Bill Text: NY A06021 | 2023-2024 | General Assembly | Amended

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Bill Title: Establishes a quality incentive program for managed care providers that is distributed based on managed care providers' performance in meeting quality objectives.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Vetoed) 2023-12-22 - tabled [A06021 Detail]

Download: New_York-2023-A06021-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         6021--A

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                     March 30, 2023
                                       ___________

        Introduced  by M. of A. PAULIN, GUNTHER -- 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 social services law and the public  health  law,  in
          relation  to establishing a quality incentive program for managed care
          providers

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

     1    Section  1. Subdivision 18 of section 364-j of the social services law
     2  is amended by adding a new paragraph (c-1) to read as follows:
     3    (c-1) In setting such reimbursement, the commissioner of health  shall
     4  establish a quality incentive program for managed care providers that is
     5  distributed  based  on  managed  care  providers' performance in meeting
     6  quality objectives, which shall be set by the commissioner in advance of
     7  the period during which quality is measured. In establishing the  manner
     8  in  which  to  measure  quality and distribute quality incentive program
     9  funds, the commissioner of health shall  establish  a  methodology  that
    10  provides the greatest level of funding to managed care providers receiv-
    11  ing the highest quality scores and shall consult with representatives of
    12  managed care providers and other key stakeholders.
    13    §  2.  Subdivision  8  of  section 4403-f of the public health law, as
    14  amended by section 21 of part B of chapter 59 of the laws  of  2016,  is
    15  amended to read as follows:
    16    8.  Payment  rates  for managed long term care plan enrollees eligible
    17  for medical assistance. The commissioner shall establish  payment  rates
    18  for  services  provided  to  enrollees  eligible  under title XIX of the
    19  federal social security act. Such payment  rates  shall  be  subject  to
    20  approval by the director of the division of the budget and shall reflect
    21  savings to both state and local governments when compared to costs which
    22  would  be incurred by such program if enrollees were to receive compara-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05012-02-3
        A. 6021--A                          2

     1  ble health and long term care services on a fee-for-service basis in the
     2  geographic region in which such services are proposed  to  be  provided.
     3  Payment rates shall be risk-adjusted to take into account the character-
     4  istics  of  enrollees, or proposed enrollees, including, but not limited
     5  to:   frailty, disability level,  health  and  functional  status,  age,
     6  gender,  the  nature  of  services provided to such enrollees, and other
     7  factors as determined by the commissioner. The  risk  adjusted  premiums
     8  may  also  be  combined  with  disincentives or requirements designed to
     9  mitigate any incentives to obtain higher payment categories. In  setting
    10  such  payment  rates, the commissioner shall consider costs borne by the
    11  managed care program to ensure actuarially sound and adequate  rates  of
    12  payment  to ensure quality of care shall comply with all applicable laws
    13  and regulations, state and federal, including regulations as to actuari-
    14  al soundness for medicaid managed care. In setting  such  reimbursement,
    15  the commissioner shall establish a quality incentive program for managed
    16  long  term  care  plans  that  shall be distributed based on such plans'
    17  performance in meeting quality objectives, which shall  be  set  by  the
    18  commissioner  in advance of the period during which quality is measured.
    19  In establishing the manner in which to measure  quality  and  distribute
    20  quality  incentive  program  funds,  the  commissioner shall establish a
    21  methodology that provides the greatest level of funding to managed  long
    22  term  care  plans receiving the highest quality scores and shall consult
    23  with representatives of managed long  term  care  plans  and  other  key
    24  stakeholders.
    25    §  3.  This act shall take effect immediately; provided, however, that
    26  the amendments to section 364-j of the social services law  and  section
    27  4403-f of the public health law made by sections one and two of this act
    28  shall  not  affect  the  repeal  of  such  sections  and shall be deemed
    29  repealed therewith.