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S06075 Summary:

S06075 Actions:

S06075 Committee Votes:

S06075 Floor Votes:

S06075 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          6075
 
                               2023-2024 Regular Sessions
 
                    IN SENATE
 
                                     March 28, 2023
                                       ___________
 
        Introduced  by  Sen. SKOUFIS -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health
 
        AN ACT to amend the social services law, in  relation  to  determination
          and  approval  of reimbursement rates for managed care providers under
          medicaid

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Paragraph  (c)  of subdivision 18 of section 364-j of the
     2  social services law, as added by section 55 of part B of chapter  57  of
     3  the laws of 2015, is amended to read as follows:
     4    (c)  The  department [of health] shall require the independent actuary
     5  selected pursuant to paragraph (b) of  this  subdivision  to  provide  a
     6  complete actuarial memorandum, along with all actuarial assumptions made
     7  and  all other data, materials and methodologies used in the development
     8  of rates, to managed care providers thirty days prior to  submission  of
     9  such  rates  to  the  centers  for  medicare  and  medicaid services for
    10  approval. The actuarial memorandum  shall  include  (i)  any  additional
    11  materials  submitted  to  the centers for medicare and medicaid services
    12  including  actuarial  certification  letters,  (ii)  any  correspondence
    13  between  the  state  and  the centers for medicare and medicaid services
    14  related to the rates, (iii)  other  data,  materials  and  methodologies
    15  considered  but  not  used  by  the department in the development of the
    16  rates, and (iv) any information required to be disclosed to managed care
    17  providers or the  public  under  federal  rules.  The  department  shall
    18  require  the independent actuary to separately identify and present in a
    19  collective group the required material under  each  applicable  subpara-
    20  graph  (i)  through  (iv)  of this paragraph. Managed care providers may
    21  request that the department and its independent  actuary  conduct  addi-
    22  tional  review  of  the  actuarial soundness of the rate setting process
    23  and/or methodology.  Prior to submission of rates  to  the  centers  for
    24  medicare  and  medicaid  services  for  approval,  the  department shall
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09075-01-3
        S. 6075                             2
 
     1  respond to any request from managed care providers for additional review
     2  of the actuarial soundness of the rate setting process  or  methodology,
     3  and  in  such  response  the department shall either: (1) agree to addi-
     4  tional  review  and  delay  submission  of the rates for approval to the
     5  centers for medicare and medicaid services until the department's review
     6  is complete and shared with managed care providers, or (2)  decline  the
     7  requested  additional  review,  stating in writing clear reasons why the
     8  request is denied.
     9    § 2. Subdivision 18 of section 364-j of the  social  services  law  is
    10  amended by adding a new paragraph (f) to read as follows:
    11    (f)  The  department shall notify managed care providers of reimburse-
    12  ment rates prior to the effective date of such rates.
    13    § 3. This act shall take effect immediately; provided that the  amend-
    14  ments  to  section 364-j of the social services law made by sections one
    15  and two of this act shall not affect the  repeal  of  such  section  and
    16  shall expire and be deemed repealed therewith.