S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7910
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 28, 2021
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  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:
 
   Section  1.  Paragraph  (c)  of subdivision 18 of section 364-j of the
 social services law, as added by section 55 of part B of chapter  57  of
 the laws of 2015, is amended to read as follows:
   (c)  The  department [of health] shall require the independent actuary
 selected pursuant to paragraph (b) of  this  subdivision  to  provide  a
 complete actuarial memorandum, along with all actuarial assumptions made
 and  all other data, materials and methodologies used in the development
 of rates, to managed care providers thirty days prior to  submission  of
 such  rates  to  the  centers  for  medicare  and  medicaid services for
 approval. THE ACTUARIAL MEMORANDUM  SHALL  INCLUDE  (I)  ANY  ADDITIONAL
 MATERIALS  SUBMITTED  TO  THE CENTERS FOR MEDICARE AND MEDICAID SERVICES
 INCLUDING  ACTUARIAL  CERTIFICATION  LETTERS,  (II)  ANY  CORRESPONDENCE
 BETWEEN  THE  STATE  AND  THE CENTERS FOR MEDICARE AND MEDICAID SERVICES
 RELATED TO THE RATES, (III)  OTHER  DATA,  MATERIALS  AND  METHODOLOGIES
 CONSIDERED  BUT  NOT  USED  BY  THE DEPARTMENT IN THE DEVELOPMENT OF THE
 RATES, AND (IV) ANY INFORMATION REQUIRED TO BE DISCLOSED TO MANAGED CARE
 PROVIDERS OR THE  PUBLIC  UNDER  FEDERAL  RULES.  THE  DEPARTMENT  SHALL
 REQUIRE  THE INDEPENDENT ACTUARY TO SEPARATELY IDENTIFY AND PRESENT IN A
 COLLECTIVE GROUP THE REQUIRED MATERIAL UNDER  EACH  APPLICABLE  SUBPARA-
 GRAPH  (I)  THROUGH  (IV)  OF THIS PARAGRAPH. Managed care providers may
 request THAT THE DEPARTMENT AND ITS INDEPENDENT  ACTUARY  CONDUCT  addi-
 tional  review  of  the  actuarial soundness of the rate setting process
 and/or methodology.  PRIOR TO SUBMISSION OF RATES  TO  THE  CENTERS  FOR
 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.
              

                                                            LBD11482-01-1

 A. 7910                             2
 
 RESPOND TO ANY REQUEST FROM MANAGED CARE PROVIDERS FOR ADDITIONAL REVIEW
 OF THE ACTUARIAL SOUNDNESS OF THE RATE SETTING PROCESS  OR  METHODOLOGY,
 AND  IN  SUCH  RESPONSE  THE DEPARTMENT SHALL EITHER: (1) AGREE TO ADDI-
 TIONAL  REVIEW  AND  DELAY  SUBMISSION  OF THE RATES FOR APPROVAL TO THE
 CENTERS FOR MEDICARE AND MEDICAID SERVICES UNTIL THE DEPARTMENT'S REVIEW
 IS COMPLETE AND SHARED WITH MANAGED CARE PROVIDERS, OR (2)  DECLINE  THE
 REQUESTED  ADDITIONAL  REVIEW,  STATING IN WRITING CLEAR REASONS WHY THE
 REQUEST IS DENIED.
   § 2. Subdivision 18 of section 364-j of the  social  services  law  is
 amended by adding a new paragraph (f) to read as follows:
   (F)  THE  DEPARTMENT SHALL NOTIFY MANAGED CARE PROVIDERS OF REIMBURSE-
 MENT RATES PRIOR TO THE EFFECTIVE DATE OF SUCH RATES.
   § 3. This act shall take effect immediately; provided that the  amend-
 ments  to  section 364-j of the social services law made by sections one
 and two of this act shall not affect the  repeal  of  such  section  and
 shall expire and be deemed repealed therewith.