Legislation

Search OpenLegislation Statutes
This entry was published on 2014-09-22
The selection dates indicate all change milestones for the entire volume, not just the location being viewed. Specifying a milestone date will retrieve the most recent version of the location before that date.
SECTION 364-J-2
Transitional supplemental payments
Social Services (SOS) CHAPTER 55, ARTICLE 5, TITLE 11
§ 364-j-2. Transitional supplemental payments. 1. As used in this
section, "covered provider" shall mean a voluntary not-for-profit health
care provider that is any of the following:

(a) a freestanding diagnostic and treatment center licensed under
article twenty-eight of the public health law that qualifies for a
distribution pursuant to section twenty-eight hundred seven-p of such
article, or section seven of chapter four hundred thirty-three of the
laws of nineteen hundred ninety-seven, or receives funding under section
three hundred thirty-three of the federal public health services act for
health care for the homeless; or

(b) a freestanding diagnostic and treatment center which operates an
approved program under the prenatal care assistance program established
pursuant to article twenty-five of the public health law; or

(c) a facility licensed under article twenty-eight of the public
health law that is sponsored by a university or dental school which has
been granted an operating certificate pursuant to article twenty-eight
of the public health law to provide dental services; or

(d) a freestanding family planning clinic licensed under article
twenty-eight of the public health law.

2. (a) Notwithstanding paragraphs (b) and (h) of subdivision two of
section twenty-eight hundred seven of the public health law, the
commissioner of health shall make supplemental payments of nine million
eight hundred twenty-four thousand dollars ($9,824,000), to covered
providers described in subdivision one of this section who are qualified
providers as described in paragraph (a) of subdivision three of this
section, based on adjustments to fee-for-service rates for the period
February first through March thirty-first, two thousand two and nine
million eight hundred twenty-four thousand dollars ($9,824,000) for the
period October first through December thirty-first, two thousand two and
four million nine hundred twelve thousand dollars ($4,912,000) for the
period October first through December thirty-first, two thousand three
and an additional amount of four million nine hundred twelve thousand
dollars ($4,912,000) for the period October first through December
thirty-first, two thousand three and nine million eight hundred
twenty-four thousand dollars ($9,824,000) for the period April first
through June thirtieth, two thousand five, and nine million eight
hundred twenty-four thousand dollars ($9,824,000) for the period October
first through December thirty-first, two thousand six, and an additional
nine million eight hundred twenty-four thousand dollars ($9,824,000) for
the period October first through December thirty-first, two thousand
six, and nine million eight hundred twenty-four thousand dollars
($9,824,000) for the period October first through December thirty-first,
two thousand seven, as medical assistance payments for services provided
pursuant to this title for persons eligible for federal financial
participation under title XIX of the federal social security act to
reflect additional costs associated with the transition to a managed
care environment, and nine million eight hundred twenty-four thousand
dollars ($9,824,000) for the period October first through December
thirty-first, two thousand eight, and seven million three hundred
eighty-eight thousand dollars ($7,388,000) for the period October first
through December thirty-first, two thousand nine, as medical assistance
payments for services provided pursuant to this title for persons
eligible for federal financial participation under title XIX of the
federal social security act to reflect additional costs associated with
the operation of electronic health record systems that meet such
standards as may be established by the commissioner of health. There
shall be no local share in these payments. The director of the budget
shall allocate the non-federal share of such payments from an
appropriation for the miscellaneous special revenue fund - 339 community
service provider assistance program account for the two thousand
one--two thousand two state fiscal year for adjustments for the period
February first through March thirty-first, two thousand two. Adjustments
for the period October first, two thousand two through December
thirty-first, two thousand two shall be within amounts appropriated for
the two thousand two--two thousand three state fiscal year and
adjustments for the period October first, two thousand three through
December thirty-first, two thousand three shall be within amounts
appropriated for the two thousand three--two thousand four state fiscal
year and adjustments for the non-federal share of the additional amount
of four million nine hundred twelve thousand dollars ($4,912,000) for
such period shall be allocated by the director of the budget from an
appropriation for maintenance undistributed general fund community
projects fund - 007 account for the two thousand three--two thousand
four state fiscal year. The director of the budget shall allocate the
non-federal share of adjustments for the period April first, two
thousand five through June thirtieth, two thousand five from an
appropriation for the maintenance undistributed general fund community
projects fund - 007 - cc account for the two thousand four--two thousand
five state fiscal year. The director of the budget shall allocate the
non-federal share of adjustments for the period October first, two
thousand six through December thirty-first, two thousand six from an
appropriation for the maintenance undistributed, general fund, community
projects fund - 007-cc account for the two thousand five--two thousand
six state fiscal year. The director of the budget shall allocate the
non-federal share of the additional adjustments for the period October
first, two thousand six through December thirty-first, two thousand six
from such funds as may be made available from an appropriation for the
maintenance undistributed, general fund, community projects fund -
007-cc account for the two thousand six--two thousand seven state fiscal
year. The director of the budget shall allocate the non-federal share of
the adjustments for the period October first, two thousand seven through
December thirty-first, two thousand seven from an appropriation for the
medical assistance program, general fund, local assistance account - 001
for the two thousand seven--two thousand eight state fiscal year. The
director of the budget shall allocate the non-federal share of the
adjustments for the period October first, two thousand eight through
December thirty-first, two thousand eight from an appropriation for the
medical assistance program, general fund, local assistance account - 001
for the two thousand eight--two thousand nine state fiscal year. The
director of the budget shall allocate the non-federal share of the
adjustments for the period October first, two thousand nine through
December thirty-first, two thousand nine from an appropriation for the
medical assistance program, general fund, local assistance account - 001
for the two thousand nine--two thousand ten state fiscal year. Such
adjustments to fee for service rates shall not be subject to subsequent
adjustment or reconciliation. Alternatively, such payments may be made
as aggregate payments to eligible providers.

