Assembly Bill A6766A

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6766--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                May 8, 2023
                                ___________
 
 Introduced  by  M.  of  A.  PAULIN,  SEPTIMO,  McDONALD -- read once and
   referred to the Committee on  Health  --  committee  discharged,  bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee
 
 AN ACT to amend the public health law, in relation to setting reimburse-
   ment rates for essential safety net hospitals

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Section  2807-c  of  the  public health law is amended by
 adding a new subdivision 34-a to read as follows:
   34-A. HEALTH EQUITY STABILIZATION AND TRANSFORMATION ACT.  (A) FOR THE
 PURPOSES OF THIS SUBDIVISION,  "ESSENTIAL  SAFETY  NET  HOSPITAL"  SHALL
 MEAN:
   (I)  ANY  HOSPITAL  ELIGIBLE FOR PARTICIPATION IN THE DIRECTED PAYMENT
 TEMPLATE (DPT) PREPRINT SUBMITTED BY THE STATE TO THE CENTERS FOR  MEDI-
 CAID AND MEDICARE SERVICES FOR FISCAL YEAR TWO THOUSAND TWENTY-THREE;
   (II)  ANY NON-STATE PUBLIC HOSPITAL OPERATED BY A COUNTY, MUNICIPALITY
 OR PUBLIC BENEFIT CORPORATION; OR
   (III) IS AN ACUTE  CHILDREN'S  HOSPITAL  LICENSED  BY  THE  DEPARTMENT
 PRIMARILY FOR THE PROVISION OF PEDIATRIC AND NEONATAL SERVICES FOR WHICH
 A  DISCRETE  INSTITUTIONAL  COST  REPORT  WAS FILED FOR THE PAST   THREE
 CALENDAR YEARS, AND WHICH HAS MEDICAID   DISCHARGES IN EXCESS  OF  FIFTY
 PERCENT OF IT'S TOTAL DISCHARGES.
   (IV)  ANY  VOLUNTARY  HOSPITAL  CERTIFIED UNDER THIS ARTICLE THAT IS A
 GENERAL HOSPITAL, WHICH, IN ANY OF THE PREVIOUS  THREE  CALENDAR  YEARS,
 HAS MET THE FOLLOWING CRITERIA:
   (A)  AT  LEAST  THIRTY-SIX PERCENT OF INPATIENT VOLUMES ARE ASSOCIATED
 WITH MEDICAID AND UNINSURED INDIVIDUALS;
   (B) AT LEAST THIRTY-SIX PERCENT OF OUTPATIENT VOLUMES  ARE  ASSOCIATED
 WITH MEDICAID AND UNINSURED INDIVIDUALS; AND
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10306-06-3
 A. 6766--A                          2
              

