Bill Text: NY S03146 | 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 4-0)

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

Download: New_York-2023-S03146-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          3146

                               2023-2024 Regular Sessions

                    IN SENATE

                                    January 27, 2023
                                       ___________

        Introduced  by  Sens. MANNION, CLEARE -- read twice and ordered printed,
          and when printed to be committed 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
        S. 3146                             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.