NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A10629
SPONSOR: Rules (Rajkumar) TITLE OF BILL:
An act to amend the social services law, in relation to capitated
payments under medical assistance for needy persons
PURPOSE OR GENERAL IDEA OF BILL: To move state healthcare spending
toward a system of capitation payments.
SUMMARY OF PROVISIONS: Section 1. Section 367-a of the social services
law is amended by adding a new subdivision 13 allowing the health
commissioner to set different rates for patients for the purposes of
capitation payments
2. Section 364-j of the social services law is amended by adding a new
subdivision 3-a elaborating on terms available for capitation payments
§ 3. Provides that the commissioner of health shall draft legislation
necessary
Sec 4 is the effective date
DIFFERENCE BETWEEN ORIGINAL AND AMENDED VERSION (IF APPLICABLE):
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JUSTIFICATION:
The current healthcare spending model of fee for service creates a
perverse incentive for providers to perform unnecessary medical proce-
dures without any incentive to reduce costs or improve outcomes. Under
the capitation payment model, providers receive a flat fee for each
patient, generally including incentives for improved outcomes and reduc-
ing costs. SEIU 775NW stated this system "offers the best possibility
for improving health outcomes and reducing Medicare costs." Switching to
capitation payments will help control healthcare costs and produce
better health outcomes.
PRIOR LEGISLATIVE HISTORY:
New bill.
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
To be determined.
EFFECTIVE DATE:
This act shall take effect immediately, provided that sections one and
two of this act shall take effect five years after such effective date;
and provided, further, that the amendments to section 364-j of the
social services law, made by section two of this act, shall not affect
the repeal of such section, and shall be deemed repealed therewith.
Effective immediately, the commissioner of health shall make regulations
and take other actions, including applying for federal waivers and
submitting state Medicaid plan amendments, reasonably necessary to
implement the provisions of this act.
STATE OF NEW YORK
________________________________________________________________________
10629
IN ASSEMBLY
June 20, 2024
___________
Introduced by COMMITTEE ON RULES -- (at request of M. of A. Rajkumar) --
read once and referred to the Committee on Health
AN ACT to amend the social services law, in relation to capitated
payments under medical assistance for needy persons
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 367-a of the social services law is amended by
2 adding a new subdivision 13 to read as follows:
3 13. (a) Any inconsistent provision of this chapter or other law
4 notwithstanding, on and after the effective date of this subdivision,
5 all payments with respect to medical assistance shall be capitated
6 payments.
7 (b) The commissioner may develop and assign patients rating categories
8 based on risk for the purposes of developing reimbursement methodologies
9 and payments under this subdivision.
10 § 2. Section 364-j of the social services law is amended by adding a
11 new subdivision 3-a to read as follows:
12 3-a. Special contract provisions. Any capitation payment system for
13 medical assistance under this article may include contract arrangements
14 that further adjust the payment amounts, including but not limited to
15 incentive arrangements, pass-through payments, risk corridor mechanisms,
16 or withhold arrangements as defined by 42 CFR 438.6.
17 § 3. No later than one year after the effective date of this act, the
18 commissioner of health shall provide drafts of legislation necessary to
19 convert all payments under the medical assistance for needy persons
20 program from fee-for-service payments to capitated payments, to the
21 governor, the temporary president of the senate and the speaker of the
22 assembly.
23 § 4. This act shall take effect immediately, provided that sections
24 one and two of this act shall take effect five years after such effec-
25 tive date; and provided, further, that the amendments to section 364-j
26 of the social services law, made by section two of this act, shall not
27 affect the repeal of such section, and shall be deemed repealed there-
28 with. Effective immediately, the commissioner of health shall make regu-
29 lations and take other actions, including applying for federal waivers
30 and submitting state Medicaid plan amendments, reasonably necessary to
31 implement the provisions of this act.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15520-03-4
