NON-STATE OPERATED PUBLIC GENERAL HOSPI-
 TAL MEDICAL ASSISTANCE AND UNINSURED PATIENT LOSSES. THE PAYMENTS MAY BE
 ADDED  TO  RATES OF PAYMENT OR MADE AS AGGREGATE PAYMENTS TO AN ELIGIBLE
 PUBLIC GENERAL HOSPITAL.
   § 7. Subdivision 1 of section 212 of chapter 474 of the laws  of  1996
 amending the education law and other laws relating to rates for residen-
 tial health care facilities, is amended by adding a new paragraph (c) to
 read as follows:
   (C) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE  CONTRARY,  EFFECTIVE  FOR  THE STATE FISCAL YEAR BEGINNING APRIL 1,
 2019, AND ANNUALLY THEREAFTER, THE DEPARTMENT OF HEALTH IS AUTHORIZED TO
 PAY PUBLIC GENERAL HOSPITALS, AS DEFINED IN SUBDIVISION  10  OF  SECTION
 2801  OF THE PUBLIC HEALTH LAW, OPERATED BY THE STATE OF NEW YORK OR THE
 STATE UNIVERSITY OF NEW YORK OR BY A COUNTY, WHICH SHALL NOT  INCLUDE  A
 CITY  WITH  A  POPULATION OF OVER ONE MILLION, OF THE STATE OF NEW YORK,
 AND THOSE PUBLIC GENERAL HOSPITALS LOCATED IN THE COUNTY OF WESTCHESTER,
 THE COUNTY OF ERIE OR THE COUNTY  OF  NASSAU,  ADDITIONAL  PAYMENTS  FOR
 INPATIENT  HOSPITAL SERVICES OF 100 MILLION DOLLARS ANNUALLY, AS MEDICAL
 ASSISTANCE PAYMENTS PURSUANT TO TITLE 11 OF  ARTICLE  5  OF  THE  SOCIAL
 SERVICES  LAW  FOR PATIENTS ELIGIBLE FOR FEDERAL FINANCIAL PARTICIPATION
 UNDER TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT, PURSUANT TO  FEDERAL
 LAWS AND REGULATIONS GOVERNING DISPROPORTIONATE SHARE PAYMENTS TO HOSPI-
 TALS. THE PAYMENTS MAY BE ADDED TO RATES OF PAYMENT OR MADE AS AGGREGATE
 PAYMENTS TO AN ELIGIBLE PUBLIC GENERAL HOSPITAL.
   §  8.  This  act shall take effect immediately; provided however, that
 the amendments made to paragraph (a) of subdivision 1 of section  2807-c
 of  the  public health law by section three of this act shall be subject
 to the expiration and reversion of such paragraph when  upon  such  date
 the provisions of section four of this act shall take effect.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6677--A
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 15, 2019
                                ___________
 
 Introduced by M. of A. GOTTFRIED, REYES, DICKENS, MOSLEY, WEPRIN, RODRI-
   GUEZ,  SANTABARBARA  --  read  once  and  referred to the Committee on
   Health -- committee discharged, bill  amended,  ordered  reprinted  as
   amended and recommitted to said committee
 
 AN ACT to amend the public health law, in relation to the general hospi-
   tal  indigent  care  pool,  hospital reimbursements and adjustments to
   medical assistance rates to 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 extending the effectiveness of such rates
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivision 5-d of section 2807-k of the public health law,
 as amended by section 6 of part H of chapter 57 of the laws of 2019,  is
 amended to read as follows:
   5-d.  (a)  Notwithstanding any inconsistent provision of this section,
 section twenty-eight hundred  seven-w  of  this  article  or  any  other
 contrary  provision  of  law, and subject to the availability of federal
 financial participation, for periods [on and after January] APRIL first,
 two thousand [thirteen,] NINETEEN through [March] DECEMBER thirty-first,
 two thousand [twenty] NINETEEN AND EACH CALENDAR  YEAR  THEREAFTER,  all
 funds  available  for distribution pursuant to this section, [except for
 funds distributed pursuant to  subparagraph  (v)  of  paragraph  (b)  of
 subdivision  five-b  of  this  section,]  and  all  funds  available for
 distribution pursuant to section twenty-eight hundred  seven-w  of  this
 article,  shall  be reserved and set aside and distributed in accordance
 with the provisions of this subdivision.
