S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8922
 
                           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 and the public health law, in
   relation to establishing a quality incentive program for managed  care
   providers
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subdivision 18 of section 364-j of the social services  law
 is amended by adding a new paragraph (c-1) to read as follows:
   (C-1)  IN SETTING SUCH REIMBURSEMENT, THE COMMISSIONER OF HEALTH SHALL
 ESTABLISH A QUALITY INCENTIVE PROGRAM FOR MANAGED CARE PROVIDERS THAT IS
 DISTRIBUTED BASED ON MANAGED  CARE  PROVIDERS'  PERFORMANCE  IN  MEETING
 QUALITY OBJECTIVES, WHICH SHALL BE SET BY THE COMMISSIONER IN ADVANCE OF
 THE  PERIOD  DURING  WHICH  QUALITY  IS MEASURED. SUCH QUALITY INCENTIVE
 PROGRAM SHALL BE FUNDED AT A LEVEL OF AT LEAST ONE PERCENT OF THE  TOTAL
 ANNUAL  PREMIUM PAID TO MANAGED CARE PROVIDERS, OR THREE HUNDRED MILLION
 DOLLARS, WHICHEVER IS GREATER. IN ESTABLISHING THE MANNER  IN  WHICH  TO
 MEASURE  QUALITY  AND  DISTRIBUTE  QUALITY  INCENTIVE PROGRAM FUNDS, THE
 COMMISSIONER OF HEALTH SHALL ESTABLISH A METHODOLOGY THAT  PROVIDES  THE
 GREATEST  LEVEL OF FUNDING TO MANAGED CARE PROVIDERS RECEIVING THE HIGH-
 EST QUALITY SCORES AND SHALL CONSULT  WITH  REPRESENTATIVES  OF  MANAGED
 CARE PROVIDERS AND OTHER KEY STAKEHOLDERS.
   §  2.  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.  Payment  rates  for managed long term care plan enrollees eligible
 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.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD05012-01-3
 A. 8922                             2
 
 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
 and regulations, state and federal, including regulations as to actuari-
 al soundness for medicaid managed care. IN SETTING  SUCH  REIMBURSEMENT,
 THE COMMISSIONER SHALL ESTABLISH A QUALITY INCENTIVE PROGRAM FOR MANAGED
 LONG  TERM  CARE  PLANS  THAT  SHALL BE DISTRIBUTED BASED ON SUCH PLANS'
 PERFORMANCE IN MEETING QUALITY OBJECTIVES, WHICH SHALL  BE  SET  BY  THE
 COMMISSIONER  IN ADVANCE OF THE PERIOD DURING WHICH QUALITY IS MEASURED.
 SUCH QUALITY INCENTIVE PROGRAM SHALL BE FUNDED AT A LEVEL  OF  AT  LEAST
 ONE  PERCENT  OF THE TOTAL ANNUAL PREMIUM PAID TO MANAGED LONG TERM CARE
 PLANS.   IN ESTABLISHING THE MANNER IN  WHICH  TO  MEASURE  QUALITY  AND
 DISTRIBUTE  QUALITY  INCENTIVE  PROGRAM  FUNDS,  THE  COMMISSIONER SHALL
 ESTABLISH A METHODOLOGY THAT PROVIDES THE GREATEST LEVEL OF  FUNDING  TO
 MANAGED  LONG  TERM  CARE PLANS RECEIVING THE HIGHEST QUALITY SCORES AND
 SHALL CONSULT WITH REPRESENTATIVES OF MANAGED LONG TERM CARE  PLANS  AND
 OTHER KEY STAKEHOLDERS.
   §  3.  This act shall take effect immediately; provided, however, that
 the amendments to section 364-j of the social services law  and  section
 4403-f of the public health law made by sections one and two of this act
 shall  not  affect  the  repeal  of  such  sections  and shall be deemed
 repealed therewith.