2012 New York Consolidated Laws
PBH - Public Health
Article 28 - (2800 - 2823) HOSPITALS
2807-S - Professional education pool funding.

 
    * §  2807-s.  Professional  education pool funding. 1. (a) Payments to
  general hospitals by all specified third-party  payors,  as  defined  in
  paragraph (b) of subdivision one-a of this section, making payments on a
  rate,  charge, negotiated payment, or other basis for inpatient hospital
  services provided to persons  who  are  not  eligible  for  payments  as
  beneficiaries  of  title  XVIII  of  the  federal  social  security  act
  (medicare) or eligible for medical assistance pursuant to  title  eleven
  of  article  five  of  the  social  services law (including enrollees in
  medicaid managed care programs) or eligible for the family  health  plus
  program  pursuant  to  title  eleven-D  of  article  five  of the social
  services law, and related payments of patient deductible and coinsurance
  amounts and of secondary third-party payors, shall include  a  surcharge
  for  a  regional  allowance  on  inpatient  hospital net patient service
  revenues in the percentage amount  and  for  the  periods  specified  in
  subdivision  two  of this section. Any such allowance shall be submitted
  by general hospitals to the commissioner or the commissioner's  designee
  in accordance with subdivision five of this section.
    (b)  The  allowance  established pursuant to this section shall not be
  applicable to specified third-party payors filing an election and making
  payments  to  the  commissioner  or  the  commissioner's   designee   in
  accordance with section twenty-eight hundred-seven-t of this article and
  pursuant  to  paragraph  (a) of subdivision five of section twenty-eight
  hundred seven-j of this article, nor  to  related  payments  of  patient
  deductible and coinsurance amounts and of secondary third-party payors.
    1-a.  Definitions.  (a)  "Third-party  coverage", for purposes of this
  section and section twenty-eight hundred seven-t of this article,  shall
  include  payments  by  a  specified third-party payor making payments on
  behalf of a patient; whether made directly  to  a  general  hospital  or
  indirectly  as  indemnity  or  similar  payments made to the patient (or
  patient's representative such as parent or family member) for  inpatient
  hospital  services provided by a general hospital, or through the use of
  payments made payable to both the general hospital and  the  patient  or
  patient's representative, or similar devices.
    (b)  "Specified  third-party payors", for purposes of this section and
  sections twenty-eight hundred seven-j and twenty-eight  hundred  seven-t
  of  this  article, shall include corporations organized and operating in
  accordance with article forty-three of the insurance law,  organizations
  operating  in  accordance  with  the provisions of article forty-four of
  this chapter, self-insured funds and administrators acting on behalf  of
  self-insured funds, and commercial insurers authorized to write accident
  and  health  insurance  and whose policy provides coverage on an expense
  incurred basis. Specified  third-party  payors,  for  purposes  of  this
  section,  shall  not  include  governmental  agencies  or  providers  of
  coverage  pursuant  to  the  comprehensive   motor   vehicle   insurance
  reparations   act,   the   workers'   compensation  law,  the  volunteer
  firefighters' benefit law, or the volunteer ambulance  workers'  benefit
  law.
    (c)  "Regions",  for purposes of this section and section twenty-eight
  hundred seven-t of this article shall mean the  regions  as  defined  in
  paragraph  (b)  of  subdivision  sixteen of section twenty-eight hundred
  seven-c of this article as in effect on June thirtieth, nineteen hundred
  ninety-six.
