NY State Senate Bill 2023-S8928

Senate Bill S8928

2023-2024 Legislative Session

Relates to the general hospital indigent care pool and funding for safety net and enhanced safety net hospitals

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Current Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Mar 28, 2024	referred to health

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2023-S8928 (ACTIVE) - Details

See Assembly Version of this Bill:: A7217
Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Amd §§2807-k, 2807 & 2807-c, Pub Health L; amd §§211 & 212, Chap 474 of 1996
Versions Introduced in 2021-2022 Legislative Session:: S5954, A6883

2023-S8928 (ACTIVE) - Summary

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

2023-S8928 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S8928

SPONSOR: RIVERA
 
TITLE OF BILL:

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 inpa-
tient hospital services

 
PURPOSE OR GENERAL IDEA OF BILL:

Redistribute indigent care pool (ICP) funding to better target support
to safety net hospitals which provide services to persons who are unin-
sured, under insured, or insured by Medicaid.

 
SUMMARY OF SPECIFIC PROVISIONS:

  Section  1  amends  subdivision 5-d of section 2807-k of Public Health
Law (PHL), as it relates to the general hospital indigent care pool,  to

reduce  allocations to general hospitals other than major public general
hospitals, or qualified safety net general hospitals  by  $275  million.
This  section  also extends the removal of the transition collar enacted
in 2020 and retains the reduction of the  $25  million  associated  with
this  provision.  These  funds are distributed under other provisions of
the bill starting in 2021 and continuing every year thereafter.

  Section 2 of the bill adds a new subdivision 22 to PHL 2807 to author-
ize adjustments to Medicaid rates for Enhanced Safety Net  hospitals  as
defined  in the PHL, and to a newly defined category of Qualified Safety
Net hospitals. The new definition of Qualified Safety  Net  hospital  is
intended  for  hospitals  that  fall  outside of the enhanced safety net
definition, but provide significant indigent care, such  as  those  that
have  received  financial  assistance  through  the existing VBPQIPNAPAP
programs and hospitals on the state's financial watch  list;  the  defi-
nition  takes into account patient demographics, financial hardship, and
service provision.  This  section  also  requires  the  commissioner  to
increase  Medicaid  payments  for  inpatient  and outpatient services by
$34.125 million to major public general hospitals and  $228.375  million
to  Enhanced  Safety  Net  and Qualified Safety Net hospitals other than
major public general hospitals. An additional $12.5 million is dedicated
to federally designated critical access and  sole  community  hospitals.
This section increases rates/lump sum payments or using either VBPQIP or
other  supplemental  programs  to safety net hospitals (other than major
public general hospitals) that lose funds compared to  the  current  ICP
distribution.

  Sections 3 and 4 amend subdivision 1 of PHL 2807-c, which provides for
hospital  inpatient  Medicaid  payment  rates,  to allow adjustments for
modifications in case payments under the revised PHL 2807(22).

  Section 5 adds a new paragraph (d) to subdivision 34 of PHL 2807-c  to
make clear that payments to Enhanced Safety Net and Qualified Safety Net
hospitals  do  not supplant other funding streams to Enhanced Safety Net
hospitals.


  Sections 6 and 7 amend subdivision 1 of section 211 of Chapter 474  of
the  Laws  of  1996,  as  it relates to the education law and other laws
relating to rates for residential health care facilities,  by  adding  a
new   paragraph  (g)  to  allow  additional  $200  million  in  Medicaid
Disproportionate  Share  Hospital  (DSH) payments to NYC Health + Hospi-
tals, and additional $100 million annually in DSH  to  all  other  major
public  hospitals,  including  those  operated  by  the state, the State
University of New York, or Erie, Nassau, or Westchester counties.

 
JUSTIFICATION:

This legislation will fix inequities in  the  distribution  of  indigent
care pool (ICP) funds without hurting hospitals that provide services to
low  income  and  at  risk communities, by increasing Medicaid rates for
enhanced safety net and qualified safety net hospitals;  optimizing  new
federal  Medicaid  funds;  and  retaining  all existing federal Medicaid
Disproportionate Share Hospital (DSH) funds to support  these  essential
services.

This  legislation  will  rebalance  the  distribution without additional
financial impact to the State. The bill  better  targets  ICP  funds  to
uninsured  patient  care.  To  address the Medicaid rate issue, the bill
would invest $275 million of  ICP  funds  into  Medicaid  increases  for
enhanced  and qualified safety net hospitals. The investment by hospital
ownership type is proportional to the current pool funding  with  public
shares of ICP at 13% and voluntary shares of the ICP at 87%.

