2807-P - Comprehensive diagnostic and treatment centers indigent care program.

§ 2807-p. Comprehensive diagnostic and treatment centers indigent care  program. 1. (a) For periods prior to July first, two thousand three, and  on  and  after  July  first,  two  thousand  five  the  commissioner  is  authorized  to  make  payments  to  eligible  diagnostic  and  treatment  centers,  to  the  extent of funds available therefor, up to forty-eight  million dollars annually, to assist in  meeting  losses  resulting  from  uncompensated  care.  The  amount  of  funds available for such payments  pursuant to subdivision  four  of  this  section  shall  be  the  amount  remaining after the allocation provided in section seven of chapter four  hundred  thirty-three  of  the  laws of nineteen hundred ninety-seven as  amended by section seventy-five of chapter one of the laws  of  nineteen  hundred ninety-nine.    (b)  For  periods on and after July first, two thousand three, through  June thirtieth, two thousand five, the commissioner  shall,  subject  to  the  availability  of  federal  financial  participation, adjust medical  assistance rates of payment to assist in meeting losses  resulting  from  uncompensated  care,  provided,  however, in the event federal financial  participation is  not  available,  the  commissioner  is  authorized  to  continue  to make payments to eligible diagnostic and treatment centers,  to the extent of funds available therefor, in accordance with provisions  of  paragraph  (a)  of  this  subdivision  and  without  regard  to  the  provisions of subdivisions four-a and four-b of this section.    (c)  Notwithstanding  paragraph  (a)  of this subdivision, subdivision  four-c of this section or  any  other  inconsistent  provision  of  this  section,  distributions made pursuant to this section for annual periods  on and after July first, two thousand nine shall be subject to a uniform  reduction of two percent.    (d) The commissioner may require  facilities  receiving  distributions  pursuant  to  this  section  as  a  condition  of  participating in such  distributions, to provide reports and data  to  the  department  as  the  commissioner  deems  necessary to adequately implement the provisions of  this section.    2. Definitions. (a) "Eligible diagnostic and treatment  centers",  for  purposes  of  this section, shall mean voluntary non-profit and publicly  sponsored diagnostic and treatment  centers  providing  a  comprehensive  range  of primary health care services which can demonstrate losses from  disproportionate share of uncompensated care during a  base  period  two  years  prior to the grant period; provided that for periods on and after  January first, two thousand four an eligible  diagnostic  and  treatment  center  shall  not  include  any  voluntary  non-profit  diagnostic  and  treatment center controlling, controlled by or under common control with  a health maintenance organization, as  defined  by  subdivision  one  of  section  forty-four  hundred  one of this chapter; provided further that  for purposes of this section, a health  maintenance  organization  shall  not  include a prepaid health services plan licensed pursuant to section  forty-four hundred three-a of this chapter. For  periods  on  and  after  July  first,  two  thousand  three, the base period and the grant period  shall be the calendar year.    (b) "Uncompensated care need", for purposes  of  this  section,  means  losses  from  reported  self-pay  and  free  visits  multiplied  by  the  facility's  medical  assistance  payment   rate   for   the   applicable  distribution year, offset by payments received from such patients during  the reporting period.    3.  (a) During the period January first, nineteen hundred ninety-seven  through September thirtieth, nineteen hundred ninety-seven and for  each  fiscal  year  period  commencing  on  October  first  thereafter through  December thirty-first, nineteen hundred ninety-nine and for  periods  on  and  after January first, two thousand, diagnostic and treatment centersshall be eligible for allocations  of  funds  or  for  rate  adjustments  determined  in  accordance with this section to reflect the needs of the  diagnostic and treatment center for the financing  of  losses  resulting  from uncompensated care.    (b) A diagnostic and treatment center qualifying for a distribution or  a  rate  adjustment  pursuant  to  this section shall provide assurances  satisfactory to the commissioner  that  it  shall  undertake  reasonable  efforts  to maintain financial support from community and public funding  sources and reasonable efforts to collect  payments  for  services  from  third-party   insurance  payors,  governmental  payors  and  self-paying  patients.    (c) To be eligible for an allocation of funds  or  a  rate  adjustment  pursuant to this section, a diagnostic and treatment center must provide  a   comprehensive  range  of  primary  health  care  services  and  must  demonstrate that a minimum  of  five  percent  of  total  clinic  visits  reported  during  the  applicable  base  year  period  were to uninsured  individuals. The commissioner may retrospectively reduce the allocations  of funds or the rate adjustments to a diagnostic and treatment center if  it is determined that provider  management  actions  or  decisions  have  caused  a  significant reduction for the grant period in the delivery of  comprehensive  primary  health  care  services  to  uncompensated   care  residents of the community.    4.  (a)  (i) The total amount of funds to be allocated and distributed  for uncompensated care to eligible voluntary non-profit  diagnostic  and  treatment  centers  for  a  distribution period prior to July first, two  thousand three, and on and after July first, two thousand  five  through  December  thirty-first,  two  thousand  six,  in  accordance  with  this  subdivision shall be  limited  to  thirty-three  percent  of  the  funds  available  therefor pursuant to paragraph (a) of subdivision one of this  section and, for the period January first, two  thousand  seven  through  December  thirty-first,  two thousand seven, such distributions shall be  limited to sixteen and one-half percent of the funds available therefor.    (ii) The total amount of funds to be  allocated  and  distributed  for  uncompensated   care  to  eligible  publicly  sponsored  diagnostic  and  treatment centers for a grant period prior to July first,  two  thousand  three,  and  on and after July first, two thousand five through December  thirty-first, two thousand six,  in  accordance  with  this  subdivision  shall  be  limited  to  sixty-seven  percent of funds available therefor  pursuant to paragraph (a) of subdivision one of this  section  and,  for  the   period   January   first,  two  thousand  seven  through  December  thirty-first, two thousand seven, such distributions shall be limited to  thirty-three and one-half  percent  of  the  funds  available  therefor;  provided,  however,  that  for periods up through December thirty-first,  two thousand seven, forty-one percent of the amount of  funds  allocated  for distribution to eligible publicly sponsored diagnostic and treatment  centers  shall  be available for clinics operating under the auspices of  the New York city health and hospitals  corporation  as  established  by  chapter  one thousand sixteen of the laws of nineteen hundred sixty-nine  as amended.    (iii)  (A)  Notwithstanding  any  inconsistent   provision   of   this  paragraph,  for  the period January first, nineteen hundred ninety-seven  through December thirty-first,  nineteen  hundred  ninety-nine  and  for  periods  on  and  after  January  first,  two  thousand through December  thirty-first, two thousand two, and for periods  on  and  after  January  first,  two  thousand  four  through December thirty-first, two thousand  seven,  in  the  event  that  federal  financial  participation  is  not  available  for rate adjustments pursuant to this section, diagnostic and  treatment centers which received an allowance pursuant to paragraph  (f)of subdivision two of section twenty-eight hundred seven of this article  for   the   period   through  December  thirty-first,  nineteen  hundred  ninety-six shall  receive  an  annual  uncompensated  care  distribution  allocation  of  funds  of  not less than the amount that would have been  received for any losses associated with the delivery  of  bad  debt  and  charity  care  for  nineteen  hundred  ninety-five had the provisions of  paragraph (f) of subdivision two of section twenty-eight  hundred  seven  of  this  article  remained  in  effect, provided, however, that for the  period January first, two thousand seven through December  thirty-first,  two  thousand  seven,  the  dollar  value  of  the  application  of  the  provisions of this subparagraph for any such  diagnostic  and  treatment  center shall be reduced by fifty percent.    (B)  For  the  period  January  first, two thousand three through June  thirtieth, two thousand three,  and  for  the  period  July  first,  two  thousand  three through December thirty-first, two thousand three and in  the event that federal financial participation is not available for rate  adjustments pursuant to this section, each such diagnostic and treatment  center shall receive an uncompensated care  distribution  allocation  of  funds of not less than one-half the amount calculated pursuant to clause  (A) of this subparagraph.    (b)  (i)  A  nominal  payment  amount  for  the  financing  of  losses  associated with the delivery of uncompensated care will  be  established  for  each  eligible diagnostic and treatment center. The nominal payment  amount shall be calculated as the sum of the dollars attributable to the  application of an incrementally increasing nominal  coverage  percentage  of base year period losses associated with the delivery of uncompensated  care  for  percentage  increases  in  the relationship between base year  period eligible uninsured care clinic visits and base year period  total  clinic visits according to the following scale:     % of eligible bad debt and charity care      % of nominal financial          clinic visits to total visits               loss coverage                  up to 15%                                50%                   15 - 30%                                75%                        30%+                              100%     (ii)  For  periods  prior to January first, two thousand eight, if the  sum of the nominal payment amounts for all eligible voluntary non-profit  diagnostic and treatment centers or for all eligible  public  diagnostic  and treatment centers or for all clinics operating under the auspices of  the  New  York  city  health  and hospitals corporation is less than the  amount allocated for uncompensated care allowances pursuant to paragraph  (a) of this  subdivision  for  such  diagnostic  and  treatment  centers  respectively,  the  nominal  coverage  percentages  of  base year period  losses associated with the delivery of uncompensated  care  pursuant  to  this  scale  may  be  increased to not more than one hundred percent for  voluntary non-profit diagnostic and  treatment  centers  or  for  public  diagnostic  and treatment centers or for all clinics operating under the  auspices of the New  York  city  health  and  hospitals  corporation  in  accordance  with  rules  and  regulations  adopted  by  the  council and  approved by the commissioner.    (c) For periods prior  to  January  first,  two  thousand  eight,  the  uncompensated  care  allocations  of  funds  for each eligible voluntary  non-profit diagnostic and treatment center, as  computed  in  accordance  with  paragraph  (a)  of  this subdivision, shall be based on the dollar  value  of  the  result  of  the  ratio  of  total  funds  allocated  for  distributions  for voluntary non-profit diagnostic and treatment centers  pursuant to paragraph (a) of this subdivision  to  the  total  statewidenominal payment amounts for all eligible voluntary non-profit diagnostic  and  treatment  centers  determined  in accordance with paragraph (b) of  this subdivision applied to the nominal payment  amount  for  each  such  diagnostic and treatment center.    (d)  For  periods  prior  to  January  first,  two thousand eight, the  uncompensated  care  allocations  of  funds  for  each  eligible  public  diagnostic  and treatment center, other than clinics operating under the  auspices of the New York city health and hospitals  corporation  and  as  computed  in accordance with paragraph (a) of this subdivision, shall be  based on the dollar value of the result of  the  ratio  of  total  funds  allocated for distributions for public diagnostic and treatment centers,  other  than  clinics  operating  under the auspices of the New York city  health and hospitals corporation, pursuant  to  paragraph  (a)  of  this  subdivision  to  the  total  statewide  nominal  payment amounts for all  eligible public diagnostic and treatment  centers,  other  than  clinics  operating  under  the auspices of the New York city health and hospitals  corporation,  determined  in  accordance  with  paragraph  (b)  of  this  subdivision  applied  to  the  nominal  payment  amount  for  each  such  diagnostic and treatment center.    (e) For periods prior  to  January  first,  two  thousand  eight,  the  uncompensated  care  grant allocations of funds for each eligible public  diagnostic and treatment center operating under the auspices of the  New  York  city  health  and hospitals corporation, as computed in accordance  with paragraph (a) of this subdivision, shall be  based  on  the  dollar  value  of  the  result  of  the  ratio  of  total  funds  allocated  for  distributions for public  diagnostic  and  treatment  centers  operating  under the auspices of the New York city health and hospitals corporation  pursuant  to  paragraph  (a)  of this subdivision to the total statewide  nominal payment amounts for all eligible public diagnostic and treatment  centers operating under the auspices of the New  York  city  health  and  hospitals  corporation  determined  in  accordance with paragraph (b) of  this subdivision applied to the nominal payment  amount  for  each  such  diagnostic and treatment center.    (f)  For  periods  prior  to  January  first,  two thousand eight, any  residual amount  allocated  for  distribution  to  a  classification  of  diagnostic  and  treatment  centers  in accordance with this subdivision  shall be reallocated by the commissioner for distributions to the  other  classifications based on remaining need.    (g)  For  periods  on and after January first, two thousand seven, the  uncompensated care allocations of funds for each eligible diagnostic and  treatment center, other than allocations  made  pursuant  to  paragraphs  (c),  (d),  (e) or (f) of this subdivision, shall be based on the dollar  value  of  the  result  of  the  ratio  of  total  funds  allocated  for  distributions  for  all eligible diagnostic and treatment centers to the  total statewide nominal payment amounts for all eligible diagnostic  and  treatment  centers  determined  in accordance with paragraph (b) of this  subdivision  applied  to  the  nominal  payment  amount  for  each  such  diagnostic and treatment center.    4-a.  (a)(i)  For periods on and after July first, two thousand three,  through June thirtieth, two thousand five, funds shall be made available  for adjustments to rates of payments made pursuant to paragraph  (b)  of  subdivision  one  of  this  section  for  eligible  voluntary non-profit  diagnostic and treatment centers in accordance with  subparagraphs  (ii)  and  (iii) of this paragraph, for the following periods in the following  aggregate amounts:    (A) For the period July first, two  thousand  three  through  December  thirty-first,  two  thousand  three,  up  to  seven million five hundred  thousand dollars;(B) For the period January first, two thousand four  through  December  thirty-first, two thousand four, up to fifteen million dollars;    (C)  For  the  period  January  first,  two thousand five through June  thirtieth, two thousand five, up to seven million five hundred  thousand  dollars.    (ii)  A  nominal payment amount for the financing of losses associated  with the delivery of uncompensated care will  be  established  for  each  eligible  diagnostic  and  treatment  center. The nominal payment amount  shall be calculated as the  sum  of  the  dollars  attributable  to  the  application  of  an incrementally increasing nominal coverage percentage  of base year period losses associated with the delivery of uncompensated  care for percentage increases in  the  relationship  between  base  year  period  eligible uninsured care clinic visits and base year period total  clinic visits according to the following scale:     % of eligible bad debt and charity care      % of nominal financial          clinic visits to total visits               loss coverage                  up to 15%                                50%                   15 - 30%                                75%                        30%+                              100%     (iii) The  uncompensated  care  rate  adjustments  for  each  eligible  voluntary  non-profit  diagnostic and treatment center shall be based on  the dollar value of the result of the ratio of total funds allocated for  distributions for voluntary non-profit diagnostic and treatment  centers  pursuant  to  subparagraph (i) of this paragraph, to the total statewide  nominal payment amounts for all eligible voluntary non-profit diagnostic  and treatment centers determined in accordance with subparagraph (ii) of  this paragraph applied to the  nominal  payment  amount  for  each  such  diagnostic and treatment center.    (b)(i) For periods on and after July first, two thousand three through  June  thirtieth,  two  thousand  five, funds shall be made available for  adjustments to rates of payments  made  pursuant  to  paragraph  (b)  of  subdivision  one  of  this  section  for  eligible public diagnostic and  treatment centers, other than clinics operated under the auspices of the  New York city health  and  hospitals  corporation,  in  accordance  with  subparagraphs  (ii)  and  (iii)  of  this  paragraph,  for the following  periods in the following aggregate amounts:    (A) For the period July first, two  thousand  three  through  December  thirty-first, two thousand three, up to nine million dollars;    (B)  For  the period January first, two thousand four through December  thirty-first, two thousand four, up to eighteen million dollars;    (C) For the period January  first,  two  thousand  five  through  June  thirtieth, two thousand five, up to nine million dollars.    (ii)  A  nominal payment amount for the financing of losses associated  with the delivery of uncompensated care will  be  established  for  each  eligible  diagnostic  and  treatment  center. The nominal payment amount  shall be calculated as the  sum  of  the  dollars  attributable  to  the  application  of  an incrementally increasing nominal coverage percentage  of base year period losses associated with the delivery of uncompensated  care for percentage increases in  the  relationship  between  base  year  period  eligible uninsured care clinic visits and base year period total  clinic visits according to the following scale:     % of eligible bad debt and charity care      % of nominal financial          clinic visits to total visits               loss coverage                  up to 15%                                50%                   15 - 30%                                75%30%+                              100%     (iii) The uncompensated care rate adjustments for each eligible public  diagnostic  and treatment center, other than clinics operating under the  auspices of the New York city health and hospitals corporation, shall be  based on the dollar value of the result of  the  ratio  of  total  funds  allocated for distributions for public diagnostic and treatment centers,  other  than  clinics  operating  under the auspices of the New York city  health and hospitals corporation, pursuant to subparagraph (i)  of  this  paragraph  to  the  total  statewide  nominal  payment  amounts  for all  eligible public diagnostic and treatment  centers,  other  than  clinics  operating  under  the auspices of the New York city health and hospitals  corporation, determined in accordance with  subparagraph  (ii)  of  this  paragraph applied to the nominal payment amount for each such diagnostic  and treatment center.    (c)(i)  For  periods  on  and  after  July  first, two thousand three,  through June thirtieth, two thousand five, funds shall be made available  for adjustments to rates of payments made pursuant to paragraph  (b)  of  subdivision  one  of  this  section  for  eligible public diagnostic and  treatment centers operating under the auspices  of  the  New  York  city  health  and hospitals corporation, in accordance with subparagraphs (ii)  and (iii) of this paragraph, for the following periods in the  following  aggregate amounts:    (A)  For  the  period  July first, two thousand three through December  thirty-first, two thousand three, up to six million dollars;    (B) For the period January first, two thousand four  through  December  thirty-first, two thousand four, up to twelve million dollars;    (C)  For  the  period  January  first,  two thousand five through June  thirtieth, two thousand five, up to six million dollars.    (ii) A nominal payment amount for the financing of  losses  associated  with  the  delivery  of  uncompensated care will be established for each  eligible diagnostic and treatment center.  The  nominal  payment  amount  shall  be  calculated  as  the  sum  of  the dollars attributable to the  application of an incrementally increasing nominal  coverage  percentage  of base year period losses associated with the delivery of uncompensated  care  for  percentage  increases  in  the relationship between base year  period eligible uninsured care clinic visits and base year period  total  clinic visits according to the following scale:     % of eligible bad debt and charity care      % of nominal financial          clinic visits to total visits               loss coverage                  up to 15%                                50%                   15 - 30%                                75%                        30%+                              100%     (iii) The uncompensated care rate adjustment, for each eligible public  diagnostic  and treatment center operating under the auspices of the New  York city health and hospitals corporation shall be based on the  dollar  value  of  the  result  of  the  ratio  of  total  funds  allocated  for  distributions for public  diagnostic  and  treatment  centers  operating  under the auspices of the New York city health and hospitals corporation  pursuant  to  subparagraph  (i) of this paragraph to the total statewide  nominal payment amounts for all eligible public diagnostic and treatment  centers operating under the auspices of the New  York  city  health  and  hospitals corporation determined in accordance with subparagraph (ii) of  this  paragraph  applied  to  the  nominal  payment amount for each such  diagnostic and treatment center.