NY State Senate Bill 2023-S9013

Archive: Last Bill Status - In Senate Committee Insurance Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
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Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Apr 09, 2024	referred to insurance

2023-S9013 (ACTIVE) - Details

See Assembly Version of this Bill:: A9249
Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L; amd §4406, Pub Health L; amd §162, Civ Serv L
Versions Introduced in 2025-2026 Legislative Session:: A2371

2023-S9013 (ACTIVE) - Summary

Requires contracts for insurance to provide value-based care for maternity coverage; defines value-based care as an arrangement that financially rewards certain positive outcomes and financially penalizes certain negative outcomes.

2023-S9013 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S9013

SPONSOR: WEBB
 
TITLE OF BILL:

An act to amend the insurance law, the public health law and the civil
service law, in relation to value-based care for maternity coverage

 
PURPOSE:

The purpose of this bill is to require all types of health insurance to
enter value-based arrangements for maternity coverage for at least nine-
ty five percent of the maternity cases of each insurer.

 
SUMMARY OF PROVISIONS:

Section 1 adds a new subparagraph c to paragraph 10 of subsection (i) of
section 3216 of the insurance law to define "value-based arrangement".
It also further defines a negative outcome as a c- section on a low risk
individual.

Section 2 adds an amendment to paragraph 5 of subsection (k) of section

3221 of the insurance law to define "value-based arrangement". It also
further defines a negative outcome as a c-section on a low risk individ-
ual.

Section 3 amends paragraph 1 of subsection c of section 4303 of the
insurance law to add a new subparagraph d which defines "value-based
arrangement". It also further defines a negative outcome as a c- section
on a low risk individual.

Section 4 adds a new subdivision 6 of section 4406 of the public health
law to require a health maintenance organization reimburse and pay for
maternity care through a value-based arrangement. It also defines a
"value-based arrangement." It further defines a negative outcome as a
0-section on a low risk individual.

Sections 5 add as new subdivision 10 to section 162 of the civil service
law to require any contract entered into for maternity care be organized
and paid for through a value-based arrangement. It also defines a
"value-based arrangement". It further defines a negative outcome as a
c-section on a low risk individual.

Section 6 establishes the effective date. Such effective date shall be
45 days after enactment.

 
JUSTIFICATION:

Since the 1970s, the c-section rate in this country has increased by 500
percent, where 1 in 3 babies are born via c-section today.  Despite this
growing trend, research demonstrates there is no evidence that cesarean
births provide any benefit to the mother or newborn when the procedure
is not required, in fact, it is quite the opposite.

Currently, the c-section rate in New York State is approximately 34.1
percent, which slightly exceeds the national average and greatly exceeds
the World Health Organization and the Center for Disease Control's (CDC)
ideal rate of 10-15 percent. Importantly, cesarean birth rates vary

greatly across hospitals, ranging between 7% and 70% depending on what
hospital a birthing person goes to.

Studies have found that cesarean birth rates in hospitals are directly
linked to higher maternal death rates and higher costs for healthcare.
The increase in cesarean rates in the U.S. is linked to an increase in
maternal deaths overall as the procedure can lead to neonatal respir-
atory problems and maternal health complications. In fact, cesareans can
account for three of the top six leading causes of maternal mortality -
hemorrhage, complications of anesthesia, and infection.

Additionally, there is an alarming disparity in cesarean birth rates
among different birthing populations. Black birthing people are more
likely to receive a cesarean overall and they are also more likely to
undergo repeated cesareans compared to other birthing people, which
further increases the risk of mortality. In fact, in the U.S., black
birthing people are 4 times more likely to die from pregnancy-related
complications than white birthing people.

In 2023, America's Health Rankings (AHR) reported that of the 50 states,
New York is ranked 49th for the highest rate of low-risk c-sections. A
cesarean delivery is considered "low-risk" if a single infant is deliv-
ered head first at full term to a mother who has not given birth before.
AHR further reported that between 2019 and 2021, the rate of low-risk
cesarean delivery increased 6 percent in NYS and only 3 percent
nationally. Low-risk cesarean deliveries were higher among Black birth-
ing people.

With the rate of c-sections steadily rising in New York State over the
last several years, more needs to be done to reverse this trend.
Value-based arrangements have the potential to reduce the number of
medically unnecessary procedures, like c-sections, and the negative
health outcomes that often follow. Value-based arrangements reward
health care providers with incentive payments for the quality of care
they give to people, not the quantity.