   (b) The commissioner shall promulgate regulations, and may  promulgate
 emergency  regulations,  establishing methodologies for the distribution
 of funds as described in paragraph (a)  of  this  subdivision  and  such
 regulations shall include, but not be limited to, the following:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD10355-04-9

 A. 6677--A                          2
 
   (i)  Such  regulations  shall  establish methodologies for determining
 each facility's relative uncompensated care need amount based  on  unin-
 sured  inpatient and outpatient units of service from the cost reporting
 year two years prior to the distribution year, multiplied by the  appli-
 cable  medicaid  rates in effect January first of the distribution year,
 as summed and adjusted by a statewide cost adjustment factor and reduced
 by the  sum  of  all  payment  amounts  collected  from  such  uninsured
 patients,  and  as  further  adjusted  by  application of a nominal need
 computation that shall take into account each facility's medicaid  inpa-
 tient share.
   (ii)  Annual  distributions  pursuant to such regulations for [the two
 thousand thirteen through  two  thousand  twenty  calendar  years]  EACH
 CALENDAR  YEAR  BEGINNING  WITH  THE TWO THOUSAND NINETEEN CALENDAR YEAR
 shall be in accord with the following:
   (A) [one hundred thirty-nine million four  hundred  thousand  dollars]
 ONE HUNDRED ONE MILLION SEVEN HUNDRED THOUSAND DOLLARS FOR EACH CALENDAR
 YEAR  (PRORATED,  AS MAY BE NECESSARY, TO REFLECT ANY PERIOD LESS THAN A
 YEAR) shall be distributed as Medicaid Disproportionate  Share  Hospital
 ("DSH") payments to major public general hospitals; and
   (B)  [nine  hundred ninety-four million nine hundred thousand dollars]
 SEVEN HUNDRED SEVEN MILLION SIX HUNDRED THOUSAND DOLLARS FOR EACH CALEN-
 DAR YEAR (PRORATED, AS MAY BE NECESSARY, TO REFLECT ANY PERIOD LESS THAN
 A YEAR) as Medicaid DSH payments to eligible  general  hospitals,  other
 than major public general hospitals.
   (iii)[(A)  Such  regulations shall establish transition adjustments to
 the distributions made pursuant to clauses (A) and (B)  of  subparagraph
 (ii)  of this paragraph such that no facility experiences a reduction in
 indigent care pool payments pursuant to this subdivision that is greater
 than the percentages, as specified in clause (C) of this subparagraph as
 compared to the average distribution that each  such  facility  received
 for  the three calendar years prior to two thousand thirteen pursuant to
 this section and section twenty-eight hundred seven-w of this article.
   (B) Such regulations shall also  establish  adjustments  limiting  the
 increases  in  indigent  care  pool  payments  experienced by facilities
 pursuant to this subdivision by an amount that will be, as determined by
 the commissioner and in conjunction with such other funding  as  may  be
 available  for  this  purpose, sufficient to ensure full funding for the
 transition adjustment payments authorized by clause (A) of this subpara-
 graph.
   (C) No facility shall experience a reduction  in  indigent  care  pool
 payments pursuant to this subdivision that: for the calendar year begin-
 ning  January first, two thousand thirteen, is greater than two and one-
 half percent; for the calendar year beginning January first,  two  thou-
 sand  fourteen, is greater than five percent; and, for the calendar year
 beginning on January first, two thousand fifteen; is greater than  seven
 and  one-half  percent,  and  for the calendar year beginning on January
 first, two thousand sixteen, is greater than ten percent;  and  for  the
 calendar  year  beginning  on  January first, two thousand seventeen, is
 greater than twelve and one-half percent;  and  for  the  calendar  year
 beginning  on  January  first,  two  thousand  eighteen, is greater than
 fifteen percent; and for the calendar year beginning on  January  first,
 two  thousand  nineteen, is greater than seventeen and one-half percent;
 and for the calendar year beginning on January first, two thousand twen-
 ty, is greater than twenty percent.