(d) (i) Notwithstanding  the  provisions  of  paragraph  (b)  of  this  subdivision  and  any  other  provisions of this chapter, municipalities  which received state aid pursuant to article two of this chapter for the  nineteen hundred eighty-nine--nineteen hundred ninety state fiscal  year  in   support   of  non-hospital  based  free-standing  or  local  health  department  operated  general   medical   clinics   shall   receive   an  uncompensated  care  rate  adjustment  for  the  period  July first, two  thousand three through December thirty-first, two thousand three, of not  less  than  one-half  the  amount  received  in  the  nineteen   hundred  eighty-nine--nineteen  hundred  ninety  state  fiscal  year  for general  medical clinics.    (ii) For the period January first, two thousand four through  December  thirty-first, two thousand four, each such municipality shall receive an  uncompensated  care  rate  adjustment  of not less than twice the amount  calculated pursuant to subparagraph (i) of this paragraph.    (iii) For the period January first, two  thousand  five  through  June  thirtieth,  two  thousand  five, each such municipality shall receive an  annual uncompensated care rate adjustment of not less  than  the  amount  calculated pursuant to subparagraph (i) of this paragraph.    (e)   (i)   Notwithstanding   any   inconsistent   provision  of  this  subdivision, for the period  July  first,  two  thousand  three  through  December  thirty-first,  two  thousand  three,  diagnostic and treatment  centers which  received  an  allowance  pursuant  to  paragraph  (f)  of  subdivision  two  of  section twenty-eight hundred seven of this article  for  the  period  through  December   thirty-first,   nineteen   hundred  ninety-six  shall  receive  an uncompensated care rate adjustment of not  less than one-half the amount that would  have  been  received  for  any  losses  associated  with  the  delivery of bad debt and charity care for  nineteen hundred ninety-five had the  provisions  of  paragraph  (f)  of  subdivision  two  of  section twenty-eight hundred seven of this article  remained in effect.    (ii) For the period January first, two thousand four through  December  thirty-first,  two  thousand  four,  each  such diagnostic and treatment  center shall receive an uncompensated care rate adjustment of  not  less  than  twice  the  amount calculated pursuant to subparagraph (i) of this  paragraph.    (iii) For the period January first, two  thousand  five  through  June  thirtieth,  two thousand five, each such diagnostic and treatment center  shall receive an annual uncompensated care rate adjustment of  not  less  than  the  amount  calculated  pursuant  to  subparagraph  (i)  of  this  paragraph,  and  shall  be   subject   to   subsequent   adjustment   or  reconciliation.    (f) Any residual amount allocated for distribution to a classification  of  diagnostic and treatment centers in accordance with this subdivision  shall be reallocated by the commissioner for distributions to the  other  classifications based on remaining need.    4-b.  (a)  For  periods  on  and after July first, two thousand three,  through June thirtieth, two thousand five, funds shall be made available  for adjustments to rates of payment made pursuant to  paragraph  (b)  of  subdivision  one  of  this section for eligible diagnostic and treatment  centers with less than two years of operating experience, and diagnostic  and treatment centers which have received certificate of  need  approval  on  applications  which  indicate  a  significant  increase in uninsured  visits, for  the  following  periods  and  in  the  following  aggregate  amounts:    (i)  For  the  period  July first, two thousand three through December  thirty-first, two  thousand  three,  up  to  one  million  five  hundred  thousand dollars;(ii)  For the period January first, two thousand four through December  thirty-first, two thousand four, up to three million dollars;    (iii)  For  the  period  January first, two thousand five through June  thirtieth, two thousand five, up to one million  five  hundred  thousand  dollars.    (b)  To  be eligible for a rate adjustment pursuant to this section, a  diagnostic and treatment center shall  be  a  voluntary,  non-profit  or  publicly   sponsored   diagnostic   and  treatment  center  providing  a  comprehensive range of primary health care services and be  eligible  to  receive  a medicaid budgeted rate prior to April first of the applicable  rate adjustment period after which time, the department shall issue rate  adjustments  pursuant  to  this  subdivision  for  such  periods.   