Bill Text: NY A05795 | 2023-2024 | General Assembly | Amended

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Bill Title: Provides for supplemental quality improvement payments for managed long term care plans that meet certain criteria.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-01-03 - referred to ways and means [A05795 Detail]

Download: New_York-2023-A05795-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         5795--A

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                     March 23, 2023
                                       ___________

        Introduced by M. of A. PAULIN -- read once and referred to the Committee
          on  Health -- reported and referred to the Committee on Ways and Means
          -- committee discharged, bill amended, ordered  reprinted  as  amended
          and recommitted to said committee

        AN  ACT to amend the public health law, in relation to payment rates for
          managed long term care plans

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Subdivision 8 of section 4403-f of the public health law,
     2  as amended by section 21 of part B of chapter 59 of the laws of 2016, is
     3  amended to read as follows:
     4    8. (a) Payment rates for managed long term care plan enrollees  eligi-
     5  ble  for  medical  assistance.  The commissioner shall establish payment
     6  rates for services provided to enrollees eligible under title XIX of the
     7  federal social security act. Such payment  rates  shall  be  subject  to
     8  approval by the director of the division of the budget and shall reflect
     9  savings to both state and local governments when compared to costs which
    10  would  be incurred by such program if enrollees were to receive compara-
    11  ble health and long term care services on a fee-for-service basis in the
    12  geographic region in which such services are proposed  to  be  provided.
    13  Payment rates shall be risk-adjusted to take into account the character-
    14  istics  of  enrollees, or proposed enrollees, including, but not limited
    15  to:   frailty, disability level,  health  and  functional  status,  age,
    16  gender,  the  nature  of  services provided to such enrollees, and other
    17  factors as determined by the commissioner. The  risk  adjusted  premiums
    18  may  also  be  combined  with  disincentives or requirements designed to
    19  mitigate any incentives to obtain higher payment categories. In  setting
    20  such  payment  rates, the commissioner shall consider costs borne by the
    21  managed care program to ensure actuarially sound and adequate  rates  of
    22  payment  to ensure quality of care shall comply with all applicable laws

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD10268-02-3
        A. 5795--A                          2

     1  and regulations, state and federal, including regulations as to actuari-
     2  al soundness for medicaid managed care.
     3    (b)  Supplemental  quality  improvement  payments.  (i) For the period
     4  beginning April first, two thousand twenty-three through  March  thirty-
     5  first,  two  thousand  twenty-four,  payment rates for managed long term
     6  care plans shall be adjusted to increase payments to all plans that  (1)
     7  have received four or more star ratings for an overall score in the most
     8  recently  available  managed  long  term  care consumer regional quality
     9  guide produced by the department on April first,  two  thousand  twenty-
    10  three, and (2) have a relative risk score greater than one and one-tenth
    11  in  effect  on  April first, two thousand twenty-three. Funding for such
    12  rate increases shall be provided by reducing payment rates to plans  not
    13  eligible  for a rate increase pursuant to this paragraph, by one percent
    14  or thirty million dollars, whichever is less.
    15    (ii) Eligible plans shall receive an amount  determined  by  (1)  each
    16  eligible  plan  allocated an equal share of such funding, and (2) multi-
    17  plying that amount by one hundred percent for each  eligible  plan  that
    18  received  a  rating of five stars in the managed long term care consumer
    19  regional quality guide, and eighty percent for each eligible  plan  that
    20  received  a  rating of four stars in the managed long term care consumer
    21  regional quality guide.
    22    § 2. This act shall take effect immediately; provided,  however,  that
    23  the  amendments  to subdivision 8 of section 4403-f of the public health
    24  law made by section one of this act shall not affect the repeal of  such
    25  section and shall be deemed repealed therewith.