   (iv)] Such regulations shall reserve one percent of the  funds  avail-
 able  for  distribution  in  the  two thousand fourteen and two thousand

 A. 6677--A                          3
 
 fifteen calendar years, and for calendar years thereafter,  pursuant  to
 this subdivision, subdivision fourteen-f of section twenty-eight hundred
 seven-c of this article, and sections two hundred eleven and two hundred
 twelve  of  chapter  four  hundred  seventy-four of the laws of nineteen
 hundred ninety-six, in a  "financial  assistance  compliance  pool"  and
 shall establish methodologies for the distribution of such pool funds to
 facilities  based  on  their  level  of compliance, as determined by the
 commissioner, with the provisions of subdivision nine-a of this section.
   (c) The commissioner shall annually report to  the  governor  and  the
 legislature  on the distribution of funds under this subdivision includ-
 ing, but not limited to:
   (i) the impact on safety net providers, including community providers,
 rural general hospitals and major public general hospitals;
   (ii) the provision of indigent care by units  of  services  and  funds
 distributed by general hospitals; and
   (iii) the extent to which access to care has been enhanced.
   §  2. Section 2807 of the public health law is amended by adding a new
 subdivision 23 to read follows:
   23. ADJUSTMENTS TO MEDICAID RATES. (A) THE COMMISSIONER IS  AUTHORIZED
 TO  MAKE ADJUSTMENTS TO MEDICAL ASSISTANCE RATES IN ACCORDANCE WITH THIS
 SUBDIVISION TO ENHANCED SAFETY NET HOSPITALS, AS  DEFINED  IN  PARAGRAPH
 (A)  OF  SUBDIVISION THIRTY-FOUR OF SECTION TWENTY-EIGHT HUNDRED SEVEN-C
 OF THIS ARTICLE, AND TO QUALIFIED SAFETY NET HOSPITALS,  AS  DEFINED  IN
 PARAGRAPH  (B) OF THIS SUBDIVISION, FOR THE PURPOSES OF SUPPORTING CRIT-
 ICALLY NEEDED HEALTH CARE SERVICES AND TO ENSURE THE  CONTINUED  MAINTE-
 NANCE AND OPERATION OF SUCH HOSPITALS.
   (B)  FOR  THE  PURPOSES  OF THIS SUBDIVISION, A "QUALIFIED SAFETY NET"
 HOSPITAL SHALL MEAN A HOSPITAL, OTHER THAN AN ENHANCED SAFETY NET HOSPI-
 TAL, SO DESIGNATED BY THE COMMISSIONER PURSUANT TO CRITERIA DEVELOPED BY
 THE COMMISSIONER THAT TAKE INTO ACCOUNT: (I)  THE  HOSPITAL'S  FINANCIAL
 HARDSHIP,  EVIDENCED  BY  THE  OPERATING  LOSSES  OF THE HOSPITAL OR THE
 SYSTEM OF HOSPITALS TO WHICH THE HOSPITAL BELONGS  AND/OR  PARTICIPATION
 BY  THE  HOSPITAL  IN PROGRAMS ESTABLISHED BY THE COMMISSIONER TO ENABLE
 HOSPITALS  IN  FINANCIAL  DISTRESS  TO  MAINTAIN  OPERATIONS  AND  VITAL
 SERVICES;  (II)  THE  VOLUME  OF  MEDICAID  AND/OR  MEDICALLY  UNINSURED
 PATIENTS SERVED BY THE HOSPITAL  COMPARED  TO  OTHER  HOSPITALS  IN  THE
 HOSPITAL'S  REGION;  AND/OR  (III) THE IMPORTANCE OF THE HOSPITAL IN THE
 HOSPITAL'S  REGION  IN  ENABLING  MEDICAID  AND/OR  MEDICALLY  UNINSURED
 PATIENTS'  ACCESS  TO  HEALTH CARE SERVICES IN INPATIENT, OUTPATIENT AND
 COMMUNITY SETTINGS.