The  bill  builds  on  the  Enhanced  Safety  Net Hospitals statute, and
reforms enacted in 2020. The bill also  retains  the  reduction  of  $25
million related to the reforms enacted in 2020. It recognizes that addi-
tional hospitals are providing essential services to safety net communi-
ties and face serious financial jeopardy. Those hospitals are defined as
qualified safety net hospitals and may be identified by criteria includ-
ing  having  been  awarded  VAPAP or VBP QIP funds, or placed on the DOH
Financially Distressed Watch List; the volume of Medicaid  or  uninsured
patients  served;  or  the  importance of the hospital in the hospital's
region in providing services to Medicaid  and  uninsured  patients.  The
bill  would retain all existing federal DSH by allowing public hospitals
access to $300 million federal DSH formerly used for ICP.

The bill would increase Medicaid reimbursement rates for safety net  and
qualified  safety  net  hospitals;  dedicate funding for critical access
hospitals and sole community hospitals; and expand existing programs for
financially distressed hospitals to ensure no  harm  to  safety  net  or
qualified safety net hospitals.

 
PRIOR LEGISLATIVE HISTORY:

S5954/A6883 of 2021-22

S5546A/A6677B of 2020

 
FISCAL IMPLICATIONS:

None.

 
EFFECTIVE DATE:
Immediately.

2023-S8928 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8928
 
                             I N  S E N A T E
 
                              March 28, 2024
                                ___________
 
 Introduced  by  Sens. RIVERA, BAILEY, GOUNARDES, HOYLMAN-SIGAL, JACKSON,
   LIU, MYRIE, PARKER, PERSAUD, RAMOS, SALAZAR, STAVISKY, THOMAS --  read
   twice  and  ordered  printed,  and when printed to be committed 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:
 
   Section 1. Subparagraph (ii) of paragraph  b  of  subdivision  5-d  of
 section 2807-k of the public health law, as amended by section 1 of part
 E of chapter 57 of the laws of 2023, is amended to read as follows:
   (ii)  Annual  distributions  pursuant  to such regulations for the two
 thousand twenty through two thousand twenty-five calendar years AND EACH
 CALENDAR YEAR THEREAFTER shall be in accord with the following:
   (A) one hundred thirty-nine  million  four  hundred  thousand  dollars
 shall be distributed as Medicaid Disproportionate Share Hospital ("DSH")
 payments to major public general hospitals; and
   (B)  nine  hundred sixty-nine million nine hundred thousand dollars as
 Medicaid DSH payments to eligible general hospitals,  other  than  major
 public general hospitals.
   For  the calendar years two thousand twenty through two thousand twen-
 ty-two, the total distributions to  eligible  general  hospitals,  other
 than  major  public  general hospitals, shall be subject to an aggregate
 reduction of one hundred fifty million dollars annually,  provided  that
 eligible  general  hospitals, other than major public general hospitals,
 that qualify as enhanced safety net hospitals under section two thousand
 eight hundred seven-c of this article  shall  not  be  subject  to  such
 reduction.
   For  the calendar years two thousand twenty-three through two thousand
 twenty-five AND EACH CALENDAR YEAR THEREAFTER, the  total  distributions
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD08098-02-3
 S. 8928                             2
 