    2. (a) The regional percentage allowance for  any  period  during  the
  period  January  first,  nineteen  hundred ninety-seven through December
  thirty-first, nineteen hundred ninety-nine for all general hospitals  in
  the  region  applicable to a specified third-party payor, and applicable
  to related patient coinsurance and deductible amounts and  to  secondary
  third-party  payors  under coordination of benefits principles, shall be

  the following, and shall be applied to inpatient  hospital  net  patient
  service revenues:
    (b) the result expressed as a percentage of:
    (i)  for each region, the amount allocated to the region in accordance
  with subdivision six of this section, divided by
    (ii) the total estimated nineteen hundred ninety-six general  hospital
  inpatient  revenue of all general hospitals in the region, excluding (A)
  an estimate of revenue from services provided to beneficiaries of  title
  XVIII  of the federal social security act (medicare), (B) an estimate of
  revenue from services provided to  patients  eligible  for  payments  by
  governmental  agencies,  patients  eligible for payments pursuant to the
  comprehensive motor vehicle  insurance  reparations  act,  the  workers'
  compensation  law,  the  volunteer  firefighters'  benefit  law, and the
  volunteer ambulance workers' benefit law,  and  self-pay  patients,  (C)
  from  general  hospitals  providing  graduate  medical  education in the
  aggregate an amount equal to the amount specified in subparagraph (i) of
  this subdivision, other than the components of such amount allocable  to
  payors specified in clause (B) of this subparagraph, and (D) an estimate
  of  revenue  reductions  related to negotiated reimbursement in nineteen
  hundred ninety-seven with specified third-party payors which shall be  a
  uniform statewide percentage estimated reduction.
    (c)  (i)  The  regional  percentage  allowance for the periods January
  first, two thousand through June thirtieth, two thousand three, for  all
  general  hospitals  in  the  region  applicable to specified third-party
  payors, and applicable to related  patient  coinsurance  and  deductible
  amounts,  shall  be  the  same  regional percentage allowance calculated
  pursuant to paragraph (b) of this subdivision  for  the  period  January
  first,  nineteen  hundred  ninety-nine  through  December  thirty-first,
  nineteen hundred ninety-nine.
    (ii) The regional percentage allowance for the periods July first, two
  thousand three through December thirty-first, two thousand five, for all
  general hospitals in the  region  applicable  to  specified  third-party
  payors,  and  applicable  to  related patient coinsurance and deductible
  amounts, shall be the  same  regional  percentage  allowance  calculated
  pursuant  to  paragraph  (b)  of this subdivision for the period January
  first,  nineteen  hundred  ninety-nine  through  December  thirty-first,
  nineteen  hundred  ninety-nine  multiplied  by  one  hundred  eight  and
  nineteen hundredths percent.
    (iii) The regional percentage allowance for the periods January first,
  two thousand six through June thirtieth, two  thousand  seven,  for  all
  general  hospitals  in  the  region  applicable to specified third-party
  payors, and applicable to related  patient  coinsurance  and  deductible
  amounts,  shall  be  the  same  regional percentage allowance calculated
  pursuant to subparagraph (ii) of this paragraph for the  period  January
  first,  two  thousand  five  through December thirty-first, two thousand
  five multiplied by one hundred one and thirteen hundredths percent.
    (iv) The regional percentage allowance for periods on and  after  July
  first,  two  thousand  seven,  for  all  general hospitals in the region
  applicable to specified third-party payors, and  applicable  to  related
  patient  coinsurance  and deductible amounts, shall be the same regional
  percentage allowance calculated pursuant to subparagraph (iii)  of  this
  paragraph  for  the  period January first, two thousand six through June
  thirtieth, two thousand seven.
    3. Inpatient hospital net patient service revenues,  for  purposes  of
  this  section,  shall mean for general hospitals all moneys received for
  or on account of inpatient hospital services provided  to  persons  with
  third-party  coverage  from  a  specified  third-party  payor, including
  capitation payments  allocable  to  inpatient  hospital  services,  less

  refunds,  for  patients  discharged  or  contracted  hospital  inpatient
  service obligations for periods on  or  after  January  first,  nineteen
  hundred  ninety-seven  excluding the following subject to the provisions
  of subdivision eight of this section:
    (a)   revenue   received  from  the  allowances  pursuant  to  section
  twenty-eight hundred seven-j of this article and this section; and
    (b) revenue received from physician practice or faculty practice  plan
  discrete billings for private practicing physician services.
