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A08922 Summary:

BILL NOA08922
 
SAME ASSAME AS S07992
 
SPONSORPaulin
 
COSPNSRHevesi, Gunther
 
MLTSPNSR
 
Amd §364-j, Soc Serv L; amd §4403-f, Pub Health L
 
Establishes a quality incentive program for managed care providers that is distributed based on managed care providers' performance in meeting quality objectives.
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A08922 Actions:

BILL NOA08922
 
01/26/2024referred to health
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A08922 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A8922
 
SPONSOR: Paulin
  TITLE OF BILL: 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   PURPOSE: The purpose of this bill is to direct the Commissioner of Health to establish a quality incentive program and to consult with managed care plans and other relevant stakeholders in establishing the criteria for distribution of funds under the Medicaid managed care quality incentive program.   SUMMARY OF PROVISIONS: Section - 1 of this bill would amend the Social Services Law to require the Commissioner of Health to codify a quality incentive program for Medicaid managed care (MMC) plans. Section 2 of this bill would amend the Public Health Law to set payment rates for the managed long-term care plans. Section 3 of this bill provides that the effective date shall take effect immediately;   JUSTIFICATION: The State's quality incentive program is a powerful tool for improving and maintaining high-quality and high-value care in the Medicaid program by funding programs that aim to address social determinants of health and health disparities and improve health outcomes.. Currently, the State authorizes a quality incentive program through allocation of fund- ing in the enacted state budget, however, this-legislation would codify such program in law. The Medicaid managed care quality incentive program is a crucial tool to leverage federal dollars to advance the State's Medicaid Policy goals of improving access to higher-quality care. It is imperative that the Medi- caid managed care quality incentive program be adequately and consist- ently funded.   LEGISLATIVE HISTORY: 2022-2023: A.6021a- vetoed (Veto No. 126) 2022: A.10031 - referred to Health   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: This act shall take effect immediately;
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A08922 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          8922
 
                   IN ASSEMBLY
 
                                    January 26, 2024
                                       ___________
 
        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
    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.
                                                                   LBD05012-01-3

        A. 8922                             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.
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