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, if such factors are applicable to a given year, 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 fourteen,
shall be nine hundred forty-four million dollars.

(xv) A gross annual statewide amount for the period January first, two
thousand fifteen through December thirty-first, two thousand twenty-two,
shall be one billion forty-five million dollars.

(xvi) A gross annual statewide amount for the period January first,
two thousand twenty-three to December thirty-first, two thousand
twenty-six shall be one billion eighty-five million dollars, forty
million dollars annually of which shall be allocated under section
twenty-eight hundred seven-o of this article among the municipalities of
and the state of New York based on each municipality's share and the
state's share of early intervention program expenditures not
reimbursable by the medical assistance program for the latest twelve
month period for which such data is available.

(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 annual statewide amount for the period January
first, two thousand fourteen through December thirty-first, two thousand
fourteen, shall be eighty-nine million 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) A further gross annual statewide amount shall be twelve million
dollars for each period prior to January first, two thousand fifteen.

(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.

(g) A further gross statewide amount for the state fiscal year two
thousand twenty-two shall be forty million dollars.

(h) The amount specified in paragraph (g) of this subdivision shall be
allocated under section twenty-eight hundred seven-o of this article
among the municipalities and the state of New York based on each
municipality's share and the state's share of early intervention program
expenditures not reimbursable by the medical assistance program for the
latest twelve month period for which such data is 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 twenty-six;

(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.

(d) funds shall be added to the funds collected by the commissioner
for distribution in accordance with section twenty-eight hundred seven-o
of this article, in the following amount: forty million dollars for the
period beginning April first, two thousand twenty-two, and continuing
each state fiscal year thereafter.

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, 2026