S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8877
 
                           I N  A S S E M B L Y
 
                             January 26, 2024
                                ___________
 
 Introduced by M. of A. PAULIN -- 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
 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD09075-01-3
 A. 8877                             2
 
 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.