STATE OF NEW YORK ________________________________________________________________________ 9421 IN ASSEMBLY March 14, 2024 ___________ Introduced by M. of A. CUNNINGHAM -- read once and referred to the Committee on Health AN ACT to amend the executive law, in relation to establishing the commission for the modernization and revitalization of the state university of New York downstate medical center The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The executive law is amended by adding a new article 49-C 2 to read as follows: 3 ARTICLE 49-C 4 COMMISSION FOR THE MODERNIZATION AND REVITALIZATION OF SUNY DOWNSTATE 5 MEDICAL CENTER 6 Section 996. Legislative intent. 7 996-a. Commission for the modernization and revitalization of 8 SUNY downstate medical center. 9 996-b. Severability. 10 § 996. Legislative intent. 1. The legislature hereby finds and 11 declares that the state university downstate medical center (hereinafter 12 referred to as "downstate") as established pursuant to section three 13 hundred fifty-two of the education law, is a vital component of our 14 state's health care system. As one of three state hospitals and the only 15 state hospital in the city of New York, it is incumbent upon the state 16 to ensure that this hospital remains fiscally viable to continue to 17 provide the health care services that the residents of central Brooklyn 18 deserve and depend on. The state university downstate medical center is 19 one of the state's largest safety-net hospitals, which cares for all 20 patients, regardless of their ability to pay. It predominantly serves 21 people of color, low income, uninsured, underinsured, undocumented and 22 at-risk individuals who have limited access to affordable health care 23 and who are more prone to suffer from serious disease and face higher 24 morbidity rates than other patients across our city and state. In two 25 thousand twenty-two, the hospital had over three hundred thousand outpa- 26 tient visits and has an average of fourteen thousand inpatients each EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD14727-01-4
A. 9421 2 1 year. It also provides seven thousand four hundred free health screen- 2 ings a year and sponsors over one hundred community service projects 3 annually. 4 2. Provided further, downstate is in the heart of central Brooklyn and 5 has the largest medical school in New York city, which offers training 6 in fifty-six specialties across five schools and colleges and annually 7 educates and trains nearly one thousand nine hundred students. The 8 medical school student population is made up of nearly sixty percent 9 students of color, produces the most physicians of color in the state of 10 New York, and nearly seventy percent of two thousand twenty-two gradu- 11 ates remained in New York for their residency. Having a hospital affil- 12 iated with the medical school is both critical for the training of 13 medical students and is an essential part in producing the next gener- 14 ation of health care professionals, which are desperately needed to 15 enhance the access to vital health care in our communities. 16 3. The legislature further finds that the entire Brooklyn health care 17 delivery system remains in need of a continued global examination, 18 assessing the needs of each of its diverse communities, the access to 19 high quality of care throughout Brooklyn, the demographics, health care 20 equities and disparities of each community, the availability of special- 21 ty services for low income populations, and the interconnectivity 22 between the various health care systems to ensure the long term finan- 23 cial sustainability of each of the various delivery systems in the 24 borough. Such further examination can begin with the modernization and 25 revitalization of downstate continuing as a hospital offering critical 26 hospital specialty services for the community, becoming a core specialty 27 hospital center of excellence for those critical specialty services, but 28 simultaneously undertaking an examination of the appropriateness of 29 converting certain designated inpatient beds that are not utilized for 30 the specialty hospital center of excellence providing specialty services 31 pursuant to subdivision two of section nine hundred ninety-six-a of this 32 article, to an outpatient setting, expanding services to include access 33 to primary care through clinics, urgent care or other hospital affil- 34 iated practices. 35 4. The legislature further finds that the continued operation of the 36 state university downstate medical center as a free-standing state-oper- 37 ated public hospital, staffed with public employees, at its current 38 location, within and under the appointing authority of the state univer- 39 sity of New York in a modernized and revitalized form, is vital and 40 necessary, and the state should develop a plan to ensure its future 41 sustainability and shall provide state funding and other resources 42 necessary to implement and execute such plan. Such plan shall be based 43 on the recommendations of the commission for the modernization and revi- 44 talization of SUNY downstate medical center ("the commission"). The 45 commission shall examine those services that are necessary to be 46 provided at downstate, alternative services which are more suitable for 47 the community, and which are in addition to the core center of excel- 48 lence specialty services which shall continue to be offered at down- 49 state. 