(a-1) Notwithstanding the provisions of paragraph (a) of this
subdivision, for facilities licensed under article twenty-eight of the
public health law that are sponsored by a university or dental school
which has been granted an operating certificate pursuant to article
twenty-eight of the public health law and which provides dental services
as its principal mission, two hundred twenty-four thousand dollars
($224,000) in the aggregate for use pursuant to this section shall be
allocated for distribution to such facilities pursuant to the
methodology described in paragraph (b) of subdivision two and
subparagraph (i) of paragraph (b) of subdivision four of section two
thousand eight hundred seven-p of the public health law for services
provided for the period February first, two thousand two through March
thirty-first, two thousand two to persons eligible for federal financial
participation under title XIX of the federal social security act,
provided, however, that the amount paid pursuant to this paragraph for
each such facility shall equal the facility's proportional share of the
total nominal payment amounts calculated under this section of all such
facilities multiplied by the total funds allocated for such payments.
There shall be no local share in these payments. The director of the
budget shall allocate the non-federal share of such payments from an
appropriation for the miscellaneous special revenue fund - 339 community
service provider assistance program account for the two thousand
one--two thousand two state fiscal year. Such adjustments to fee for
service rates shall not be subject to subsequent adjustment or
reconciliation. Alternatively, such payments may be made as aggregate
payments to eligible providers.

