N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.15

Current through Register Vol. 46, No. 51, December 18, 2024

Section 86-8.15 - Closures, mergers, acquisitions, consolidations, restructurings and inpatient bed de-certifications

(a) The commissioner may grant approval of a temporary adjustment to the non-capital components of rates calculated pursuant to this Subpart for eligible ambulatory care facilities licensed under article 28 of the Public Health Law (PHL).

(b) Eligible facilities shall include:

(1) facilities undergoing closure;

(2) facilities impacted by the closure of other health care facilities;

(3) facilities subject to mergers, acquisitions, consolidations or restructuring;

(4) facilities impacted by the merger, acquisition, consolidation or restructuring of other health care facilities; or

(5) outpatient facilities of general hospitals which have entered into an agreement with the department to permanently decertify a specified number of staffed hospital inpatient beds, as reported to the department.

(c) 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:

(1) protect or enhance access to care;

(2) protect or enhance quality of care;

(3) improve the cost effectiveness of the delivery of health care services; or

(4) otherwise protect or enhance the health care delivery system, as determined by the commissioner.

(d)

(1) 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 in conformity 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.

(2) 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.

(e) Federally qualified health centers with reimbursement rates issued pursuant to PHL section 2807(8) may apply for a temporary rate adjustment pursuant to this section as an alternative rate-setting methodology in accordance with the provisions of PHL section 2807(8)(f).

N.Y. Comp. Codes R. & Regs. Tit. 10 §§ 86-8.15