2024 Quarterly Provider Tax Reports - Quarter 2

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PROVIDER-RELATED DONATIONS AND
HEALTH CARE RELATED TAXES, FEES AND ASSESSMENTS RECEIVED UNDER PUBLIC HEALTH LAW 102-334 BY

New York State Department of Health
(Print or type name of agency)

FOR THE QUARTER ENDED

JUNE 30, 2024
CODE NAME OF TAX/ASSESSMENT PROGRAM ST. CITE PROVIDER/SERVICE CLASS (42 CFR) AMOUNT
1 Bad Debt and Charity Care and Capital Statewide Pool Assessment PHL 2807-c(18) Inpatient Hospital Services 126,219,692.00
1 Bad Debt and Charity Care Regional Allowance PHL 2807-c(14) & (16) Inpatient Hospital Services 0.00
1 Patient Services Payments PHL 2807-j Inpatient Hospital Services 642,295,394.09
1 Patient Services Payments PHL 2807-j Outpatient Hospital Services 593,638,783.63
1 Patient Services Payments PHL 2807-j Ambulatory Surgical Center Services 23,855,327.52
1 Patient Services Payments PHL 2807-j Diagnostic and Treatment Centers 18,342,257.81
1 Patient Services Payments PHL 2807-j Clinical Laboratories 0.00
1 Patient Services Payments PHL 2807-s Inpatient Hospital Services 897,885.00
1 Health Facility Cash Assessment Program PHL 2807-d Nursing Facility Services (6.0%) 141,131,167.85
1 Health Facility Cash Assessment Program PHL 2807-d Nursing Facility Services (5.0%) 8,433.01
1 Health Facility Cash Assessment Program PHL 2807-d Inpatient Hospital Services (.35%) 88,530,401.00
1 Health Facility Cash Assessment Program PHL 3614-a & b Home Health Care Services (.35%) 1,690,595.00
1 Health Facility Cash Assessment Program PHL 3614-a & b LT Home Health Care Services (.35%) 4,077.00
5 Health Facility Cash Assessment Program Social Services Law 367-i Personal Care Providers (.35%) 2,047,688.96
1 Health Facility Cash Assessment Program Section 90 of Part H of Chapter 59 of the Laws of 2011 LT Home Health Care Services (.7%) 0.00
1 Health Facility Cash Assessment Program Section 90 of Part H of Chapter 59 of the Laws of 2011 Nursing Facility Services (.8%) 18,815,084.43
1 Health Facility Cash Assessment Program PHL 2807-dd Nursing Facility Services (.4%) 0.00
1 Health Facility Cash Assessment Program PHL 2807-dd Nursing Facility Services (.2%) 0.00
1 Hospital Quality Contribution Report PHL 2807-d-1 Inpatient Hospital Services (1.6%) 15,576,077.00
  Total     1,673,052,864.30

I certify that this report represents a true and accurate statement of actual cash revenues collected by the above agency during the quarter described above.

Dated: ________________________   Signature: _______________________________________________   Title:

Codes 1 - Permissible