    4.  (a)  For  periods  prior  to January first, two thousand five, the
  commissioner is authorized to  contract  with  the  article  forty-three
  insurance law plans, or such other contractors as the commissioner shall
  designate,   to   receive  and  distribute  funds  from  the  allowances
  established pursuant to this section  and  funds  from  the  assessments
  established  pursuant  to  section  twenty-eight hundred seven-t of this
  article. In the event contracts with the article  forty-three  insurance
  law  plans  or  other  commissioner's  designees  are  effectuated,  the
  commissioner shall conduct annual audits of the receipt and distribution
  of the funds. The reasonable costs and expenses of an  administrator  as
  approved by the commissioner, not to exceed for personnel services on an
  annual  basis  eight  hundred  fifty thousand dollars for collection and
  distribution of allowances established  pursuant  to  this  section  and
  assessments   established  pursuant  to  this  section  and  assessments
  established pursuant to section twenty-eight  hundred  seven-t  of  this
  article shall be paid from the allowance and assessment funds.
    (b)  Notwithstanding any inconsistent provision of section one hundred
  twelve or one hundred sixty-three of the state finance law or any  other
  law,  at the discretion of the commissioner without a competitive bid or
  request for proposal process, contracts in effect for administration  of
  bad  debt  and charity care pools for the period January first, nineteen
  hundred ninety-six through June thirtieth, nineteen  hundred  ninety-six
  pursuant  to section twenty-eight hundred seven-c of this article may be
  extended to provide for administration pursuant  to  this  section,  and
  section  twenty-eight hundred seven-t of this article and may be amended
  as may be necessary.
    5. Funds due  by  a  general  hospital  to  the  commissioner  or  the
  commissioner's  designee  from  the  allowance  pursuant to this section
  shall be due and shall be  collected  under  the  terms  and  conditions
  provided  for  payment  and collection of allowances pursuant to section
  twenty-eight hundred seven-j of this article.
    6. The amount allocated to each region for purposes of calculating the
  regional allowance percentage pursuant to this  section  for  each  year
  during  the  period January first, nineteen hundred ninety-seven through
  December thirty-first, nineteen hundred  ninety-nine  and  the  regional
  assessments  pursuant  to  section  twenty-eight hundred seven-t of this
  article for each year during the period January first, nineteen  hundred
  ninety-seven through December thirty-first, nineteen hundred ninety-nine
  and for each year on and after January first, two thousand, shall be the
  sum  of  the  factors  computed  in  paragraphs (b), (d) and (f) of this
  subdivision as follows:
    (a)  (i)  A  gross  annual  statewide  amount  for  nineteen   hundred
  ninety-seven shall be five hundred eighty-nine million dollars.
    (ii) A gross annual statewide amount for nineteen hundred ninety-eight
  shall be five hundred eighty-nine million dollars.
    (iii) A gross annual statewide amount for nineteen hundred ninety-nine
  shall be five hundred eighty-nine million dollars.
    (iv)  A  gross  annual statewide amount for two thousand shall be five
  hundred eighty-nine million dollars.

    (v) A gross annual statewide amount for two thousand one shall be five
  hundred sixty-nine million dollars.
    (vi)  A  gross  annual  statewide amount for two thousand two shall be
  five hundred eighty-nine million dollars.
    (vii) A gross annual statewide amount for two thousand three shall  be
  five hundred eighty-nine million dollars.
    (viii)  A  gross annual statewide amount for two thousand four and two
  thousand five shall be six hundred twenty-four million dollars.
    (ix) A gross annual statewide amount for two thousand six shall be six
  hundred seventy-four million dollars.