   (C) FOR THE STATE FISCAL YEAR COMMENCING  APRIL  FIRST,  TWO  THOUSAND
 NINETEEN,  AND EACH STATE FISCAL YEAR THEREAFTER, THE COMMISSIONER SHALL
 INCREASE MEDICAL ASSISTANCE  RATES  OF  PAYMENTS  FOR  INPATIENT  AND/OR
 OUTPATIENT SERVICES MADE BY EITHER STATE GOVERNMENTAL AGENCIES OR ORGAN-
 IZATIONS  OPERATING IN ACCORDANCE WITH ARTICLE FORTY-THREE OF THE INSUR-
 ANCE LAW OR ARTICLE FORTY-FOUR OF THIS CHAPTER BY AN AGGREGATE OF:
   (I) THIRTY-SEVEN MILLION SEVEN HUNDRED THOUSAND DOLLARS  FOR  ENHANCED
 SAFETY NET HOSPITALS THAT ARE MAJOR PUBLIC GENERAL HOSPITALS;
   (II)  TWO  HUNDRED SEVENTY-FOUR MILLION EIGHT HUNDRED THOUSAND DOLLARS
 FOR QUALIFIED SAFETY NET HOSPITALS AND  ENHANCED  SAFETY  NET  HOSPITALS
 OTHER  THAN  MAJOR  PUBLIC  GENERAL  HOSPITALS, OF WHICH AT LEAST TWELVE
 MILLION FIVE HUNDRED THOUSAND DOLLARS SHALL  BE  ALLOCATED  TO  ENHANCED
 SAFETY NET HOSPITALS THAT ARE FEDERALLY DESIGNATED AS CRITICAL ACCESS OR
 SOLE COMMUNITY HOSPITALS; AND
   (III) TWELVE MILLION FIVE HUNDRED THOUSAND DOLLARS FOR THOSE HOSPITALS
 ELIGIBLE  UNDER  SUBPARAGRAPH  (II)  OF  THIS  PARAGRAPH  FOR  WHICH THE

 A. 6677--A                          4
 
 COMBINED PAYMENTS MADE, OR TO BE MADE, UNDER SUBPARAGRAPH (II)  OF  THIS
 PARAGRAPH  AND  SUBDIVISION  FIVE-D  OF  SECTION  TWENTY-EIGHT  THOUSAND
 SEVEN-K OF THIS ARTICLE FOR CALENDAR YEAR  TWO  THOUSAND  NINETEEN,  AND
 EACH  CALENDAR  YEAR THEREAFTER, ARE PROJECTED BY THE COMMISSIONER TO BE
 LESS THAN PAYMENTS MADE TO SUCH HOSPITALS PURSUANT TO SUBDIVISION FIVE-D
 OF SECTION TWENTY-EIGHT THOUSAND SEVEN-K OF THIS  ARTICLE  FOR  CALENDAR
 YEAR TWO THOUSAND EIGHTEEN.
