Amends the inpatient reimbursement rates for certain general hospitals

2 Co-sponsors

• William Parment
• Joseph Giglio

BILL NUMBER:A10119A

Title of bill

An act to amend the public health law, in relation to inpatient reimbursement rates for general hospitals

Purpose: Ensure that general hospitals which are the most severely impacted by Medicaid rebasing receive an add-on to their reimbursement rates that is equivalent to the difference between uninsured units of service and cost based methodologies for the 2009 indigent care pool distributions divided 2005 Medicaid fee-for-service discharges.

Summary of Provisions: Section 1. This legislation provides for the inpatient reimbursement rate add-on for general hospitals whose total Medicaid revenues resulting from Medicaid rebasing place an institution among the top five (5) percent hardest hit hospitals in the State in terms of the percentage of their Medicaid revenue losses.

Section 2. effective date: April 1, 2010

Justification: The Medicaid Fee for Service revenues resulting from the December 1, 2009 Medicaid rebasing had the unintended consequence of dramatically reducing Medicaid revenues to certain general hospitals in New York State. As a result, eight general hospitals rank among the top five (5) percent hardest hit hospitals in the state, experiencing total Medicaid revenue losses ranging from a reduction of 71.1 percent to a reduction of 54.1 percent. These losses are as much as nine times great- er than the statewide average Medicaid loss of 7.8 percent. Five of the most impacted hospitals are located in Western New York; one is located in Central New York; one on Long Island; and one in the Rochester area.The five most impacted Western New York hospitals are located in the counties of Erie, Chautauqua and Niagara, which are among the lowest ranked counties in New York State in terms of morbidity rates, health behaviors and physical environment, according to a major study commis- sioned by the Robert Wood Johnson Foundation.

To provide relief and correct the extreme inequities of Medicaid rebas- ing, this legislation authorizes the use of an inpatient rate add-on to the top five (5) percent hardest hit hospitals. This legislation provides that, effective April 1, 2010, an add-on to those qualifying hospitals shall be equivalent to the difference between the uninsured units of service and cost based methodologies for 2009 indigent care pool distributions divided by 2005 Medicaid fee-for-service discharges. This legislation recognizes that higher Medicaid Fee for Service reven- ues needs to be authorized for hospitals with a significant share of Medicaid patients in order to preserve access to Medicaid beneficiaries.

Legislative History: None

Fiscal Impact: Budget neutral.