    (x) A gross  statewide  amount  for  the  period  January  first,  two
  thousand  seven  through March thirty-first, two thousand seven shall be
  one hundred sixty-eight million five hundred thousand dollars,  and  for
  the   period   April   first,   two   thousand  seven  through  December
  thirty-first, two thousand seven shall be five hundred sixty-one million
  seven hundred fifty thousand dollars.
    (xi) A gross statewide  amount  for  the  period  January  first,  two
  thousand  eight through March thirty-first, two thousand eight, shall be
  one hundred eighty-seven million two hundred fifty thousand dollars.
    (xii) A gross  statewide  amount  for  the  period  April  first,  two
  thousand  eight through December thirty-first, two thousand eight, shall
  be five hundred sixty-one million seven hundred fifty thousand dollars.
    (xiii) A gross statewide amount for  the  period  October  first,  two
  thousand  eight  through March thirty-first, two thousand nine, shall be
  one hundred seventy-four million  two  hundred  thousand  dollars.  Such
  amount shall be separately reported and paid in six monthly installments
  by  the tenth day of each month from October two thousand eight to March
  two thousand nine. Such reports and payments must initially be based  on
  each  payers' monthly enrollment count for the preceding month and shall
  be reconciled on a month to month basis to reflect  the  actual  monthly
  enrollment counts for the applicable month.
    (xiv)  A  gross  annual statewide amount for the period January first,
  two thousand nine through December thirty-first, two thousand  thirteen,
  shall be nine hundred forty-four million dollars.
    (xv)  A  gross  statewide  amount  for  the  period January first, two
  thousand fourteen through March  thirty-first,  two  thousand  fourteen,
  shall be two hundred thirty-six million dollars.
    (b) The amount specified in paragraph (a) of this subdivision shall be
  allocated among the regions based on each region's proportional share of
  the sum of the estimated revenue of all general hospitals in the region,
  excluding revenue related to services provided to beneficiaries of title
  XVIII  of  the  federal  social  security act (medicare), related to one
  hundred percent of the direct medical education expenses and  fifty-nine
  and five-tenths percent of indirect medical education expenses reflected
  in  general  hospital  inpatient  revenue  compared  to  the sum of such
  amounts for all regions, based on estimated nineteen hundred  ninety-six
  data  and  statistics,  excluding  an  estimate of revenue from services
  provided to patients eligible for  payments  by  governmental  agencies,
  patients  eligible  for  payments  pursuant  to  the comprehensive motor
  vehicle insurance reparations act, the workers'  compensation  law,  the
  volunteer   firefighters'  benefit  law,  and  the  volunteer  ambulance
  workers' benefit law, and self-pay patients.
    (c) (i) A further gross annual statewide amount for  nineteen  hundred
  ninety-seven shall be sixty-four million dollars.
    (ii)  A  further  gross  annual  statewide amount for nineteen hundred
  ninety-eight shall be sixty-four million dollars.
    (iii) A further gross annual statewide  amount  for  nineteen  hundred
  ninety-nine shall be eighty-nine million dollars.

    (iv)  A  further  gross  annual statewide amount for two thousand, two
  thousand one, two thousand two, two thousand three, two  thousand  four,
  two  thousand  five,  two thousand six, two thousand seven, two thousand
  eight, two thousand nine, two thousand ten,  two  thousand  eleven,  two
  thousand  twelve  and two thousand thirteen shall be eighty-nine million
  dollars.
    (v) A further gross statewide amount for the period January first, two
  thousand fourteen through March  thirty-first,  two  thousand  fourteen,
  shall be twenty-two million two hundred fifty thousand dollars.
    (d)  For  each  year,  the  amount  specified in paragraph (c) of this
  subdivision shall be allocated among  the  regions  based  on  the  same
  regional   percentage  allocations  as  determined  in  accordance  with
  paragraph (b) of this subdivision.
    (e) (i) A further  gross  annual  statewide  amount  shall  be  twelve
  million  dollars  for  each  period prior to January first, two thousand
  fourteen.
