Current as of January 01, 2021 | Updated by FindLaw Staff
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1. As used in this section, “covered provider” shall mean a voluntary not-for-profit health care provider that is any of the following:
(a) a diagnostic and treatment center licensed under article twenty-eight of the public health law that qualifies for a distribution pursuant to section twenty-eight hundred seven-p of such article, or section seven of chapter four hundred thirty-three of the laws of nineteen hundred ninety-seven, or receives funding under section three hundred thirty-h of the federal public health services act for health care for the homeless or has a contract with a unit of local government for the provision of primary care services to homeless people; or
(b) an entity licensed under article thirty-one of the mental hygiene law, or any other entity licensed by the office of mental health; or
(c) a provider licensed by the office of alcoholism and substance abuse services; or
(d) an approved provider under the prenatal care assistance program established pursuant to article twenty-five of the public health law; or
(e) a facility licensed under article twenty-eight of the public health law that is sponsored by and affiliated with a public or not-for-profit college or university that educates and trains health care professionals; or
(f) a family planning clinic licensed under article twenty-eight of the public health law.
2. Notwithstanding the provisions of subdivision one of this section, the term “covered provider” shall not include any entity owned or operated by a health maintenance organization, an integrated delivery system, prepaid health service plan, a general hospital or any entity controlled by a general hospital.
3. The commissioner of health shall make supplemental payments to covered providers with funds appropriated on an annual basis for the period beginning April first, nineteen hundred ninety-eight and ending March thirty-first, two thousand.
4. (a) (i) For the period April first, nineteen hundred ninety-eight through March thirty-first, nineteen hundred ninety-nine, a covered provider shall be qualified to receive a supplemental payment only if its number of medicaid visits for patient care services equals or exceeds thirty percent of its total number of visits for patient care services and it participates in medicaid managed care directly through a contract with a medicaid managed care organization, or through a sub-contract with a managed care organization, and its number of medicaid visits for patient care services for medicaid managed care enrollees equals or exceeds three percent of its total number of medicaid visits for patient care services.
(ii) During such period, a qualified covered provider shall receive a supplemental payment with respect to its visits from medical assistance recipients reimbursed by managed care organizations based upon the ratio of the qualified covered provider's visits from medical assistance recipients reimbursed by managed care organizations during that quarter to the total number of visits to qualified covered providers from medical assistance recipients reimbursed by managed care organizations.
(b) (i) For the period of April first, nineteen hundred ninety-nine through March thirty-first, two thousand, a covered provider shall be qualified to receive a supplemental payment only if its number of medicaid visits for patient care services equals or exceeds thirty percent of its total number of visits for patient care services, and it participates in medicaid managed care directly through a contract with a medicaid managed care organization or through a sub-contract with a managed care organization, and its number of medicaid visits for patient care services for medicaid managed care enrollees equals or exceeds five percent of its total number of medicaid visits for patient care services.
(ii) During such period, a qualified covered provider shall receive a supplemental payment with respect to its visits from medical assistance recipients reimbursed by managed care organizations based upon the ratio of the qualified covered provider's visits from medical assistance recipients reimbursed by managed care organizations during that quarter to the total number of visits to qualified covered providers from medical assistance recipients reimbursed by managed care organizations.
(c) In order to be eligible to receive supplemental payments, a qualified covered provider must submit data on the number of visits from medical assistance recipients reimbursed by managed care organizations thirty days after the end of the quarter; within fifteen days of receiving all the data necessary to determine the supplemental payments, the commissioner of health must advise the qualified covered provider of its proportionate share of the quarterly payment; within thirty days of the first quarter of a state fiscal year, the qualified covered provider shall submit a plan to the commissioner of health demonstrating the provider's ability to transition to a medicaid managed care environment. Upon receipt of an acceptable plan, the commissioner of health shall authorize payment to the covered provider.
(d) All data required shall be submitted in a manner approved by the commissioner of health.
Cite this article: FindLaw.com - New York Consolidated Laws, Social Services Law - SOS § 364-j-1. Transitional supplemental payments - last updated January 01, 2021 | https://codes.findlaw.com/ny/social-services-law/sos-sect-364-j-1/
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