   (D)  PAYMENTS  MADE PURSUANT TO THIS SUBDIVISION MAY BE ADDED TO RATES
 OF PAYMENT, OR MADE AS AGGREGATE PAYMENTS OF EQUAL  AMOUNTS  ON  OCTOBER
 ONE AND APRIL ONE OF EACH STATE FISCAL YEAR, TO SUCH ENHANCED SAFETY NET
 HOSPITALS  AND QUALIFIED SAFETY NET HOSPITALS IN ACCORDANCE WITH A METH-
 ODOLOGY TO BE ESTABLISHED BY THE COMMISSIONER; PROVIDED, HOWEVER,  THAT,
 THE  COMMISSIONER  MAY  MAKE  THE  TWELVE  MILLION FIVE HUNDRED THOUSAND
 DOLLARS IN PAYMENTS DUE TO ELIGIBLE HOSPITALS UNDER  SUBPARAGRAPH  (III)
 OF  PARAGRAPH  (C)  OF THIS SUBDIVISION BY INSTEAD INCREASING THE AMOUNT
 OTHERWISE AWARDED TO SUCH ELIGIBLE HOSPITALS UNDER PROGRAMS  ESTABLISHED
 BY  THE  COMMISSIONER TO ENABLE HOSPITALS IN FINANCIAL DISTRESS TO MAIN-
 TAIN OPERATIONS AND VITAL SERVICES WHILE WORKING TO ACHIEVE  LONGER-TERM
 SUSTAINABILITY,  INCLUDING,  BUT NOT LIMITED TO, THE VALUE BASED PAYMENT
 QUALITY IMPROVEMENT PROGRAM.
   § 3. Subparagraph (v) of paragraph (a) of  subdivision  1  of  section
 2807-c  of  the public health law, as amended by chapter 639 of the laws
 of 1996, is amended and a new subparagraph (vi)  is  added  to  read  as
 follows:
   (v)  adjustments for any modifications to the case payments determined
 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
 this section[.]; AND
   (VI) ADJUSTMENTS FOR ANY MODIFICATIONS TO THE CASE PAYMENTS DETERMINED
 IN ACCORDANCE WITH  SUBDIVISION  TWENTY-THREE  OF  SECTION  TWENTY-EIGHT
 HUNDRED SEVEN OF THIS ARTICLE.
   §  4.  Subparagraph  (v)  of paragraph (a) of subdivision 1 of section
 2807-c of the public health law, as amended by chapter 731 of  the  laws
 of  1993,  is  amended  and  a new subparagraph (vi) is added to read as
 follows:
   (v) adjustments for any modifications to the case payments  determined
 in accordance with paragraph (a), (b), (c) or (d) of subdivision four of
 this section[.]; AND
   (VI) ADJUSTMENTS FOR ANY MODIFICATIONS TO THE CASE PAYMENTS DETERMINED
 IN  ACCORDANCE  WITH  SUBDIVISION  TWENTY-THREE  OF SECTION TWENTY-EIGHT
 HUNDRED SEVEN OF THIS ARTICLE.
   § 5. Subdivision 34 of section 2807-c of  the  public  health  law  is
 amended by adding a new paragraph (d) to read as follows:
   (D) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE  CONTRARY, ADJUSTMENTS MADE PURSUANT TO THIS SUBDIVISION SHALL BE IN
 ADDITION TO ANY ADJUSTMENTS MADE TO MEDICAL ASSISTANCE RATES TO ENHANCED
 SAFETY NET HOSPITALS AUTHORIZED BY SUBDIVISION TWENTY-THREE  OF  SECTION
 TWENTY-EIGHT HUNDRED SEVEN OF THIS ARTICLE.
