STATE OF NEW YORK ________________________________________________________________________

8229

2023-2024 Regular Sessions

IN ASSEMBLY

November 6, 2023 ___________

Introduced by M. of A. PAULIN -- 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. LBD13466-01-3

A. 8229 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.