    (ii) A further gross statewide amount for the  period  January  first,
  two  thousand fourteen through March thirty-first, two thousand fourteen
  shall be three million dollars.
    (f) For each year, the amount  specified  in  paragraph  (e)  of  this
  subdivision  shall be allocated among the regions based on each region's
  allocated share of the AIDS drug assistance program expenditures for the
  latest annual period for which such data are available.
    7. Funds accumulated, including income from invested funds,  from  the
  allowances  specified  in  this  section and the assessments pursuant to
  section twenty-eight hundred seven-t of this article, including interest
  and  penalties,  shall  be  deposited  by  the   commissioner   or   the
  commissioner's designee as follows:
    (a)  funds  shall  be  accumulated  in regional professional education
  pools established by the  commissioner  or  the  healthcare  reform  act
  (HCRA)  resources  fund established pursuant to section ninety-two-dd of
  the state finance law, whichever  is  applicable,  for  distribution  in
  accordance with section twenty-eight hundred seven-m of this article, in
  the following amounts:
    (i)   ninety-two   and  forty-five-hundredths  percent  of  the  funds
  accumulated less seventy-six million  dollars  for  the  period  January
  first,  nineteen  hundred  ninety-seven  through  December thirty-first,
  nineteen hundred ninety-seven,
    (ii)  ninety-two  and  forty-five-hundredths  percent  of  the   funds
  accumulated  less  seventy-six  million  dollars  for the period January
  first, nineteen  hundred  ninety-eight  through  December  thirty-first,
  nineteen hundred ninety-eight,
    (iii)  ninety-two  and  forty-five-hundredths  percent  of  the  funds
  accumulated less one hundred one million dollars for the period  January
  first,  nineteen  hundred  ninety-nine  through  December  thirty-first,
  nineteen hundred ninety-nine,
    (iv) four hundred ninety-four million dollars on an annual  basis  for
  the  periods  January first, two thousand through December thirty-first,
  two thousand three,
    (v) four hundred sixty-three million dollars for  the  period  January
  first,  two  thousand  four  through December thirty-first, two thousand
  four,
    (vi) four hundred eighty-eight million dollars for the period  January
  first,  two  thousand  five  through December thirty-first, two thousand
  five,
    (vii) four hundred ninety-four million dollars for the period  January
  first, two thousand six through December thirty-first, two thousand six,

    (viii)  four  hundred  seventy  million dollars for the period January
  first, two thousand seven through December  thirty-first,  two  thousand
  seven,
    (ix)  four  hundred forty-six million six hundred thousand dollars for
  the  period  January  first,  two  thousand   eight   through   December
  thirty-first, two thousand eight,
    (x)  forty-seven million two hundred ten thousand dollars on an annual
  basis for the periods January first, two thousand nine through  December
  thirty-first, two thousand ten;
    (xi)  eleven  million  eight  hundred  thousand dollars for the period
  January first, two  thousand  eleven  through  March  thirty-first,  two
  thousand eleven;
    (xii)  twenty-three  million eight hundred thirty-six thousand dollars
  for  the  period  April  first,  two  thousand  eleven   through   March
  thirty-first, two thousand twelve;
    (xiii)  twenty-three million eight hundred thirty-six thousand dollars
  each state fiscal year for the period April first, two  thousand  twelve
  through March thirty-first, two thousand fourteen;
    (xiv)  provided,  however,  for  periods  prior  to January first, two
  thousand nine, amounts set forth in this paragraph may be reduced by the
  commissioner in an amount to be approved by the director of  the  budget
  to  reflect  the  amount  received from the federal government under the
  state's 1115 waiver which is directed under its terms and conditions  to
  the  graduate  medical education program established pursuant to section
  twenty-eight hundred seven-m of this article;
    (xv) provided further, however, for periods prior to July  first,  two
  thousand  nine,  amounts set forth in this paragraph shall be reduced by
  an amount equal to the total  actual  distribution  reductions  for  all
  facilities  pursuant  to  paragraph  (e) of subdivision three of section
  twenty-eight hundred seven-m of this article; and
    (xvi) provided further, however, for periods prior to July first,  two
  thousand  nine,  amounts set forth in this paragraph shall be reduced by
  an amount equal to the actual distribution reductions for all facilities
  pursuant to paragraph (s) of subdivision  one  of  section  twenty-eight
  hundred seven-m of this article.
