(a)
Rates of payment.
As used in this section, the terms merger,
acquisition and consolidation shall mean the
combining of two or more general hospitals licensed under article 28 of the
Public Health Law, where such combination is consistent with the public need,
would create a new, more economical entity, reduce the costs of operation,
result in the reduction of beds and/or improve service delivery. In order to be
eligible for reimbursement pursuant to this section, the applicant facility
must have previously received a certificate of need (CON) approval by the
commissioner and/or Public Health Council approval for the merger, acquisition,
or consolidation pursuant to the Public Health Law. Payments for hospitals
subject to a merger, acquisition or consolidation for inpatient acute care
services that are not otherwise exempt from DRG case-based rates of payment
will be effective on the date the transaction is effected and shall be computed
in accordance with this Subpart except as follows:
(1) The WEF used to adjust the statewide base
price shall be calculated by combining all components used in the calculation
pursuant to section
86-1.19
of this Subpart for all hospitals subject to the merger, acquisition or
consolidation.
(2) The direct GME
payment per discharge added to the case payment rates of teaching hospitals
shall be calculated by dividing the total reported Medicaid direct GME costs
for all teaching hospitals subject to the merger, acquisition, or consolidation
by the total reported Medicaid discharges reported by such hospitals in the
applicable base period.
(3) The
indirect GME payment per discharge added to the case payment rates of teaching
hospitals shall be calculated in accordance with section
86-1.20
of this Subpart, except the ratio of residents to beds used in the calculation
shall be based on the total residents and beds of all such hospitals subject to
the merger, acquisition, or consolidation.
(4) The non-comparable payment per discharge
added to the case payment rates shall be calculated by dividing the total
reported Medicaid costs for qualifying non-comparable cost categories for all
hospitals subject to the merger, acquisition, or consolidation by the total
reported Medicaid discharges reported by such hospitals in the applicable base
period.
(b)
Closures, mergers, acquisitions, consolidations and
restructurings.
(1) The commissioner
may grant approval of a temporary adjustment to the non-capital components of
rates calculated pursuant to this Subpart for eligible general
hospitals.
(2) Eligible facilities
shall include:
(i) facilities undergoing
closure;
(ii) facilities impacted
by the closure of other health care providers;
(iii) facilities subject to mergers,
acquisitions, consolidations or restructuring; or
(iv) facilities impacted by the merger,
acquisition, consolidation or restructuring of other health care
providers.
(3)
Facilities seeking rate adjustments under this section shall demonstrate
through submission of a written proposal to the commissioner that the
additional resources provided by a temporary rate adjustment will achieve one
or more of the following:
(i) protect or
enhance access to care;
(ii)
protect or enhance quality of care;
(iii) improve the cost effectiveness of the
delivery of health care services; or
(iv) otherwise protector enhance the health
care delivery system, as determined by the commissioner.
(4)
(i)
Such written proposal shall be submitted to the commissioner at least 60 days
prior to the requested effective date of the temporary rate adjustment and
shall include a proposed budget to achieve the goals of the proposal. Any
temporary rate adjustment issued pursuant to this section shall be in effect
for a specified period of time as determined by the commissioner, of up to
three years. At the end of the specified timeframe, the facility shall be
reimbursed in accordance with the otherwise applicable rate-setting methodology
as set forth in applicable statutes and this Subpart. The commissioner may
establish, as a condition of receiving such a temporary rate adjustment,
benchmarks and goals to be achieved inconformity with the facility's written
proposal as approved by the commissioner and may also require that the facility
submit such periodic reports concerning the achievement of such benchmarks and
goals as the commissioner deems necessary. Failure to achieve satisfactory
progress, as determined by the commissioner, in accomplishing such benchmarks
and goals shall be a basis for ending the facility's temporary rate adjustment
prior to the end of the specified timeframe.
(ii) The commissioner may require that
applications submitted pursuant to this section be submitted in response to and
in accordance with a request for applications or a request for proposals issued
by the commissioner.
Notes
N.Y. Comp. Codes R. & Regs. Tit. 10
§§
86-1.31
Amended,
New
York State Register, Volume XXXVI, Issue 27, effective
7/9/2014