Rate  adjustments  made  pursuant to this subdivision shall be allocated based  upon each eligible facility's proportional share of costs  for  services  rendered  to  uninsured  patients which have otherwise not been used for  establishing  distributions  pursuant  to  subdivision  four-a  of  this  section. For the purposes of this subdivision costs shall be measured by  multiplying  each  facility's  medicaid  budgeted  rate by the estimated  number of visits reported for services anticipated  to  be  rendered  to  uninsured   patients  meeting  the  aforementioned  criteria,  less  any  anticipated  patient  service  revenues  received  from  such  uninsured  patients, during the applicable rate adjustment period.    4-c.  Notwithstanding  any  provision  of  law  to  the  contrary, the  commissioner shall make additional payments for  uncompensated  care  to  voluntary  non-profit diagnostic and treatment centers that are eligible  for  distributions  under  subdivision  four  of  this  section  in  the  following  amounts:  for the period June first, two thousand six through  December thirty-first, two thousand six, in the amount of seven  million  five  hundred  thousand  dollars,  for  the  period  January  first, two  thousand seven through December thirty-first, two thousand seven,  seven  million five hundred thousand dollars, for the period January first, two  thousand  eight through December thirty-first, two thousand eight, seven  million five hundred thousand dollars, for the period January first, two  thousand nine through December thirty-first, two thousand nine,  fifteen  million five hundred thousand dollars, for the period January first, two  thousand  ten  through  December  thirty-first,  two thousand ten, seven  million five hundred thousand dollars, and for the period January first,  two thousand eleven through March thirty-first, two thousand eleven,  in  the  amount  of one million eight hundred seventy-five thousand dollars,  provided, however, that for periods on  and  after  January  first,  two  thousand  eight,  such  additional  payments  shall  be  distributed  to  voluntary, non-profit diagnostic and treatment  centers  and  to  public  diagnostic  and  treatment  centers  in accordance with paragraph (g) of  subdivision four of this section. In the event  that  federal  financial  participation  is  available  for  rate  adjustments  pursuant  to  this  section,  the  commissioner  shall  make  such  payments  as  additional  adjustments  to rates of payment for voluntary non-profit diagnostic and  treatment centers that are eligible for distributions under  subdivision  four-a  of  this  section  in the following amounts: for the period June  first, two thousand six through December thirty-first, two thousand six,  fifteen million dollars in the aggregate, and  for  the  period  January  first,  two  thousand  seven through June thirtieth, two thousand seven,  seven million five  hundred  thousand  dollars  in  the  aggregate.  The  amounts  allocated  pursuant  to this paragraph shall be aggregated with  and distributed pursuant to  the  same  methodology  applicable  to  the  amounts  allocated  to  such  diagnostic  and treatment centers for such  periods  pursuant  to  subdivision  four  of  this  section  if  federal  financial  participation  is  not  available, or pursuant to subdivisionfour-a of this section if federal financial participation is  available.  Notwithstanding  section  three  hundred  sixty-eight-a  of  the  social  services law, there shall be no local  share  in  a  medical  assistance  payment adjustment under this subdivision.    5.  Diagnostic  and  treatment centers shall furnish to the department  such reports and information as may be required by the  commissioner  to  assess  the  cost,  quality,  access to, effectiveness and efficiency of  uncompensated  care  provided.  The  council  shall  adopt   rules   and  regulations,  subject  to the approval of the commissioner, to establish  uniform  reporting  and  accounting  principles   designed   to   enable  diagnostic  and treatment centers to fairly and accurately determine and  report uncompensated care visits and the costs of uncompensated care. In  order to be eligible  for  an  allocation  of  funds  pursuant  to  this  section,  a  diagnostic  and treatment center must be in compliance with  uncompensated care reporting requirements.    6. Notwithstanding any inconsistent provision of law to the  contrary,  the  availability  or  payment  of  funds  to a diagnostic and treatment  center pursuant to this section shall not be admissible  as  a  defense,  offset  or reduction in any action or proceeding relating to any bill or  claim for  amounts  due  for  services  provided  by  a  diagnostic  and  treatment center.    7.  