(a-2) (i) Notwithstanding the provisions of paragraph (a) of this
subdivision, for facilities licensed under article twenty-eight of the
public health law that are sponsored by a university or dental school
which has been granted an operating certificate pursuant to article
twenty-eight of the public health law and which provides dental services
as its principal mission, two hundred twenty-four thousand dollars
($224,000) in the aggregate of the amount appropriated for the two
thousand two--two thousand three state fiscal year for use pursuant to
this section shall be allocated for the period October first through
December thirty-first, two thousand two and one hundred twelve thousand
dollars ($112,000) in the aggregate of the amount appropriated for the
two thousand three--two thousand four state fiscal year, and an
additional amount of one hundred twelve thousand dollars ($112,000) in
the aggregate for use pursuant to this section shall be allocated for
the period October first through December thirty-first, two thousand
three and two hundred twenty-four thousand dollars ($224,000) in the
aggregate of the amount appropriated for the two thousand four--two
thousand five state fiscal year shall be allocated for the period April
first, two thousand five through June thirtieth, two thousand five, and
two hundred twenty-four thousand dollars ($224,000) in the aggregate of
the amount appropriated for the two thousand five--two thousand six
state fiscal year shall be allocated for the period October first, two
thousand six through December thirty-first, two thousand six, and an
additional two hundred twenty-four thousand dollars ($224,000) in the
aggregate of the amount appropriated for the two thousand six--two
thousand seven state fiscal year shall be allocated for the period
October first, two thousand six through December thirty-first, two
thousand six, and two hundred twenty-four thousand dollars ($224,000) in
the aggregate of the amount appropriated for the two thousand seven--two
thousand eight state fiscal year shall be allocated for the period
October first, two thousand seven through December thirty-first, two
thousand seven, and two hundred twenty-four thousand dollars ($224,000)
in the aggregate of the amount appropriated for the two thousand
eight--two thousand nine state fiscal year shall be allocated for the
period October first, two thousand eight through December thirty-first,
two thousand eight and two hundred twenty-four thousand dollars
($224,000) in the aggregate of the amount appropriated for the two
thousand nine--two thousand ten state fiscal year shall be allocated for
the period October first, two thousand nine through December
thirty-first, two thousand nine for distribution to such facilities
pursuant to subparagraphs (ii) and (iii) of this paragraph. Adjustments
for the non-federal share of the additional amount of one hundred twelve
thousand dollars ($112,000) for the period October first, two thousand
three through December thirty-first, two thousand three shall be
allocated by the director of the budget from an appropriation for
maintenance undistributed general fund community projects fund - 007
account for the two thousand three--two thousand four state fiscal year.
The non-federal share of adjustments for the period April first, two
thousand five through June thirtieth, two thousand five shall be
allocated by the director of the budget from an appropriation for the
maintenance undistributed general fund community projects fund - 007
account for the two thousand four--two thousand five state fiscal year.
The non-federal share of adjustments for the period October first, two
thousand six through December thirty-first, two thousand six shall be
allocated by the director of the budget from an appropriation for the
maintenance undistributed, general fund, community projects fund -
007-cc account for the two thousand five--two thousand six state fiscal
year. The non-federal share of the additional adjustments for the period
October first, two thousand six through December thirty-first, two
thousand six shall, subject to the availability of funds, be allocated
by the director of the budget from the medical assistance local
assistance appropriation for the two thousand six--two thousand seven
state fiscal year. The non-federal share of the adjustments for the
period October first, two thousand seven through December thirty-first,
two thousand seven shall be allocated by the director of the budget from
an appropriation for the medical assistance program, general fund, local
assistance account - 001 for the two thousand seven--two thousand eight
state fiscal year. The non-federal share of the adjustments for the
period October first, two thousand eight through December thirty-first,
two thousand eight shall be allocated by the director of the budget from
an appropriation for the medical assistance program, general fund, local
assistance account - 001 for the two thousand eight--two thousand nine
state fiscal year. The non-federal share of the adjustments for the
period October first, two thousand nine through December thirty-first,
two thousand nine shall be allocated by the director of the budget from
an appropriation for the medical assistance program, general fund, local
assistance account - 001 for the two thousand nine--two thousand ten
state fiscal year.

(ii) Forty percent shall be allocated for equal distribution to such
facilities, reduced by the amount, if any, that a distribution exceeds
forty percent of a facility's uncompensated care need as defined in
paragraph (b) of subdivision two of section two thousand eight hundred
seven-p of the public health law. Any funds allocated but not
distributed in accordance with this subparagraph shall be added to those
amounts distributed in accordance with subparagraph (iii) of this
paragraph.

(iii) Sixty percent, plus any funds allocated and not distributed in
accordance with subparagraph (ii) of this paragraph, shall be allocated
for distribution to such facilities pursuant to the methodology
described in paragraph (b) of subdivision two and subparagraph (i) of
paragraph (b) of subdivision four of section two thousand eight hundred
seven-p of the public health law, provided, however, that the amount
paid pursuant to this allocation for each such facility shall equal the
facility's proportional share of the total nominal payment amounts
calculated under this section of all such facilities multiplied by the
total funds allocated for such payments.

(iv) There shall be no local share in these payments.

(b) Notwithstanding the provisions of subdivision one of section three
hundred sixty-eight-a of this title, there shall be paid to each social
services district the full amount expended on behalf of the department
of health for medical assistance furnished pursuant to the provisions of
this section, after first deducting therefrom any federal funds properly
received or to be received on account thereof.