    (b)  funds  shall  be added to the funds collected by the commissioner
  for distribution in accordance with section twenty-eight hundred seven-j
  of this article, in the following amounts:
    (i) seven and fifty-five-hundredths percent of the  funds  accumulated
  less  seventy-six million dollars for the period January first, nineteen
  hundred ninety-seven through  December  thirty-first,  nineteen  hundred
  ninety-seven,
    (ii)  seven and fifty-five-hundredths percent of the funds accumulated
  less seventy-six million dollars for the period January first,  nineteen
  hundred  ninety-eight  through  December  thirty-first, nineteen hundred
  ninety-eight,
    (iii) seven and fifty-five-hundredths percent of the funds accumulated
  less one hundred one million  dollars  for  the  period  January  first,
  nineteen  hundred  ninety-nine  through  December thirty-first, nineteen
  hundred ninety-nine,
    (iv) the remaining balance of the funds accumulated for each period on
  and after January first, two thousand; and
    (c) further funds shall  be  added  to  the  funds  collected  by  the
  commissioner  for  distribution  in accordance with section twenty-eight
  hundred seven-j of this article:
    (i) for the nineteen hundred ninety-seven period, seventy-six  million
  dollars;

    (ii) for the nineteen hundred ninety-eight period, seventy-six million
  dollars; and
    (iii)  for  the  nineteen  hundred ninety-nine period, one hundred one
  million dollars.
    8. Each exclusion from the allowances effective on  or  after  January
  first,  nineteen  hundred  ninety-seven  established  pursuant  to  this
  section shall be  contingent  upon  either:  (a)  qualification  of  the
  allowances  for  waiver  pursuant  to federal law and regulation; or (b)
  consistent with federal law and regulation, not requiring  a  waiver  by
  the  secretary of the department of health and human services related to
  such exclusion; in order for the allowances under  this  section  to  be
  qualified  as  a broad-based health care related tax for purposes of the
  revenues received by the state pursuant to the allowances  not  reducing
  the  amount  expended by the state as medical assistance for purposes of
  federal financial participation.  The  commissioner  shall  collect  the
  allowances  relying  on  such exclusions, pending any contrary action by
  the secretary of the department of health and  human  services.  In  the
  event  the  secretary  of  the  department  of health and human services
  determines that the allowances do not  so  qualify  based  on  any  such
  exclusion, then the exclusion shall be deemed to have been null and void
  as of January first, nineteen hundred ninety-seven, and the commissioner
  shall  collect  any retroactive amount due as a result, without interest
  or penalty provided the general hospital pays the retroactive amount due
  within ninety days of  notice  from  the  commissioner  to  the  general
  hospital  that  an  exclusion  is  null and void. Interest and penalties
  shall be measured from the due date of ninety days following notice from
  the commissioner or the commissioner's designee to the general hospital.
    9. Revenue from the allowances pursuant to this section shall  not  be
  included  in  gross  revenue  received  for  purposes of the assessments
  pursuant to subdivision eighteen of section twenty-eight hundred seven-c
  of  this  article,  subject  to  the  provisions  of  paragraph  (e)  of
  subdivision  eighteen  of  section  twenty-eight hundred seven-c of this
  article, and shall  not  be  included  in  gross  revenue  received  for
  purposes  of  the  assessments  pursuant to section twenty-eight hundred
  seven-d of this article, subject to the provisions of subdivision twelve
  of section twenty-eight hundred seven-d of this article.
    * NB Expires December 31, 2014