50 § 996-a. Commission for the modernization and revitalization of SUNY 51 downstate medical center. 1. Commission established. (a) There shall be 52 established the commission for the modernization and revitalization of 53 SUNY downstate medical center (hereinafter referred to as "the commis- 54 sion"). The commission shall conduct a study to examine those services 55 that should be offered at SUNY downstate medical center (hereinafter 56 referred to as "downstate"), or a downstate affiliate, which shall be in A. 9421 3 1 addition to the core specialty center of excellence services which shall 2 continue to be offered at downstate, and make recommendations to the 3 legislature and the executive. In conducting its study and determining 4 its recommendations, the commission shall consider the following 5 factors: (i) the financial sustainability of downstate considering 6 management operations, billing practices, current health care services 7 and delivery model; (ii) the patient mix and demographics, including but 8 not limited to, the financial challenges posed by the provision of safe- 9 ty net services to low income, uninsured, underinsured, undocumented and 10 at-risk individuals; (iii) services available and readily accessible, at 11 other health care systems or providers in Brooklyn, and access to those 12 services by residents of central Brooklyn; (iv) the health care dispari- 13 ties in central Brooklyn; (v) access to primary care, outpatient 14 services, and emergency services for residents of the community where 15 downstate is located and the feasibility of downstate offering expanded 16 services to address such needs; (vi) those services which are necessary 17 for the training and education of students and graduates of the down- 18 state medical school; and (vii) other services the commission deems 19 appropriate in making its recommendations. 20 (b) The commissioner shall also determine what capital project 21 improvements are required at downstate medical center to both maintain 22 the core specialty center of excellence services and also enable down- 23 state to adequately meet current and future health care needs of the 24 community as identified by the commission. The commission shall also 25 provide an analysis of current emergency room operations, which shall 26 include, but shall not be limited to, patient care and service capacity 27 as well as improvements needed to adequately address patient service 28 demands and the technology, equipment and capital infrastructure 29 improvements that are required to improve patient services and improve- 30 ment of the financial position of downstate. 31 2. Definitions. (a) For purposes of this article, "core specialty 32 center of excellence services" shall mean the following services which 33 shall continue to be offered in a hospital setting at downstate, 34 notwithstanding the recommendations of the commission: 35 (i) level II trauma care and related services; 36 (ii) transplant care and related services; 37 (iii) cardiologic care and related services; 38 (iv) maternity and pediatric care for low income and ethnically 39 diverse populations; and 40 (v) emergency services, provided, however, the commission shall be 41 authorized to examine the size, scope and other appropriate features 42 necessary in providing emergency services at downstate. 43 (b) The commission shall not be authorized to make recommendations 44 which reduce, limit or in any way alter the core specialty center of 45 excellence services offered in a hospital setting at downstate. 46 3. Commission members. The commission shall consist of the following 47 members: 48 (a) the commissioner of health, who shall serve as the ex-officio 49 chair of the commission; 50 (b) a representative of each organized labor representing employees at 51 the state university of New York pursuant to article fourteen of the 52 civil service law, which shall include the united university professions 53 union, civil service employees association, public employees federation 54 and New York state correctional officers and police benevolent associ- 55 ation; 56 (c) one member appointed by the temporary president of the senate;
A. 9421 4 1 (d) one member appointed by the speaker of the assembly; 2 (e) one member appointed by the minority leader of the senate; 3 (f) one member appointed by the minority leader of the assembly; 4 (g) one member appointed by the Kings county borough president; 5 (h) two members appointed by local community boards; 6 (i) one member appointed by the mayor of the city of New York; 7 (j) one member appointed by the governor; and 8 (k) the chancellor of the state university of New York. 9 4. Compensation. The members of the commission shall receive no 10 compensation for their service as members, but shall be allowed their 11 actual and necessary expenses incurred in the performance of their 12 duties. 13 5. Commission deliberations and bylaws. (a) The commission and its 14 deliberations shall be subject to article seven of the public officers 15 law. 16 (b) The commission shall adopt its bylaws on or before its second 17 meeting. 18 6. Department of health assistance. (a) The commissioner of health 19 shall designate such employees of the department of health as are 20 reasonably necessary to provide support services to the commission. 