New York S 7518: Relates to payment rates for managed long term care plans

Bill Text

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S07518 Summary:

BILL NOS07518 

&nbsp

SAME ASNo Same As

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SPONSORCLEARE

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COSPNSRJACKSON

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MLTSPNSR

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Amd §4403-f, Pub Health L

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Provides for supplemental quality improvement payments for managed long term care plans that meet certain criteria.

Go to top S07518 Actions:

BILL NOS07518 

&nbsp

04/21/2025REFERRED TO HEALTH

01/07/2026REFERRED TO HEALTH

Go to topS07518 Committee&nbspVotes:

Go to topS07518 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topS07518 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 7518

 2025-2026 Regular Sessions

 IN SENATE

 April 21, 2025
 ___________

 Introduced by Sen. CLEARE -- read twice and ordered printed, and when
 printed to be committed to the Committee on Health

 AN ACT to amend the public health law, in relation to payment rates for
 managed long term care plans

 The People of the State of New York, represented in Senate and Assem-
 bly, do enact as follows:

 1 Section 1. Subdivision 8 of section 4403-f of the public health law,
 2 as amended by section 21 of part B of chapter 59 of the laws of 2016, is
 3 amended to read as follows:
 4 8. (a) Payment rates for managed long term care plan enrollees eligi-
 5 ble for medical assistance. The commissioner shall establish payment
 6 rates for services provided to enrollees eligible under title XIX of the
 7 federal social security act. Such payment rates shall be subject to
 8 approval by the director of the division of the budget and shall reflect
 9 savings to both state and local governments when compared to costs which
 10 would be incurred by such program if enrollees were to receive compara-
 11 ble health and long term care services on a fee-for-service basis in the
 12 geographic region in which such services are proposed to be provided.
 13 Payment rates shall be risk-adjusted to take into account the character-
 14 istics of enrollees, or proposed enrollees, including, but not limited
 15 to: frailty, disability level, health and functional status, age,
 16 gender, the nature of services provided to such enrollees, and other
 17 factors as determined by the commissioner. The risk adjusted premiums
 18 may also be combined with disincentives or requirements designed to
 19 mitigate any incentives to obtain higher payment categories. In setting
 20 such payment rates, the commissioner shall consider costs borne by the
 21 managed care program to ensure actuarially sound and adequate rates of
 22 payment to ensure quality of care shall comply with all applicable laws
 23 and regulations, state and federal, including regulations as to actuari-
 24 al soundness for medicaid managed care.

 EXPLANATION--Matter in italics (underscored) is new; matter in brackets
 [ ] is old law to be omitted.
 LBD11720-01-5

 S. 7518 2

 1 (b) Supplemental quality improvement payments. (i) For the period
 2 beginning April first, two thousand twenty-five through March thirty-
 3 first, two thousand twenty-six, payment rates for managed long term care
 4 plans shall be adjusted to increase payments to all plans that (1) have
 5 received four or more star ratings for an overall score in the most
 6 recently available managed long term care consumer regional quality
 7 guide produced by the department on April first, two thousand twenty-
 8 five, and (2) have a relative risk score greater than one and one-tenth
 9 in effect on April first, two thousand twenty-five. Funding for such
 10 rate increases shall be provided by reducing payment rates to plans not
 11 eligible for a rate increase pursuant to this paragraph, by one percent
 12 or thirty million dollars, whichever is less.
 13 (ii) Eligible plans shall receive an amount determined by (1) each
 14 eligible plan allocated an equal share of such funding, and (2) multi-
 15 plying that amount by one hundred percent for each eligible plan that
 16 received a rating of five stars in the managed long term care consumer
 17 regional quality guide, and eighty percent for each eligible plan that
 18 received a rating of four stars in the managed long term care consumer
 19 regional quality guide.
 20 § 2. This act shall take effect immediately; provided, however, that
 21 the amendments to subdivision 8 of s