N.Y. Comp. Codes R. & Regs. tit. 10 § 91.3

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

Section 91.3 - Determination of cost and reimbursement of excess medical malpractice coverage

(a) Based on the certification by general hospitals pursuant to section 91.2 of this Part of physicians and dentists eligible for excess coverage or equivalent excess coverage, the Superintendent of Insurance shall determine and certify to each general hospital and to the Commissioner of Health, and may amend such determination and certification as necessary, the cost of excess malpractice insurance or equivalent excess insurance, including an allocable share of pool administration costs, for medical and dental malpractice occurrences between July 1, 1986 and June 30, 1987, July 1, 1987 through December 31, 1987, and semi-annual periods beginning July 1st and January 1st, thereafter.

(b)

(1) The Commissioner of Health or his designee shall adjust the established inpatient rates of each general hospital (for rate periods during the periods July 1, 1986 through June 30, 1987, and annual periods beginning July 1st, thereafter, excluding rates of payment for State governmental agencies for rate periods during the period July 1, 1991 through June 30, 1992 and annual periods beginning July 1st, thereafter) proportionally, based upon the allocation of the general hospital's inpatient malpractice costs among rate payors and general hospital charge payors used in determining inpatient rates of payment and charges for 1986; and each annual period thereafter, for such general hospital pursuant to Subpart 86-1 of this Title, to reflect the cost of excess insurance coverage or equivalent excess coverage allocated to such general hospital pursuant to subdivision (a) of this section for such rate periods, and shall adjust the determination of the general hospital's maximum inpatient charges. The Commissioner of Health shall further adjust such rates of payment (excluding rates applicable to State governmental agencies as of July 1, 1991) to reflect significant changes in volume of service. The adjustment shall be made for the periods July 1, 1986 to June 30, 1987, and semi-annual periods beginning July 1st and January 1st, thereafter, and shall not be carried forward.

(2) In the event that rates of payment for persons eligible for payment pursuant to title XVIII of the Federal Social Security Act (Medicare) do not include the portion of such cost allocable to such patients, such portion of the cost shall for purposes of further adjustment be reallocated among payors whose rates of payment or charges are determined in accordance with Subpart 86- 1 of this Title and rates of payment for such payors (excluding rates applicable to State governmental agencies as of July 1, 1991) shall be adjusted proportionally based upon the allocation of general hospital malpractice costs among such payors used in determining inpatient rates of payment and charges for 1986, and each respective annual rate period thereafter, for such general hospital pursuant to Subpart 86-1 of this Title and the determination of the general hospital's maximum inpatient charges shall be adjusted so that the costs of such excess insurance coverage or equivalent excess coverage excluding costs allocated or reallocated to rates applicable to State governmental agencies for periods on and after July 1, 1991, are fully reflected in hospital inpatient rates of reimbursement and maximum charges; provided, however, that if a general hospital's inpatient malpractice cost is allocated entirely to title XVIII of the Federal Social Security Act (Medicare) in determining rates and charges for 1986, and each respective annual rate period thereafter, in accordance with Subpart 86-1 of this Title, (excluding rates applicable to State governmental agencies on and after July 1, 1991) for purposes of further adjustment the cost of excess insurance coverage or equivalent excess coverage shall be reallocated among payors whose rates of payment or charges are determined in accordance with Subpart 86-1 of this Title based upon the statewide average general hospital malpractice cost allocation among such payors in each rate period. Such adjustments shall be made for the periods July 1, 1986 through June 30, 1987, and semi-annual periods beginning July 1st and January 1st, thereafter, and shall not be carried forward.

(c) In rate periods commencing January 1, 1990 and thereafter, the Commissioner of Health or his designee shall adjust proportionally the established inpatient rates of each general hospital excluding rates of payment applicable to State governmental agencies on and after July 1, 1991 based upon the allocation of the general hospital's inpatient malpractice costs among rate payors and general hospital charge payors used in determining inpatient rates of payment and charges for such general hospitals for such rate period pursuant to Subpart 86-1 of this Title, to reflect payments due to the hospital excess liability pool or refunds received from the hospital excess liability pool by the hospital pursuant to section 91.4(e) of this Part, and maximum inpatient charges of such general hospital computed in accordance with Subpart 86-1 of this Title shall be adjusted accordingly. Such adjustments in a rate period shall not be carried forward except that such adjustments shall be included in volume adjustments authorized for such hospital for such rate period.

N.Y. Comp. Codes R. & Regs. Tit. 10 § 91.3