Bill Text: NY S03146 | 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 4-0)

Status: (Introduced) 2023-06-09 - SUBSTITUTED BY A6021A [S03146 Detail]

Download: New_York-2023-S03146-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         3146--A
            Cal. No. 1366

                               2023-2024 Regular Sessions

                    IN SENATE

                                    January 27, 2023
                                       ___________

        Introduced  by  Sens.  MANNION, CLEARE, FERNANDEZ, HINCHEY -- read twice
          and ordered printed, and when printed to be committed to the Committee
          on Health -- reported favorably from said committee and  committed  to
          the Committee on Finance -- committee discharged and said bill commit-
          ted  to  the Committee on Rules -- ordered to a third reading, amended
          and ordered reprinted, retaining its place in the order of third read-
          ing

        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

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05012-03-3
        S. 3146--A                          2

     1  approval by the director of the division of the budget and shall reflect
     2  savings to both state and local governments when compared to costs which
     3  would  be incurred by such program if enrollees were to receive compara-
     4  ble health and long term care services on a fee-for-service basis in the
     5  geographic  region  in  which such services are proposed to be provided.
     6  Payment rates shall be risk-adjusted to take into account the character-
     7  istics of enrollees, or proposed enrollees, including, but  not  limited
     8  to:    frailty,  disability  level,  health  and functional status, age,
     9  gender, the nature of services provided to  such  enrollees,  and  other
    10  factors  as  determined  by the commissioner. The risk adjusted premiums
    11  may also be combined with  disincentives  or  requirements  designed  to
    12  mitigate  any incentives to obtain higher payment categories. In setting
    13  such payment rates, the commissioner shall consider costs borne  by  the
    14  managed  care  program to ensure actuarially sound and adequate rates of
    15  payment to ensure quality of care shall comply with all applicable  laws
    16  and regulations, state and federal, including regulations as to actuari-
    17  al  soundness  for medicaid managed care. In setting such reimbursement,
    18  the commissioner shall establish a quality incentive program for managed
    19  long term care plans that shall be  distributed  based  on  such  plans'
    20  performance  in  meeting  quality  objectives, which shall be set by the
    21  commissioner in advance of the period during which quality is  measured.
    22  In  establishing  the  manner in which to measure quality and distribute
    23  quality incentive program funds,  the  commissioner  shall  establish  a
    24  methodology  that provides the greatest level of funding to managed long
    25  term care plans receiving the highest quality scores and  shall  consult
    26  with  representatives  of  managed  long  term  care plans and other key
    27  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.