Revenue  from  distributions  to a diagnostic and treatment center  pursuant to this section shall not be included in gross revenue received  for purposes of the assessments pursuant to section twenty-eight hundred  seven-d of this article, subject to the provisions of subdivision twelve  of section twenty-eight hundred seven-d of this article.    8. (a) For periods on or after January  first,  two  thousand  through  June  thirtieth,  two  thousand  three,  payments  made  to  an eligible  diagnostic and treatment  center  pursuant  to  this  section  shall  be  reduced   or  increased  by  an  amount  equal  to  the  amount  of  any  overpayments or underpayments made against grants  awarded  pursuant  to  section  seven  of  chapter  four  hundred  thirty-three  of the laws of  nineteen hundred ninety-seven for the period three years  prior  to  the  annual awards made pursuant to this section.    (b)  The  determination of such overpayments or underpayments shall be  based on the submission by eligible  facilities  of  reports  reflecting  actual  uncompensated  care data, as required by the commissioner, which  are attributable to prior periods.  Submission  of  such  reports  is  a  condition  for  an  eligible  facility's receipt of payments pursuant to  this section.    (c) For any periods in which a  facility  does  not  receive  payments  pursuant to this section, the amount of any prior period overpayment may  be  offset against payments for medical assistance made to such facility  pursuant to title eleven of article five of the social services law  and  credited  to  funds allocated pursuant to this section. Any prior period  underpayment to an eligible facility may be paid to such facility  in  a  subsequent period.    9.  Adjustments  to rates of payment made pursuant to this section may  be added to rates of payment or made as aggregate payments  to  eligible  diagnostic  and treatment centers and shall not be subject to subsequent  adjustment or reconciliation, provided, however, that in the event  such  adjustments  are  made  as  aggregate payments, then notwithstanding any  law, rule or regulation to the contrary  responsibility  for  the  local  share  of such aggregate payments shall be apportioned to a local social  services district based on the most recent geographic  utilization  data  available to the department for eligible diagnostic and treatment center  services  for payments in accordance with subdivisions four-a and four-b  of this  section  for  all  diagnostic  and  treatment  center  servicesprovided  in  accordance  with section three hundred sixty-five-a of the  social services law,  regardless  of  whether  another  social  services  district  or  the department may otherwise be responsible for furnishing  medical assistance to the eligible persons receiving such services.    10.  (a) Notwithstanding any inconsistent provision of this section or  any other contrary provision of law, the commissioner is  authorized  to  seek  a  waiver from the federal department of health and human services  pursuant to  section  eleven  hundred  fifteen  of  the  federal  social  security  act,  or  such  other  federal  law provision as may be deemed  appropriate, seeking federal financial participation  in  payments  made  pursuant to this section, in which case the state funding made available  pursuant  to  this section shall be utilized as the non-federal share of  such payments. To the extent as may be required, payments made  pursuant  to  this  section and in accordance with this subdivision, may be deemed  to be disproportionate share hospital payments in  accordance  with  the  provisions of the federal social security act.    (b)  If  federal  financial participation in payments made pursuant to  this section are made available in accordance  with  the  provisions  of  this  subdivision,  free-standing  clinics  licensed  solely pursuant to  article thirty-one of the  mental  hygiene  law  shall  also  be  deemed  eligible  for  participation  in such payments to the same degree and in  accordance with the same distribution methodology otherwise provided  in  this  section,  provided,  however,  that  only  those  units of service  provided by such free-standing clinics that constitute medical  services  that  are  otherwise  eligible  for  consideration for Medicaid payments  shall be reflected in distributions made pursuant to this  section,  and  further  provided,  however,  that the commissioner may, in consultation  with the commissioner of the  office  of  mental  health,  require  such  clinics,  as  a  condition  of  receiving such distributions, to provide  reports and data to the department as the commissioner  deems  necessary  to  adequately  implement the provisions of this subdivision with regard  to such clinics.