What's happening
This bill requires rural hospitals designated as critical access hospitals to receive Medicaid payments equal to 101% of their reasonable costs, subject to appropriation.
Why it matters
Ensures financial stability for rural hospitals. By guaranteeing Medicaid payments at 101% of reasonable costs, the bill aims to help critical access hospitals cover their expenses, reducing the risk of closures that would limit healthcare options in rural communities.
Aligns state Medicaid payments with federal Medicare standards. The payment calculation method mirrors how Medicare reimburses critical access hospitals, potentially simplifying administration and ensuring consistency across government payers.
Improves access to a broad range of services. The bill covers various hospital services—including emergency, inpatient, outpatient, ambulatory surgical, and referred ambulatory care—helping rural residents maintain access to comprehensive medical care close to home.
Ties implementation to budget appropriations. The bill only takes effect if funding is specifically allocated, underscoring its dependence on state budget priorities and annual legislative approval, which could impact its reliability and timing.
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Who cares
Rural hospitals designated as critical access hospitals
Subject to an appropriation, the bill would set payment rates for specified services at 101% of reasonable costs beginning April 1, 2021.
Critical access hospitals without adequate cost experience
Rates would initially reflect budgeted costs and later be adjusted to 101% of reasonable actual costs.
Patients eligible for payments under the affected law
The bill would change reimbursement for their diagnostic, emergency, inpatient, outpatient, ambulatory surgical and referred ambulatory services at qualifying rural hospitals.
State lawmakers and budget officials
Implementation would depend on money appropriated specifically for these payments.
Headline styles
Fund Rural Critical Access Hospitals
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
History
- Referred to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Fund Rural Critical Hospitals
In Assembly Committee · Health · Sponsor Carrie Woerner
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
449
2019-2020 Regular Sessions
IN SENATE (Prefiled)
January 9, 2019
Introduced by Sen. HELMING -- 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 payments to rural hospitals designated as critical access hospitals
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 2-a of section 2807 of the public health law is amended by adding a new paragraph (j) to read as follows:
(j) Notwithstanding any other provision of this subdivision or any other provision of law to the contrary and, subject to an appropriation therefor, on and after April first, two thousand twenty-one, rates of payment for diagnostic and treatment center services, emergency services, general hospital inpatient and outpatient services, ambulatory surgical services and referred ambulatory services, provided by a rural hospital designated as a critical access hospital in accordance with title XVIII of the federal social security act shall be equal to one hundred one percent of the reasonable costs of a facility in providing such services to patients eligible for payments made in accordance with this subdivision. Reasonable costs shall be determined in a manner consistent with that used to determine payment for outpatient critical access hospital services provided to beneficiaries of title XVIII of the federal social security act. For facilities without adequate cost experience, such rates shall be based on budgeted costs subsequently adjusted to one hundred one percent of reasonable actual costs.
§ 2. This act shall take effect immediately; provided, however, that the implementation of the provisions of this act shall be subject to the appropriation of moneys specifically for the purposes thereof.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD01253-01-9
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the public health law, in relation to payments to rural hospitals designated as critical access hospitals
Purpose
To allow that on and after April 1, 2019, rural hospitals designated as critical access hospitals are paid by Medicaid in the same manner that Medicare pays critical access hospitals, which is on the basis of reasonable costs.
Summary of provisions
Amends Subdivision 2-a of section 2807 of the Public Health Law by adding a new paragraph (j) that on and after April 1, 2019, subject to funds being appropriated therefore, a rural hospital designated as a critical access hospital shall have Medicaid payments for emergency services, and all outpatient services equal to one hundred and one percent of the reasonable costs of such facility in providing these services.
Section two states the enactment date and requires that the implementa- tions of the provisions of the act be contingent upon moneys being specifically appropriated for that purpose.
Justification
Critical access hospitals serve medically underserved geographically isolated communities. They provide limited stay special care, acute care and swing bed services, as well as 24 hour emergency service capability. The maintenance of critical access hospitals is critical for preserving access to basic health care services for rural New Yorkers.
Cost based Medicaid reimbursement would help ensure the long range financial viability of primary care hospitals. New York State Medicaid reimbursement rates are presently capped at lower than operational costs. The problem is exacerbated for critical access hospitals because of the need to spread substantial fixed costs over a small number of visits and admissions. Medicare reimburses such hospitals (called crit- ical access hospitals under Medicare) on the basis of reasonable costs. This line helped stabilize such hospitals and ensure that isolated communities continue to have access to needed health care services. Having Medicaid payments, also equal reasonable costs will further ensure the financial viability of such hospitals.
The provisions of the act cannot be implemented unless moneys are specifically appropriated for that purpose.
Prior legislative history
2018: S.4536-A passed Senate 2017: S.4536 Referred to Rules 2016: S.6617 Passed Senate 2015: S.1287 Referred to Health 2013,2014: S.4376-A Referred to Health 2012: S.7371-B/A.10094-B Passed Both Houses,Veto Memo.148 2011: S.5431-A/A.5377-B Passed Both Houses,Veto Memo.80 2009,2010: S.4108-A/A.5347-A Referred to Health 2007,2008: S.7232/A.8783-A Referred to Health
Fiscal implications
This legislation is expected to cost the state $1.24 million and will ensure the financial viability of its thirteen critical access hospi- tals.
Effective date
This act shall take effect immediately; provided however, that the implementation of the provisions of this act shall be subject to the appropriation of moneys specifically for the purposes thereof.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.