S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5795--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              March 23, 2023
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on  Health -- reported and referred to the Committee on Ways and Means
   -- committee discharged, bill amended, ordered  reprinted  as  amended
   and recommitted to said committee
 
 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:
 
   Section  1.  Subdivision 8 of section 4403-f of the public health law,
 as amended by section 21 of part B of chapter 59 of the laws of 2016, is
 amended to read as follows:
   8. (A) Payment rates for managed long term care plan enrollees  eligi-
 ble  for  medical  assistance.  The commissioner shall establish payment
 rates for services provided to enrollees eligible under title XIX of the
 federal social security act. Such payment  rates  shall  be  subject  to
 approval by the director of the division of the budget and shall reflect
 savings to both state and local governments when compared to costs which
 would  be incurred by such program if enrollees were to receive compara-
 ble health and long term care services on a fee-for-service basis in the
 geographic region in which such services are proposed  to  be  provided.
 Payment rates shall be risk-adjusted to take into account the character-
 istics  of  enrollees, or proposed enrollees, including, but not limited
 to:   frailty, disability level,  health  and  functional  status,  age,
 gender,  the  nature  of  services provided to such enrollees, and other
 factors as determined by the commissioner. The  risk  adjusted  premiums
 may  also  be  combined  with  disincentives or requirements designed to
 mitigate any incentives to obtain higher payment categories. In  setting
 such  payment  rates, the commissioner shall consider costs borne by the
 managed care program to ensure actuarially sound and adequate  rates  of
 payment  to ensure quality of care shall comply with all applicable laws

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10268-02-3
 A. 5795--A                          2
              

 
 and regulations, state and federal, including regulations as to actuari-
 al soundness for medicaid managed care.
   (B)  SUPPLEMENTAL  QUALITY  IMPROVEMENT  PAYMENTS.  (I) FOR THE PERIOD
 BEGINNING APRIL FIRST, TWO THOUSAND TWENTY-THREE THROUGH  MARCH  THIRTY-
 FIRST,  TWO  THOUSAND  TWENTY-FOUR,  PAYMENT RATES FOR MANAGED LONG TERM
 CARE PLANS SHALL BE ADJUSTED TO INCREASE PAYMENTS TO ALL PLANS THAT  (1)
 HAVE RECEIVED FOUR OR MORE STAR RATINGS FOR AN OVERALL SCORE IN THE MOST
 RECENTLY  AVAILABLE  MANAGED  LONG  TERM  CARE CONSUMER REGIONAL QUALITY
 GUIDE PRODUCED BY THE DEPARTMENT ON APRIL FIRST,  TWO  THOUSAND  TWENTY-
 THREE, AND (2) HAVE A RELATIVE RISK SCORE GREATER THAN ONE AND ONE-TENTH
 IN  EFFECT  ON  APRIL FIRST, TWO THOUSAND TWENTY-THREE. FUNDING FOR SUCH
 RATE INCREASES SHALL BE PROVIDED BY REDUCING PAYMENT RATES TO PLANS  NOT
 ELIGIBLE  FOR A RATE INCREASE PURSUANT TO THIS PARAGRAPH, BY ONE PERCENT
 OR THIRTY MILLION DOLLARS, WHICHEVER IS LESS.
   (II) ELIGIBLE PLANS SHALL RECEIVE AN AMOUNT  DETERMINED  BY  (1)  EACH
 ELIGIBLE  PLAN  ALLOCATED AN EQUAL SHARE OF SUCH FUNDING, AND (2) MULTI-
 PLYING THAT AMOUNT BY ONE HUNDRED PERCENT FOR EACH  ELIGIBLE  PLAN  THAT
 RECEIVED  A  RATING OF FIVE STARS IN THE MANAGED LONG TERM CARE CONSUMER
 REGIONAL QUALITY GUIDE, AND EIGHTY PERCENT FOR EACH ELIGIBLE  PLAN  THAT
 RECEIVED  A  RATING OF FOUR STARS IN THE MANAGED LONG TERM CARE CONSUMER
 REGIONAL QUALITY GUIDE.
   § 2. This act shall take effect immediately; provided,  however,  that
 the  amendments  to subdivision 8 of section 4403-f of the public health
 law made by section one of this act shall not affect the repeal of  such
 section and shall be deemed repealed therewith.