   §  6.  Subdivision 1 of section 211 of chapter 474 of the laws of 1996
 amending the education law and other laws relating to rates for residen-
 tial health care facilities is amended by adding a new paragraph (g)  to
 read as follows:
   (G) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE  CONTRARY,  EFFECTIVE  FOR  THE STATE FISCAL YEAR BEGINNING APRIL 1,
 2019, AND ANNUALLY THEREAFTER, THE DEPARTMENT OF HEALTH IS AUTHORIZED TO
 PAY PUBLIC GENERAL HOSPITALS, OTHER THAN THOSE OPERATED BY THE STATE  OF
 NEW  YORK OR THE STATE UNIVERSITY OF NEW YORK, AS DEFINED IN SUBDIVISION

 A. 6677--A                          5
 
 10 OF SECTION 2801 OF THE PUBLIC HEALTH LAW, LOCATED IN A  CITY  WITH  A
 POPULATION OF OVER ONE MILLION, ADDITIONAL PAYMENTS FOR INPATIENT HOSPI-
 TAL  SERVICES  OF  200  MILLION  DOLLARS ANNUALLY, AS MEDICAL ASSISTANCE
 PURSUANT  TO  TITLE  11  OF  ARTICLE  5  OF  THE SOCIAL SERVICES LAW FOR
 PATIENTS ELIGIBLE FOR FEDERAL FINANCIAL PARTICIPATION UNDER TITLE XIX OF
 THE FEDERAL SOCIAL SECURITY ACT, PURSUANT  TO  FEDERAL  LAWS  AND  REGU-
 LATIONS GOVERNING DISPROPORTIONATE SHARE PAYMENTS TO HOSPITALS, BASED ON
 THE RELATIVE SHARE OF EACH SUCH NON-STATE OPERATED PUBLIC GENERAL HOSPI-
 TAL MEDICAL ASSISTANCE AND UNINSURED PATIENT LOSSES. THE PAYMENTS MAY BE
 ADDED  TO  RATES OF PAYMENT OR MADE AS AGGREGATE PAYMENTS TO AN ELIGIBLE
 PUBLIC GENERAL HOSPITAL.
   § 7. Subdivision 1 of section 212 of chapter 474 of the laws  of  1996
 amending the education law and other laws relating to rates for residen-
 tial health care facilities, is amended by adding a new paragraph (c) to
 read as follows:
   (C) NOTWITHSTANDING ANY INCONSISTENT PROVISION OF LAW OR REGULATION TO
 THE  CONTRARY,  EFFECTIVE  FOR  THE STATE FISCAL YEAR BEGINNING APRIL 1,
 2019, AND ANNUALLY THEREAFTER, THE DEPARTMENT OF HEALTH IS AUTHORIZED TO
 PAY PUBLIC GENERAL HOSPITALS, AS DEFINED IN SUBDIVISION  10  OF  SECTION
 2801  OF THE PUBLIC HEALTH LAW, OPERATED BY THE STATE OF NEW YORK OR THE
 STATE UNIVERSITY OF NEW YORK OR BY A COUNTY, WHICH SHALL NOT  INCLUDE  A
 CITY  WITH  A  POPULATION OF OVER ONE MILLION, OF THE STATE OF NEW YORK,
 AND THOSE PUBLIC GENERAL HOSPITALS LOCATED IN THE COUNTY OF WESTCHESTER,
 THE COUNTY OF ERIE OR THE COUNTY  OF  NASSAU,  ADDITIONAL  PAYMENTS  FOR
 INPATIENT  HOSPITAL SERVICES OF 100 MILLION DOLLARS ANNUALLY, AS MEDICAL
 ASSISTANCE PAYMENTS PURSUANT TO TITLE 11 OF  ARTICLE  5  OF  THE  SOCIAL
 SERVICES  LAW  FOR PATIENTS ELIGIBLE FOR FEDERAL FINANCIAL PARTICIPATION
 UNDER TITLE XIX OF THE FEDERAL SOCIAL SECURITY ACT, PURSUANT TO  FEDERAL
 LAWS AND REGULATIONS GOVERNING DISPROPORTIONATE SHARE PAYMENTS TO HOSPI-
 TALS. THE PAYMENTS MAY BE ADDED TO RATES OF PAYMENT OR MADE AS AGGREGATE
 PAYMENTS TO AN ELIGIBLE PUBLIC GENERAL HOSPITAL.
   §  8.  This  act shall take effect immediately; provided however, that
 the amendments made to paragraph (a) of subdivision 1 of section  2807-c
 of  the  public  health  law  made by section three of this act shall be
 subject to the expiration and reversion of such paragraph when upon such
 date the provisions of section four of this act shall take effect.