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

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          6021

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                     March 30, 2023
                                       ___________

        Introduced by M. of A. PAULIN -- read once and referred to the Committee
          on Health

        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. Such quality incentive
     8  program shall be funded at a level of at least one percent of the  total
     9  annual  premium paid to managed care providers, or three hundred million
    10  dollars, whichever is greater. In establishing the manner  in  which  to
    11  measure  quality  and  distribute  quality  incentive program funds, the
    12  commissioner of health shall establish a methodology that  provides  the
    13  greatest  level of funding to managed care providers receiving the high-
    14  est quality scores and shall consult  with  representatives  of  managed
    15  care providers and other key stakeholders.
    16    §  2.  Subdivision  8  of  section 4403-f of the public health law, as
    17  amended by section 21 of part B of chapter 59 of the laws  of  2016,  is
    18  amended to read as follows:
    19    8.  Payment  rates  for managed long term care plan enrollees eligible
    20  for medical assistance. The commissioner shall establish  payment  rates
    21  for  services  provided  to  enrollees  eligible  under title XIX of the
    22  federal social security act. Such payment  rates  shall  be  subject  to
    23  approval by the director of the division of the budget and shall reflect
    24  savings to both state and local governments when compared to costs which

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05012-01-3
        A. 6021                             2

     1  would  be incurred by such program if enrollees were to receive compara-
     2  ble health and long term care services on a fee-for-service basis in the
     3  geographic region in which such services are proposed  to  be  provided.
     4  Payment rates shall be risk-adjusted to take into account the character-
     5  istics  of  enrollees, or proposed enrollees, including, but not limited
     6  to:   frailty, disability level,  health  and  functional  status,  age,
     7  gender,  the  nature  of  services provided to such enrollees, and other
     8  factors as determined by the commissioner. The  risk  adjusted  premiums
     9  may  also  be  combined  with  disincentives or requirements designed to
    10  mitigate any incentives to obtain higher payment categories. In  setting
    11  such  payment  rates, the commissioner shall consider costs borne by the
    12  managed care program to ensure actuarially sound and adequate  rates  of
    13  payment  to ensure quality of care shall comply with all applicable laws
    14  and regulations, state and federal, including regulations as to actuari-
    15  al soundness for medicaid managed care. In setting  such  reimbursement,
    16  the commissioner shall establish a quality incentive program for managed
    17  long  term  care  plans  that  shall be distributed based on such plans'
    18  performance in meeting quality objectives, which shall  be  set  by  the
    19  commissioner  in advance of the period during which quality is measured.
    20  Such quality incentive program shall be funded at a level  of  at  least
    21  one  percent  of the total annual premium paid to managed long term care
    22  plans.   In establishing the manner in  which  to  measure  quality  and
    23  distribute  quality  incentive  program  funds,  the  commissioner shall
    24  establish a methodology that provides the greatest level of  funding  to
    25  managed  long  term  care plans receiving the highest quality scores and
    26  shall consult with representatives of managed long term care  plans  and
    27  other key stakeholders.
    28    §  3.  This act shall take effect immediately; provided, however, that
    29  the amendments to section 364-j of the social services law  and  section
    30  4403-f of the public health law made by sections one and two of this act
    31  shall  not  affect  the  repeal  of  such  sections  and shall be deemed
    32  repealed therewith.