 
   (C)  NO  MORE  THAN TWENTY PERCENT OF INPATIENT VOLUMES ARE ASSOCIATED
 WITH COMMERCIALLY INSURED INDIVIDUALS.
   (B)  FOR PURPOSES OF THIS SUBDIVISION, "ESSENTIAL SAFETY NET HOSPITAL"
 SHALL NOT INCLUDE HOSPITALS THAT ARE (I) PUBLIC  HOSPITALS  OPERATED  BY
 THE  STATE;  (II)  FEDERALLY  DESIGNATED  AS A CRITICAL ACCESS HOSPITAL;
 (III) FEDERALLY DESIGNATED AS A  SOLE  COMMUNITY  HOSPITAL;  OR  (IV)  A
 SPECIALTY HOSPITAL.
   (C)  FOR  PURPOSES  OF  THIS SUBDIVISION, "HEALTH CARE SERVICES" SHALL
 INCLUDE, BUT IS NOT LIMITED TO, ACUTE  INPATIENT  DISCHARGES,  INPATIENT
 PSYCHIATRIC  DAYS, AMBULATORY SURGERY VISITS, EMERGENCY ROOM VISITS, AND
 OUTPATIENT CLINIC SERVICES.
   (D) FOR ESSENTIAL SAFETY NET HOSPITALS THAT QUALIFY PURSUANT TO  PARA-
 GRAPH (A) OF THIS SUBDIVISION, THE COMMISSIONER SHALL, SUBJECT TO FEDER-
 AL  APPROVAL,  REQUIRE  INPATIENT HOSPITAL RATES AND HOSPITAL OUTPATIENT
 RATES PAID BY THE MEDICAL ASSISTANCE PROGRAM FOR  SERVICES  PROVIDED  TO
 PATIENTS ENROLLED IN MEDICAID MANAGED CARE TO REIMBURSE THE ENTIRE CLASS
 OF  ESSENTIAL  SAFETY NET HOSPITALS IN EACH GEOGRAPHIC REGION AT NO LESS
 THAN REGIONAL AVERAGE COMMERCIAL RATES FOR HEALTH CARE SERVICES PROVIDED
 BY ALL HOSPITALS IN THE SAME GEOGRAPHIC REGION, AS REPORTED IN A  BENCH-
 MARKING DATABASE MAINTAINED BY A NONPROFIT ORGANIZATION SPECIFIED BY THE
 COMMISSIONER.  SUCH  NONPROFIT ORGANIZATION SHALL NOT BE AFFILIATED WITH
 AN INSURER, A CORPORATION SUBJECT TO ARTICLE FORTY-THREE OF  THE  INSUR-
 ANCE LAW, A MUNICIPAL COOPERATIVE HEALTH BENEFIT PLAN CERTIFIED PURSUANT
 TO ARTICLE FORTY-SEVEN OF THE INSURANCE LAW, A HEALTH MAINTENANCE ORGAN-
 IZATION  CERTIFIED  PURSUANT TO ARTICLE FORTY-FOUR OF THIS CHAPTER, OR A
 PROVIDER LICENSED UNDER THIS CHAPTER.  FOR PURPOSES OF THIS PARAGRAPH:
   (I) THE COMMISSIONER SHALL ESTABLISH  GEOGRAPHIC  REGIONS  WITHIN  THE
 STATE  FOR ESTABLISHING THE REGIONAL AVERAGE COMMERCIAL RATE. ONE REGION
 SHALL CONSIST OF THE AVERAGE COMMERCIAL RATE FOR  SERVICES  PROVIDED  IN
 THE FOLLOWING COUNTIES: BRONX, KINGS, NEW YORK, QUEENS, AND RICHMOND.
   (II)  THE  REGIONAL  AVERAGE  COMMERCIAL RATE FOR HEALTH CARE SERVICES
 SHALL REFLECT THE MOST RECENT  TWELVE-MONTH  PERIOD  IN  WHICH  DATA  ON
 COMMERCIAL  RATES  IS AVAILABLE, AND SHALL BE UPDATED NO LESS FREQUENTLY
 THAN EVERY TWO YEARS, PROVIDED THAT THE AVERAGE COMMERCIAL RATE SHALL BE
 TRENDED FORWARD TO ADJUST FOR INFLATION ON AN ANNUAL BASIS BETWEEN  SUCH
 UPDATES.  SUCH ADJUSTMENT SHALL BE MADE BY A FEDERALLY RECOGNIZED METRIC
 AS DETERMINED BY THE COMMISSIONER.
   (III)  THE  COMMISSIONER  SHALL  ENSURE  THAT ALL ESSENTIAL SAFETY NET
 HOSPITALS SHALL RECEIVE THE RATES DEFINED IN THIS PARAGRAPH. THE COMMIS-
 SIONER SHALL NOT EXCLUDE ANY QUALIFYING ESSENTIAL SAFETY NET  HOSPITALS,
 INCLUDING PUBLIC HOSPITALS.
   (E)  MANAGED CARE ORGANIZATIONS SHALL PROVIDE WRITTEN CERTIFICATION TO
 THE COMMISSIONER ON A QUARTERLY BASIS THAT  ALL  PAYMENTS  TO  ESSENTIAL
 SAFETY NET HOSPITALS ARE MADE IN COMPLIANCE WITH THIS SUBDIVISION AND IN
 ACCORDANCE  WITH SECTION THREE THOUSAND TWO HUNDRED TWENTY-FOUR-A OF THE
 INSURANCE LAW.
   (F) ANY HOSPITAL QUALIFYING  UNDER  THIS  SUBDIVISION  SHALL  ANNUALLY
 REPORT  TO THE DEPARTMENT DEMONSTRATING THAT IT MEETS THE CRITERIA AS AN
 ESSENTIAL SAFETY NET HOSPITAL. THE REPORT SHALL ALSO INCLUDE INFORMATION
 TO DEMONSTRATE HOW INCREASED REIMBURSEMENT HAS BEEN UTILIZED TO  IMPROVE
 PATIENT  ACCESS,  PATIENT  QUALITY AND PATIENT EXPERIENCE.   SUCH REPORT
 SHALL ALSO INCLUDE SPECIFIC EFFORTS MADE TO IMPROVE MATERNAL HEALTH.
   (G) THE COMMISSIONER SHALL MAKE ANY QUALITY DATA REPORTED BY ESSENTIAL
 SAFETY NET HOSPITALS PURSUANT  TO  PARAGRAPH  (F)  OF  THIS  SUBDIVISION
 PUBLICLY AVAILABLE IN A MANNER THAT IS USEFUL FOR PATIENTS TO MAKE QUAL-
 A. 6766--A                          3
 
 ITY  DETERMINATIONS.    SUCH  INFORMATION SHALL BE POSTED ON THE DEPART-
 MENT'S WEBSITE.
   (H)  NO  LATER  THAN  SEPTEMBER  FIRST, TWO THOUSAND TWENTY-THREE, THE
 COMMISSIONER SHALL PROVIDE THE GOVERNOR, THE TEMPORARY PRESIDENT OF  THE
 SENATE  AND THE SPEAKER OF THE ASSEMBLY WITH A REPORT ON THE FEASIBILITY
 OF OBTAINING A STATE PLAN AMENDMENT TO MODIFY THE MEDICAID  FEE-FOR-SER-
 VICE  RATES  FOR  HEALTH  CARE SERVICES IN THE MANNER PRESCRIBED IN THIS
 SUBDIVISION.   THE REPORT SHALL  ALSO  BE  POSTED  ON  THE  DEPARTMENT'S
 WEBSITE.
   §  2.  This  act shall take effect July 1, 2023. Effective immediately
 the commissioner of health shall make such rules  and  regulations,  and
 seek  any federal approvals necessary for the implementation of this act
 on its effective date.