High need indigent care adjustment pool

§ 2807-w. High need indigent care adjustment pool. Funds allocated
pursuant to paragraph (p) of subdivision one of section twenty-eight
hundred seven-v of this article, shall be deposited as authorized and
used for the purpose of making medicaid disproportionate share payments
of up to eighty-two million dollars on an annualized basis pursuant to
subdivision twenty-one of section twenty-eight hundred seven-c of this
article, for the period January first, two thousand through March
thirty-first, two thousand fourteen, in accordance with the following:

1. From the funds in the pool each year: (a) Each eligible rural
hospital shall receive one hundred forty thousand dollars on an
annualized basis for the periods January first, two thousand through
December thirty-first, two thousand fourteen, provided as a
disproportionate share payment; provided, however, that if such payment
pursuant to this paragraph exceeds a hospital's applicable
disproportionate share limit, then the total amount in excess of such
limit shall be provided as a nondisproportionate share payment in the
form of a grant directly from this pool without allocation to the
special revenue funds - other, indigent care fund - 068, or any
successor fund or account, and provided further that payments for
periods on and after January first, two thousand nine shall be subject
to the provisions of subdivision five-a of section twenty-eight hundred
seven-k of this article;

(b) Each such hospital shall also receive an amount calculated by
multiplying the facility's uncompensated care need by the appropriate
percentage from the following scale based on hospital rankings developed
in accordance with each eligible rural hospital's weight as defined by
this section.

Rank Percentage Coverage of

Uncompensated Care Need

1-9 60.0%

10-17 52.5%

18-25 45.0%

26-33 37.5%

34-41 30.0%

42-49 22.5%

50-57 15.0%

58+ 7.5%

For purposes of calculating the distribution amount to an eligible
rural hospital which has merged with another hospital on or after
December thirty-first, nineteen hundred ninety-nine, and continues to be
an eligible rural hospital in accordance with paragraph (c) of this
subdivision, such merged facility's uncompensated care need pursuant to
this paragraph shall be calculated from data provided in the eligible
rural hospital's institutional cost report filed for the rate period two
years prior to the distribution period, or if such report is not
required for such rural hospital, the distribution amount shall be based
upon the last institutional cost report required to be filed by such
rural hospital.

(c) "Eligible rural hospital", as used in this section, shall mean a
general hospital that as of December thirty-first, nineteen hundred
ninety-nine or thereafter, was classified as a rural hospital for
purposes of determining payment for inpatient services provided to
beneficiaries of title XVIII of the federal social security act
(medicare) or under state regulations, or a general hospital, which
during the same time period, had a service area which has an average
population of less than one hundred seventy-five persons per square
mile, or a general hospital which has a service area which has an
average population of less than two hundred persons per square mile
measured as population density by zip code. The average population of
the service area is calculated by multiplying annual patient discharges
by the population density per square mile of the county of origin or zip
code as applicable for each patient discharge and dividing by total
discharges. Annual patient discharges shall be determined using
discharge data for the nineteen hundred ninety-seven rate year, as
reported to the commissioner by October first, nineteen hundred
ninety-eight. Population density shall be determined utilizing United
States census bureau data for nineteen hundred ninety-seven. If an
eligible rural hospital merges with another general hospital, on or
after December thirty-first, nineteen hundred ninety-nine, and the
merger results in separate facilities operating under a single facility
operating certificate, such eligible rural hospital shall continue to be
a separate eligible rural hospital for purposes of this subdivision and
payments provided in accordance with this section shall be made to the
merged entity; provided, however, that payments shall only be made to
the merged entity if such separate eligible rural hospital continues to
provide inpatient and/or outpatient hospital services at the same
location at which it operated prior to the merger. If an eligible rural
hospital merges with another general hospital on or after December
thirty-first, nineteen hundred ninety-nine, and the merger results in
such rural hospital continuing to operate under a separate facility
operating certificate, such rural hospital will continue to be an
eligible rural hospital after the merger; provided, however, that
payments shall only be made to such rural hospital if such eligible
rural hospital continues to provide inpatient and/or outpatient hospital
services at the same location at which it is operated prior to the
merger.

(d) "Eligible rural hospital weight", as used in this section, shall
mean the result of adding, for each eligible rural hospital:

(i) The eligible rural hospital's targeted need, as defined in section
twenty-eight hundred seven-k of this article, minus the mean targeted
need for all eligible rural hospitals, divided by the standard deviation
of the targeted need of all eligible rural hospitals; and

(ii) The mean number of beds of all eligible rural hospitals minus the
number of beds for an individual hospital, divided by the standard
deviation of the number of beds for all eligible rural hospitals.

2. From the funds in the pool each year, thirty-six million dollars on
an annualized basis for the periods January first, two thousand through
December thirty-first, two thousand fourteen, of the funds not
distributed in accordance with subdivision one of this section, shall be
distributed in accordance with the formula set forth in subdivision six
of section twenty-eight hundred seven-k of this article, provided,
however, that payments for periods on and after January first, two
thousand nine shall be subject to the provisions of subdivision five-a
of section twenty-eight hundred seven-k of this article.

3. From the funds in the pool each year, any funds not distributed in
accordance with subdivision one or two of this section, shall be
distributed in accordance with the formula set forth in paragraph (b) of
subdivision four of section twenty-eight hundred seven-k of this
article.

4. In order for a general hospital to be eligible to participate in
the distribution of funds pursuant to this section, such general
hospital must be in compliance with the provisions of subdivisions nine,
ten and twelve of section twenty-eight hundred seven-k of this article.

5. For each hospital receiving payments pursuant to paragraph (i) of
subdivision thirty-five of section twenty-eight hundred seven-c of this
article, the commissioner shall reduce the sum of any amounts paid
pursuant to this section and pursuant to section twenty-eight hundred
seven-k of this article, as computed based on projected facility
specific disproportionate share hospital ceilings, by an amount equal to
the lower of such sum or each such hospital's payments pursuant to
paragraph (i) of subdivision thirty-five of section twenty-eight hundred
seven-c of this article, provided, however, that any additional
aggregate reductions enacted in a chapter of the laws of two thousand
ten to the aggregate amounts payable pursuant to this section and
pursuant to section twenty-eight hundred seven-k of this article shall
be applied subsequent to the adjustments otherwise provided for in this
subdivision.