New York A 1933: Relates to the development and approval of reimbursement rates for managed care providers under medicaid

Bill Text

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A01933 Summary:

BILL NOA01933 

&nbsp

SAME ASNo Same As

&nbsp

SPONSORPaulin

&nbsp

COSPNSRSayegh, Simone

&nbsp

MLTSPNSR

&nbsp

Amd §364-j, Soc Serv L

&nbsp

Requires notice and additional review for managed care providers of the methodologies and fee schedules and other materials used for determining medicaid reimbursement rates.

Go to top A01933 Actions:

BILL NOA01933 

&nbsp

01/14/2025referred to health

02/24/2025reported referred to ways and means

01/07/2026referred to ways and means

Go to topA01933 Committee&nbspVotes:

Committee:HEALTH Chair:Paulin 
DATE:02/24/2025AYE/NAY:24/0 Action: Favorable refer to committee Ways and Means PaulinAyeJensenAye

DinowitzAyeGandolfoAye

RosenthalAyeBlumencranzAye

HevesiAyeGrayAye

SteckAyeMaherAye

BraunsteinAyeSlaterAye

SolagesAyeChludzinskiAye

Bichotte HermelExcusedNorberAye

SayeghAye

McDonaldAye

ReyesAye

Gonzalez-RojasAye

RajkumarAye

ForrestAbsent

KellesAye

LucasAye

MeeksAye

LunsfordAye

Go to topA01933 Floor&nbspVotes:

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

Go to topA01933 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 1933

 2025-2026 Regular Sessions

 IN ASSEMBLY

 January 14, 2025
 ___________

 Introduced by M. of A. PAULIN, SAYEGH, SIMONE -- read once and referred
 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.
 LBD05279-01-5

 A. 1933 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; provide