Bill Text: NY S07992 | 2023-2024 | General Assembly | Introduced
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 6-0)
Status: (Introduced) 2024-01-04 - REFERRED TO HEALTH [S07992 Detail]
Download: New_York-2023-S07992-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7992 IN SENATE January 4, 2024 ___________ Introduced by Sen. MANNION -- 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 25 would be incurred by such program if enrollees were to receive compara- 26 ble health and long term care services on a fee-for-service basis in the 27 geographic region in which such services are proposed to be provided. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD05012-01-3S. 7992 2 1 Payment rates shall be risk-adjusted to take into account the character- 2 istics of enrollees, or proposed enrollees, including, but not limited 3 to: frailty, disability level, health and functional status, age, 4 gender, the nature of services provided to such enrollees, and other 5 factors as determined by the commissioner. The risk adjusted premiums 6 may also be combined with disincentives or requirements designed to 7 mitigate any incentives to obtain higher payment categories. In setting 8 such payment rates, the commissioner shall consider costs borne by the 9 managed care program to ensure actuarially sound and adequate rates of 10 payment to ensure quality of care shall comply with all applicable laws 11 and regulations, state and federal, including regulations as to actuari- 12 al soundness for medicaid managed care. In setting such reimbursement, 13 the commissioner shall establish a quality incentive program for managed 14 long term care plans that shall be distributed based on such plans' 15 performance in meeting quality objectives, which shall be set by the 16 commissioner in advance of the period during which quality is measured. 17 Such quality incentive program shall be funded at a level of at least 18 one percent of the total annual premium paid to managed long term care 19 plans. In establishing the manner in which to measure quality and 20 distribute quality incentive program funds, the commissioner shall 21 establish a methodology that provides the greatest level of funding to 22 managed long term care plans receiving the highest quality scores and 23 shall consult with representatives of managed long term care plans and 24 other key 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.