3. (a) For periods prior to January first, two thousand eight, a
covered provider described in subdivision one of this section shall be
qualified to receive a supplemental payment only if its number of
medicaid visits for patient care services in the base year described in
subparagraph (ii) of paragraph (b) of this subdivision equals or exceeds
twenty-five percent of its total number of visits for patient care
services and its number of medicaid visits for patient care services for
medicaid managed care enrollees equals or exceeds three percent of its
total number of medicaid visits during the base year. For periods on and
after January first, two thousand eight, a covered provider described in
subdivision one of this section shall be qualified to receive a
supplemental payment only if it has in place during such period an
operational electronic health record system that meets such standards as
may be established by the commissioner of health and its number of
medicaid visits for patient care services in the base year described in
subparagraph (ii) of paragraph (b) of this subdivision equals or exceeds
twenty-five percent of its total number of visits for patient care
services during the base year or its number of medicaid visits combined
with its number of uninsured visits for patient care services in the
base year described in subparagraph (ii) of paragraph (b) of this
subdivision equals or exceeds thirty percent of its total number of
visits for patient care services during the base year.

(b) (i) For periods prior to January first, two thousand eight, each
qualified provider described in paragraph (a) of this subdivision shall
receive a supplemental payment equal to such provider's proportional
share of the total funds allocated pursuant to this section, based upon
the ratio of its visits from medical assistance recipients enrolled in
managed care during the base year to the total number of visits to all
such qualified providers by medical assistance recipients enrolled in
managed care during the base year. For periods on and after January
first, two thousand eight, each qualified provider described in
paragraph (a) of this subdivision shall receive a supplemental payment
equal to such provider's proportional share of the total funds allocated
pursuant to this section, based upon the ratio of its visits from
medical assistance recipients during the base year to the total number
of visits from medical assistance recipients to all such qualified
providers during the base year.

(ii) For periods prior to January first, two thousand eight, for
purposes of the calculation described in this subdivision, the base year
will be two thousand, and the commissioner of health shall utilize data
as reported on the 2000 AHCF-1 cost report initially submitted by
covered providers to the department of health on or about August
seventeenth, two thousand one. For periods on and after January first,
two thousand eight, for purposes of the calculation described in this
subdivision, the base year will be two years prior to the grant year,
and the commissioner of health shall utilize data as reported on AHCF-1
cost report submitted by covered providers to the department of health
for such base year.

4. Payments made pursuant to this section shall constitute additional
reimbursement to qualified providers and shall not be used to reduce
levels of other funding provided to qualified providers by governmental
agencies.

5. (a) The commissioner of health shall make medical assistance
payments to qualified providers from funds made available pursuant to
the provisions of this section contingent upon the receipt of all
federal approvals necessary and subject to the availability of federal
financial participation under title XIX of the federal social security
act for the transitional supplemental payments. In the event such
federal approval is not received prior to March thirty-first, two
thousand two, for adjustments for the period February first, two
thousand two through March thirty-first, two thousand two and prior to
October first, two thousand two for adjustments for the period October
first, two thousand two through December thirty-first, two thousand two
and prior to October first, two thousand three for adjustments for the
period October first, two thousand three through December thirty-first,
two thousand three, and prior to October first, two thousand five for
adjustments for the period April first, two thousand five through June
thirtieth, two thousand five, and prior to October first, two thousand
six for adjustments for the period October first, two thousand six
through December thirty-first, two thousand six, and prior to October
first, two thousand seven for adjustments for the period October first,
two thousand seven through December thirty-first, two thousand seven,
and prior to October first, two thousand eight for adjustments for the
period October first, two thousand eight through December thirty-first,
two thousand eight, and prior to October first, two thousand nine for
adjustments for the period October first, two thousand nine through
December thirty-first, two thousand nine, the commissioner of health
shall make medical assistance payments to qualified providers consisting
of the state share amount available for purposes of this section and
apportioned in accordance with subdivisions two and three of this
section. In the event such federal approval is denied, such state share
amount payments shall be deemed to be grants to such qualified providers
and such qualified providers shall not be eligible to receive any other
payments pursuant to this section.

(b) The commissioner of health shall take all steps necessary and
shall use best efforts to secure federal financial participation under
title XIX of the social security act, for the purposes of this section,
including the prompt submission of appropriate amendments to the title
XIX state plan.