STATE OF NEW YORK
________________________________________________________________________
1359
2025-2026 Regular Sessions
IN ASSEMBLY
January 9, 2025
___________
Introduced by M. of A. PAULIN, HEVESI, LUPARDO -- read once and referred
to the Committee on Health
AN ACT to amend the public health law and the social services law, in
relation to rates of payment for services under medical assistance to
needy persons
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 2807 of the public health law is amended by adding
2 a new subdivision 22 to read follows:
3 22. Notwithstanding any contrary provision of this section or any
4 other law or regulation, the commissioner shall establish medical
5 assistance rates of payment for hospital services and health-related
6 services that are reasonably related to the costs of efficient
7 production of such services and which are reasonable and adequate to
8 meet the costs which must be incurred by efficiently and economically
9 operated facilities and service providers. Such rates of payment shall
10 not be based on information or a base year calculation which is more
11 than four calendar years old.
12 § 2. Section 2807-c of the public health law is amended by adding a
13 new subdivision 34-a to read as follows:
14 34-a. The commissioner shall establish discrete rates of payment for
15 general hospitals for payments under the medical assistance program
16 pursuant to title eleven of article five of the social services law for
17 persons eligible for medical assistance who are enrolled in health main-
18 tenance organizations and for payments under the family health plus
19 program for persons enrolled in approved organizations pursuant to title
20 eleven-D of article five of the social services law and the child health
21 insurance plan under section twenty-five hundred eleven of this chapter
22 which are reasonably related to the costs of efficient production of
23 such services and which shall be reasonable and adequate to meet the
24 costs which must be incurred by efficiently and economically operated
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD03913-01-5
A. 1359 2
1 facilities and service providers. Such rates of payment shall not be
2 based on information or a base year calculation which is more than four
3 calendar years old.
4 § 3. Paragraph (a) of subdivision 18 of section 364-j of the social
5 services law, as amended by chapter 649 of the laws of 1996, is amended
6 to read as follows:
7 (a) The department of health may, where not inconsistent with the rate
8 setting authority of other state agencies and subject to approval of the
9 director of the division of the budget, develop reimbursement methodol-
10 ogies and fee schedules for determining the amount of payment to be made
11 to managed care providers under the managed care program. Such
12 reimbursement methodologies and fee schedules may include provisions for
13 payment of managed care fees and capitation arrangements. Such
14 reimbursement methodologies and fee schedules of payment shall be
15 reasonably related to the costs of efficient production of such services
16 and shall be reasonable and adequate to meet the costs which must be
17 incurred by efficiently and economically operated facilities and service
18 providers. Rates of payment shall not be based on information or a base
19 year calculation which is more than four calendar years old.
20 § 4. The social services law is amended by adding a new section 363-g
21 to read as follows:
22 § 363-g. Disclosure of Medicaid reimbursement methodology. The commis-
23 sioner of health shall annually develop and post on the department's
24 website a list of all Medicaid provider types with a detailed
25 description of the Medicaid reimbursement methodology applicable to each
26 provider type. Such description shall include information on both oper-
27 ating and capital reimbursement methodologies. The commissioner shall
28 also develop and publish on the department's website a detailed yearly
29 workplan for reimbursement modernization across Medicaid and other
30 public insurance programs.
31 § 5. This act shall take effect on the thirtieth day after it shall
32 have become a law; provided, however, that the amendments to section
33 364-j of the social services law made by section three of this act shall
34 not affect the repeal of such section and shall be deemed repealed ther-
35 ewith.