This bill would define a "value-based arrangement" as an arrangement
that financially rewards certain positive health outcomes and financial-
ly penalizes certain negative outcomes, where a negative outcome
includes performing a c-section on a low-risk individual. The bill
further requires every type of insurance to enter into a value-based
arrangement with hospitals and birthing centers in the state. By Decem-
ber 2025, each insurer and hospital and/or birthing center shall enter
value-based arrangements with eight five percent of the insurer's mater-
nity cases, increasing to ninety-five percent of the insurer's maternity
cases by December 31, 2026. For some birthing people, a c-section is the
best and safest option for both the mother and the baby. However, the
rate of low-risk c-sections performed in New York is unexplainable and
when compounded with the negative maternal health outcomes we see in
this state, the rate of this procedure is inexcusable.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL IMPLICATIONS:

To be determined.
 
EFFECTIVE DATE:
Sections 1, 3, and 4 of the bill would take effect immediately. The
remaining sections would take effect April 1, 2026.

2023-S9013 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9013
 
                             I N  S E N A T E
 
                               April 9, 2024
                                ___________
 
 Introduced  by  Sen.  WEBB  --  read twice and ordered printed, and when
   printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, the public health law and  the  civil
   service law, in relation to value-based care for maternity coverage
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Paragraph 10 of subsection  (i)  of  section  3216  of  the
 insurance  law  is  amended  by adding a new subparagraph (C) to read as
 follows:
   (C)(I) COVERAGE PROVIDED BY THIS PARAGRAPH SHALL BE ORGANIZED AND PAID
 FOR THROUGH A VALUE-BASED ARRANGEMENT PURSUANT TO THE SCHEDULE SET FORTH
 IN THIS SUBPARAGRAPH.  "VALUE-BASED ARRANGEMENT" SHALL MEAN AN  ARRANGE-
 MENT  THAT FINANCIALLY REWARDS CERTAIN POSITIVE OUTCOMES AND FINANCIALLY
 PENALIZES CERTAIN NEGATIVE OUTCOMES.  FOR THE PURPOSES OF THIS  SECTION,
 A NEGATIVE OUTCOME SHALL INCLUDE A C-SECTION ON A LOW RISK INDIVIDUAL.
   (II)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-FIVE EACH INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS  THAT  COVER  AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY
 CASES OF SUCH INSURER.
   (III) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX  EACH  INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS THAT COVER AT LEAST NINETY-FIVE PERCENT  OF  THE  MATERNITY
 CASES OF SUCH INSURER.
   §  2.  Paragraph  5 of subsection (k) of section 3221 of the insurance
 law is amended by adding a new subparagraph (C) to read as follows:
   (C)(I) COVERAGE PROVIDED BY THIS PARAGRAPH SHALL BE ORGANIZED AND PAID
 FOR THROUGH A VALUE-BASED ARRANGEMENT PURSUANT TO THE SCHEDULE SET FORTH
 IN THIS SUBPARAGRAPH.  "VALUE-BASED ARRANGEMENT" SHALL MEAN AN  ARRANGE-
 MENT  THAT FINANCIALLY REWARDS CERTAIN POSITIVE OUTCOMES AND FINANCIALLY
 PENALIZES CERTAIN NEGATIVE OUTCOMES.  FOR THE PURPOSES OF THIS  SECTION,
 A NEGATIVE OUTCOME SHALL INCLUDE A C-SECTION ON A LOW RISK INDIVIDUAL.
   (II)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-FIVE EACH INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14117-02-4