21 (b) The commissioner of health shall also submit to the commission 22 such information as may be available from the department of health on 23 general hospital and nursing home capacity, services and beds, avail- 24 ability of primary and ambulatory care services, and the current number 25 of beds in such facilities, including, but not limited to, information 26 from: 27 (i) operating certificate files; 28 (ii) institutional cost reports; 29 (iii) facility occupancy reports; 30 (iv) annual reports of the certificate of need program; 31 (v) the statewide planning and research cooperative system; and 32 (vi) any other documentation request by the commission. 33 7. Liaison. The director of the dormitory authority of the state of 34 New York shall appoint one or more representatives to be a liaison 35 between the commission and the dormitory authority. 36 8. Other required recommendations. In carrying out its tasks and 37 duties, the commission shall also formally solicit recommendations from 38 health care experts, county health departments, community-based organ- 39 izations, state and regional health care industry associations, labor 40 unions and other interested parties as broadly as it considers it neces- 41 sary and proper, and it shall take into account such recommendations and 42 the recommendations of the Kings county health care stakeholders council 43 during its deliberations. In developing its recommendations, the commis- 44 sion shall, as far as practicable, estimate the improvement in quality 45 of care, financial status of the hospitals, and all other efficiencies 46 that may be derived from reconfiguration of the Kings county health care 47 system. 48 9. Report of commission. The commission shall complete its study and 49 provide a report of its written recommendations along with suggested 50 legislative and executive action, including but not limited to infras- 51 tructure investments, and refinancing of existing debt of general hospi- 52 tals in the county of Kings, no later than December thirty-first, two 53 thousand twenty-four. Such recommendations shall include: 54 (a) recommended dates by which such legislative or executive actions 55 should occur;
A. 9421 5 1 (b) necessary investments, if any, that should be made in each case to 2 carry out the commission's recommendations, including any necessary 3 workforce, training, or other investments to ensure that remaining 4 facilities are able to adequately provide services within the context of 5 a restructured institutional provider health care system; and 6 (c) the commission's justification for such recommendations. 7 10. Implementation of recommendations. (a) Notwithstanding any 8 provision of law, rule or regulation to the contrary related to the 9 establishment, construction, approval, or revisions to the operating 10 certificates, resizing, consolidation, conversion or related to the 11 restructuring of health care facilities identified in the commission's 12 recommendations, including but not limited to sections twenty-eight 13 hundred one-a, twenty-eight hundred two, twenty-eight hundred five, 14 twenty-eight hundred six and twenty-eight hundred six-b of the public 15 health law, the commissioner of health shall take all actions necessary 16 to implement, in a reasonable, cost-efficient manner, the recommenda- 17 tions of the commission pursuant to subdivision nine of this section. 18 (b) The provisions of paragraph (a) of this subdivision shall not 19 apply if a majority of the members of each house of the legislature vote 20 to adopt a concurrent resolution rejecting the recommendations of the 21 commission pursuant to subdivision nine of this section in their entire- 22 ty by February first, two thousand twenty-five. In no event shall the 23 commissioner of health begin to implement the recommendations of the 24 commission pursuant to subdivision nine of this section prior to Febru- 25 ary first, two thousand twenty-five. Provided, further, the commissioner 26 of health shall be precluded from acting upon any certificate of need 27 application, or any other submission or closure plan which limits or in 28 any way alters the services provided by downstate, on or after the 29 effective date of this act, until after February first, two thousand 30 twenty-five. Provided, however, that nothing herein shall be construed 31 as: 32 (i) limiting the authority of the commissioner of health to enforce or 33 implement any provision of the public health law relating to the health 34 or safety of the patients at downstate; or 35 (ii) prohibiting the approval of an application relating to capital 36 and infrastructure improvements at downstate that do not impact the 37 scope or level of services offered at downstate. 38 § 996-b. Severability. If any clause, sentence, paragraph, subdivi- 39 sion, section or part of this article shall be adjudged by any court of 40 competent jurisdiction to be invalid, such judgment shall not affect, 41 impair, or invalidate the remainder thereof, but shall be confined in 42 its operation to the clause, sentence, paragraph, subdivision, section 43 or part thereof directly involved in the controversy in which such judg- 44 ment shall have been rendered. It is hereby declared to be the intent of 45 the legislature that this article would have been enacted even if such 46 invalid provisions had not been included herein. 47 § 2. This act shall take effect immediately.