Public Hearing Notice - Hospital Indigent Care

As required by Chapter 58 of the Laws of 2007, the Commissioner of Health and the Chairs of the Senate and Assembly Health Committees have appointed a 13-member Indigent Care Technical Advisory Committee (TAC) to assist in an evaluation of the Hospital Indigent Care Pool, including the methodology by which Pool funds are distributed; the type (clinic, emergency or inpatient care) and volume of services provided; the costs incurred by hospitals in relation to receipt of Hospital Indigent Care Pool distributions; and, the relationship between Indigent Care Pool monies and hospital obligations under the newly enacted Hospital Patient Financial Aid Law. The Financial Aid Law requires hospitals, among other things, to provide discounts to uninsured patients with incomes below 300 percent of the Federal Poverty Level. Compliance with these requirements is a condition of receipt of Hospital Indigent Care funding after January 1, 2009.

Chapter 58 also requires the State Department of Health to convene public hearings to obtain comments from consumers, health care providers, and other interested parties on the above stated areas of assessment. The dates, times, locations and requirements for public attendance/speaker participation are described below.

The Health Care Reform Act (HCRA) provides for $847 million to fund the Hospital Indigent Care. These funds are considered Medicaid Disproportionate Share Payments for hospitals and as such are eligible for federal matching funds. (There is a separate $60 million Pool to cover indigent care at comprehensive diagnostic and treatment centers.) HCRA sub-allocates the hospital indigent care pool funds to public hospitals, voluntary hospitals, and rural hospitals. Awards from such segregated amounts are based on specified methodologies; most funds are distributed on the basis of accounting losses reported by hospitals for uncollected receivables technically referred to as bad debt and charity care write-offs. More detail on Hospital Indigent Care Pool distributions can be found on the Department of Health's Web site.

Separate from the review of the Indigent Care Pool methodology, the Department of Health, on July 9, 2007, issued an RFP entitled "Analysis of Proposals for Achieving Universal Health Coverage in New York." The RFP is available on the Department's Web site. In addition, the State will be holding hearings on the steps necessary to achieve universal coverage. While the two processes are related, the Pool evaluation and these public hearings are limited to the data, methodology, requirements and objectives of the Hospital Indigent Care Pool.

To assist the Department of Health and the Chairs of the Senate and Assembly Health Committees in their assessment of the Hospital Indigent Care Pool, we are particularly interested in soliciting public comments on the following:

  • Can the distribution of Hospital Indigent Care Pool funds be better targeted through modifications to the existing award methodologies? In other words, should funds be distributed based on accounting losses or units of services provided to uninsured patients? If funds are distributed based on services to uninsured patients, how should the service be valued? Each hospital's costs? The Medicare rate? The Medicaid rate? Other?
  • Should Pool funds be available to cover unpaid co-payments and deductibles for insured patients? Should Pool payments be available to cover claims denied by third party payors?
  • Should additional requirements be imposed on hospitals in order to participate in the Indigent Care Pool?
  • Should hospitals be required to absorb a certain percentage of the cost of care of uninsured patients?
  • Currently, hospitals that report more bad debt and charity care costs as a percentage of operating costs have a higher percentage of their reported BDCC costs covered out of the Indigent Care Pool. Should that practice continue or should all hospitals receive the same coverage ratio? Coverage ratios currently range from 46 percent of reported BDCC costs to over 100 percent.
  • To what extent should the recently enacted Hospital Patient Financial Aid Law alter the methodology for distributing Pool funds?

The Public Hearing Schedule is as follows:

Date: Tuesday, July 31, 2007
Time: 9:30 AM
Assembly Hearing Room
Room 1923, 19th Floor
250 Broadway
New York, NY 10007
Attendance Log: Due in to the address noted below no later than July 23, 2007
Security: Attendees must present a driver's license or other government-issued photo ID upon entry.
Date: Monday, August 13, 2007
Time: 9:30 AM
Sheraton Syracuse University Hotel & Conference Center
801 University Avenue
Syracuse, NY 13210
Attendance Log: Due in to the address noted below no later than August 8, 2007

Requirements for Public Hearing Participation:

All individuals planning to attend a hearing must pre-register with the New York State Department of Health. Please submit an original copy of the New York State Department of Health Attendance Log by the due date for the respective hearing noted above to the attention of:

Ms. Marianne Wallard
Bureau of Primary and Acute Care Reimbursement
New York State Department of Health
Corning Tower Bldg., Room 1043
Empire State Plaza
Albany, New York 12237

The Department's Attendance Log can be accessed at the following Web site:

For Assembly Hearing Room security reasons in particular, the Department must provide the names of all parties that will be attending the July 31, 2007 hearing. In completing this form, please print name legibly so that an accurate listing can be provided to security.

In order to meet the needs of those who may have a disability, the New York State Department of Health, in accordance with its policy of non-discrimination on the basis of disability, as well as the Americans with Disabilities Act (ADA), has made its facilities and services available to all individuals with disabilities. For individuals with disabilities, accommodations will be provided, upon reasonable request, to afford such individuals access and admission to Assembly facilities and activities.

All speakers are required to provide six (6) written copies of their testimony to be presented at the hearing. The copies of the testimony must be provided to Department of Health staff on the date of the hearing being attended. Individuals who are unable to attend may submit written comments to the attention of Mr. John W. Gahan, Jr., Assistant Director, Bureau of Primary and Acute Care Reimbursement at the address noted above.

For further information, please contact Marianne Wallard at (518) 474-3267 or e-mail