S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2371
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 16, 2025
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to  amend  the  insurance law, the public health law, the civil
   service law and the social services 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
 SHALL ENTER INTO  VALUE-BASED  ARRANGEMENTS  WITH  HOSPITALS,  FEDERALLY
 QUALIFIED  HEALTH  CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
 CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY  CARE
 FOR ENROLLEES OF SUCH INSURER.
   (III)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
 SHALL ENTER INTO  VALUE-BASED  ARRANGEMENTS  WITH  HOSPITALS,  FEDERALLY
 QUALIFIED  HEALTH  CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
 CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY  CARE
 FOR ENROLLEES 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-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05808-01-5
              

 A. 2371                             2
 
 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
 SHALL ENTER INTO  VALUE-BASED  ARRANGEMENTS  WITH  HOSPITALS,  FEDERALLY
 QUALIFIED  HEALTH  CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
 CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY  CARE
 OF ENROLLEES OF SUCH INSURER.
   (III)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
 SHALL ENTER INTO  VALUE-BASED  ARRANGEMENTS  WITH  HOSPITALS,  FEDERALLY
 QUALIFIED  HEALTH  CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
 CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY  CARE
 OF ENROLLEES 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
 SHALL ENTER INTO  VALUE-BASED  ARRANGEMENTS  WITH  HOSPITALS,  FEDERALLY
 QUALIFIED  HEALTH  CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
 CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY  CARE
 OF ENROLLEES OF SUCH INSURER.
   (III)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
 SHALL ENTER INTO  VALUE-BASED  ARRANGEMENTS  WITH  HOSPITALS,  FEDERALLY
 QUALIFIED  HEALTH  CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
 CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY  CARE
 OF ENROLLEE 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,
 FEDERALLY  QUALIFIED  HEALTH  CENTERS  PROVIDING  MATERNITY CARE, AND/OR
 BIRTHING CENTERS THAT PROVIDE VALUE-BASED ARRANGEMENTS THAT  PROVIDE  AT
 LEAST  EIGHTY-FIVE  PERCENT  OF THE MATERNITY CARE FOR ENROLLEES OF SUCH
 ORGANIZATION.
   (C) BY DECEMBER THIRTY-FIRST, TWO  THOUSAND  TWENTY-SIX,  EACH  HEALTH
 MAINTENANCE  ORGANIZATION  SHALL  ENTER  INTO  CONTRACTS WITH HOSPITALS,
 FEDERALLY QUALIFIED HEALTH  CENTERS  PROVIDING  MATERNITY  CARE,  AND/OR
 BIRTHING  CENTERS  THAT PROVIDE VALUE-BASED ARRANGEMENTS THAT PROVIDE AT
 LEAST NINETY-FIVE PERCENT OF THE MATERNITY CARE  OF  ENROLLEES  OF  SUCH
 ORGANIZATION.
   §  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. 2371                             3
 
 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
 SHALL ENTER INTO  VALUE-BASED  ARRANGEMENTS  WITH  HOSPITALS,  FEDERALLY
 QUALIFIED  HEALTH  CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
 CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY  CARE
 OF ENROLLEES OF SUCH INSURER.
   (C)  BY  DECEMBER  THIRTY-FIRST,  TWO THOUSAND TWENTY-SIX EACH INSURER
 SHALL ENTER INTO  VALUE-BASED  ARRANGEMENTS  WITH  HOSPITALS,  FEDERALLY
 QUALIFIED  HEALTH  CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
 CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY  CARE
 OF ENROLLEES OF SUCH INSURER.
   §  6.  Section 364-j of the social services law is amended by adding a
 new subdivision 40 to read as follows:
   40. (A) A MANAGED CARE PROVIDER 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 MANAGED
 CARE PROVIDER SHALL ENTER INTO VALUE BASED ARRANGEMENTS WITH  HOSPITALS,
 FEDERALLY  QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR
 BIRTHING CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATER-
 NITY CARE OF ENROLLEES OF THE MANAGED CARE PROVIDER.
   (C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND  TWENTY-SIX,  EACH  MANAGED
 CARE  PROVIDER SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS,
 FEDERALLY QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES,  AND/OR
 BIRTHING CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATER-
 NITY CARE OF ENROLLEES OF THE MANAGED CARE PROVIDER.
   §  7. This act shall take effect on the forty-fifth day after it shall
 have become a law; provided, however, that  the  amendments  to  section
 364-j  of  the social services law made by section six of this act shall
 not affect the repeal of such section and shall be deemed repealed ther-
 ewith.  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 effective date.