 to  eligible  general  hospitals, other than major public general hospi-
 tals, shall be subject to an aggregate reduction of two  hundred  [thir-
 ty-five]  SEVENTY-FIVE  million  four hundred thousand dollars annually,
 provided that eligible general hospitals, other than major public gener-
 al hospitals that qualify as enhanced safety net hospitals under section
 two  thousand  eight  hundred seven-c of this article as of April first,
 two thousand twenty, shall not be subject to such reduction.
   Such reductions shall be determined by a methodology to be established
 by the commissioner. Such methodologies may take into account the  payor
 mix  of  each  non-public  general hospital, including the percentage of
 inpatient days paid by Medicaid.
   § 2. Section 2807 of the public health law is amended by adding a  new
 subdivision 22 to read follows:
   22.  ADJUSTMENTS  TO  MEDICAID  RATES. (A) THE COMMISSIONER SHALL MAKE
 ADJUSTMENTS TO MEDICAL ASSISTANCE RATES IN ACCORDANCE WITH THIS SUBDIVI-
 SION 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 CRITICALLY NEED-
 ED  HEALTH  CARE  SERVICES  AND  TO ENSURE THE CONTINUED MAINTENANCE AND
 OPERATION OF SUCH HOSPITALS.
   (B) FOR THE PURPOSES OF THIS  SUBDIVISION,  A  "QUALIFIED  SAFETY  NET
 HOSPITAL"  SHALL  MEAN A GENERAL HOSPITAL, OTHER THAN AN ENHANCED SAFETY
 NET HOSPITAL THAT IN ANY OF THE PREVIOUS THREE CALENDAR YEARS:
   (I) HAS MET FOUR OF THE FIVE CRITERIA LISTED UNDER SUBPARAGRAPH (I) OF
 PARAGRAPH (A) OF SUBDIVISION THIRTY-FOUR OF SECTION TWENTY-EIGHT HUNDRED
 SEVEN-C OF THIS ARTICLE; OR
   (II) HAS MET THE FOLLOWING CRITERIA:
   (A) NOT LESS THAN FORTY-FIVE PERCENT OF THE PATIENTS IT TREATS RECEIVE
 MEDICAL ASSISTANCE OR ARE MEDICALLY UNINSURED;
   (B) NOT LESS THAN THIRTY-SIX PERCENT OF ITS INPATIENT  DISCHARGES  ARE
 COVERED BY MEDICAID;
   (C)  TWENTY-EIGHT  PERCENT  OR  LESS  OF  ITS  DISCHARGED PATIENTS ARE
 COMMERCIALLY INSURED;
   (D) NOT LESS THAN TWO PERCENT OF THE PATIENTS IT PROVIDES SERVICES  TO
 ARE ATTRIBUTED TO THE CARE OF UNINSURED PATIENTS; AND
   (E)  PROVIDES CARE TO UNINSURED PATIENTS IN ITS EMERGENCY ROOM, HOSPI-
 TAL-BASED CLINICS AND COMMUNITY BASED CLINICS, INCLUDING  THE  PROVISION
 OF  IMPORTANT COMMUNITY SERVICES, SUCH AS DENTAL CARE AND PRENATAL CARE;
 OR
   (III) IS SO DESIGNATED BY THE COMMISSIONER PURSUANT TO  FINDINGS  THAT
 TAKES INTO ACCOUNT THE FOLLOWING CRITERIA:
   (A)  THE  HOSPITAL IS OPERATING UNDER 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;
   (B) THE VOLUME OF MEDICAID AND/OR MEDICALLY UNINSURED PATIENTS  SERVED
 BY  THE HOSPITAL EXCEEDS THE AVERAGE VOLUME OF SUCH SERVICES PROVIDED BY
 OTHER HOSPITALS IN THE HOSPITAL'S REGION; AND
   (C) THE  IMPORTANCE  OF  THE  HOSPITAL  IN  ENABLING  MEDICAID  AND/OR
 MEDICALLY  UNINSURED  PATIENTS'  ACCESS TO HEALTH CARE SERVICES IN INPA-
 TIENT, OUTPATIENT AND COMMUNITY SETTINGS WITHIN THE HOSPITAL'S REGION.
   (C) FOR THE STATE FISCAL YEAR COMMENCING  APRIL  FIRST,  TWO  THOUSAND
 TWENTY-FOUR  AND  EACH  STATE  FISCAL  YEAR THEREAFTER, THE COMMISSIONER
 SHALL INCREASE MEDICAL ASSISTANCE RATES OF PAYMENTS FOR INPATIENT AND/OR
 S. 8928                             3
 
 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-FOUR  MILLION ONE HUNDRED TWENTY-FIVE THOUSAND DOLLARS FOR
 ENHANCED SAFETY NET HOSPITALS THAT ARE MAJOR PUBLIC GENERAL HOSPITALS;
   (II) TWO HUNDRED TWENTY-EIGHT MILLION THREE HUNDRED SEVENTY-FIVE THOU-
 SAND 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 HUNDRED SEVEN-K
 OF THIS ARTICLE FOR CALENDAR YEAR  TWO  THOUSAND  TWENTY-FOUR  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  HUNDRED 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
 FIRST AND APRIL FIRST OF EACH STATE FISCAL YEAR, TO SUCH ENHANCED SAFETY
 NET HOSPITALS AND QUALIFIED SAFETY NET HOSPITALS IN  ACCORDANCE  WITH  A
 METHODOLOGY  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-TWO  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-TWO  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:
 S. 8928                             4
 
   (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-TWO  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,
 2024, 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
 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,
 2024, 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 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.

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