 S. 9013                             2
 
 ARRANGEMENTS  THAT  COVER  AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY
 CASES OF SUCH INSURER.
   (III)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS  THAT  COVER  AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY
 CASES OF SUCH INSURER.
   § 3. Paragraph 1 of subsection (c) of section 4303  of  the  insurance
 law is amended by adding a new subparagraph (D) to read as follows:
   (D)(I) COVERAGE PROVIDED BY THIS PARAGRAPH SHALL BE ORGANIZED AND PAID
 FOR THROUGH A VALUE-BASED ARRANGEMENT PURSUANT TO THE SCHEDULE SET FORTH
 IN  THIS SUBPARAGRAPH.  "VALUE-BASED ARRANGEMENT" SHALL MEAN AN ARRANGE-
 MENT THAT FINANCIALLY REWARDS CERTAIN POSITIVE OUTCOMES AND  FINANCIALLY
 PENALIZES  CERTAIN NEGATIVE OUTCOMES.  FOR THE PURPOSES OF THIS SECTION,
 A NEGATIVE OUTCOME SHALL INCLUDE A C-SECTION ON A LOW RISK INDIVIDUAL.
   (II) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-FIVE  EACH  INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS THAT COVER AT LEAST EIGHTY-FIVE PERCENT  OF  THE  MATERNITY
 CASES OF SUCH INSURER.
   (III)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS  THAT  COVER  AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY
 CASES OF SUCH INSURER.
   § 4. Section 4406 of the public health law is amended by adding a  new
 subdivision 6 to read as follows:
   6.  (A)  A HEALTH MAINTENANCE ORGANIZATION WHICH PROVIDES COVERAGE FOR
 MATERNITY CARE SHALL REIMBURSE AND  PAY  FOR  SUCH  COVERAGE  THROUGH  A
 VALUE-BASED  ARRANGEMENT  PURSUANT  TO  THE  SCHEDULE  CONTAINED IN THIS
 SUBDIVISION. "VALUE-BASED ARRANGEMENT" SHALL MEAN  AN  ARRANGEMENT  THAT
 FINANCIALLY  REWARDS CERTAIN POSITIVE OUTCOMES AND FINANCIALLY PENALIZES
 CERTAIN NEGATIVE OUTCOMES.  FOR THE PURPOSES OF THIS SECTION, A NEGATIVE
 OUTCOME SHALL INCLUDE A C-SECTION ON A LOW RISK INDIVIDUAL.
   (B) BY DECEMBER THIRTY-FIRST, TWO THOUSAND  TWENTY-FIVE,  EACH  HEALTH
 MAINTENANCE  ORGANIZATION  SHALL  ENTER  INTO  CONTRACTS  WITH HOSPITALS
 AND/OR BIRTHING CENTERS THAT PROVIDE VALUE-BASED ARRANGEMENTS THAT COVER
 AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY CASES  OF  SUCH  ORGANIZA-
 TION.
   (C)  BY  DECEMBER  THIRTY-FIRST,  TWO THOUSAND TWENTY-SIX, EACH HEALTH
 MAINTENANCE ORGANIZATION  SHALL  ENTER  INTO  CONTRACTS  WITH  HOSPITALS
 AND/OR BIRTHING CENTERS THAT PROVIDE VALUE-BASED ARRANGEMENTS THAT COVER
 AT  LEAST  NINETY-FIVE  PERCENT OF THE MATERNITY CASES OF SUCH ORGANIZA-
 TION.
   § 5. Section 162 of the civil service law is amended by adding  a  new
 subdivision 10 to read as follows:
   10.  (A)  ANY  CONTRACT  ENTERED INTO UNDER THIS SECTION SHALL REQUIRE
 THAT COVERAGE FOR MATERNITY CARE SHALL BE ORGANIZED AND PAID FOR THROUGH
 A VALUE-BASED ARRANGEMENT PURSUANT TO THE SCHEDULE  CONTAINED  IN  PARA-
 GRAPHS  (B) AND (C) OF THIS SUBDIVISION. "VALUE-BASED ARRANGEMENT" SHALL
 MEAN AN ARRANGEMENT THAT FINANCIALLY REWARDS CERTAIN  POSITIVE  OUTCOMES
 AND  FINANCIALLY  PENALIZES CERTAIN NEGATIVE OUTCOMES.  FOR THE PURPOSES
 OF THIS SECTION A NEGATIVE OUTCOME SHALL INCLUDE A C-SECTION  ON  A  LOW
 RISK INDIVIDUAL.
   (B)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-FIVE, EACH INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS  THAT  COVER  AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY
 CASES OF EACH INSURER.
 S. 9013                             3
 
   (C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER AND
 HOSPITAL AND/OR BIRTHING CENTER SHALL ENTER  INTO  VALUE-BASED  ARRANGE-
 MENTS  THAT COVER AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY CASES OF
 SUCH INSURER.
   §  6. This act shall take effect on the forty-fifth day after it shall
 have become a law. Effective immediately the addition, amendment  and/or
 repeal  of  any  rule  or regulation necessary for the implementation of
 this act on its effective date are authorized to be made  and  completed
 on or before such date.

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Senate Bill S9013

Sponsored By

Archive: Last Bill Status - In Senate Committee Insurance Committee

2023-S9013 (ACTIVE) - Details

2023-S9013 (ACTIVE) - Summary

2023-S9013 (ACTIVE) - Sponsor Memo

2023-S9013 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S9013

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Sponsored By

Lea Webb

Archive: Last Bill Status - In Senate Committee Insurance Committee

2023-S9013 (ACTIVE) - Details

2023-S9013 (ACTIVE) - Summary

2023-S9013 (ACTIVE) - Sponsor Memo

2023-S9013 (ACTIVE) - Bill Text download pdf

Comments