NY State Senate Bill 2025-S2113

Current Bill Status - In Senate Committee Insurance Committee

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

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jan 15, 2025	referred to insurance

co-Sponsors

2025-S2113 (ACTIVE) - Details

Current Committee:: Senate Insurance
Law Section:: Insurance Law
Laws Affected:: Amd §§4235, 3231 & 4317, Ins L
Versions Introduced in 2023-2024 Legislative Session:: S9622

2025-S2113 (ACTIVE) - Summary

Allows for Medicaid accountable care organizations to purchase experience-rated health insurance for their members.

2025-S2113 (ACTIVE) - Sponsor Memo

                                 
BILL NUMBER: S2113

SPONSOR: COONEY
 
TITLE OF BILL:

An act to amend the insurance law, in relation to allowing for Medicaid
accountable care organizations to purchase experience-rated health
insurance for their members

 
PURPOSE:

Health care providers serving predominantly Medicaid populations provide
a tremendous service to underserved communities, but they do so with
limited margins. The cost of providing health care to their own employ-
ees can become challenging. This is true even for larger groups of
providers who join together as a Medicaid accountable care organization
(AC0). Medicaid ACOs must be approved by the State Department of Health,
and must drive quality for Medicaid beneficiaries and efficiencies for
the Medicaid program. There are currently about ten Medicaid ACOs that
have been issued a certificate of authority in the State.

Recognizing these ACO's commitments to the State Medicaid program and
the people across the State served by the Medicaid program, this bill

would allow Medicaid ACOs that meet certain requirements to be recog-
nized as a group and be experience-rated, rather than to make available
community-rated plans to its members. This measure would recognize the
challenges faced by these providers and create a mechanism to allow the
limited number of Medicaid ACOs that otherwise meet the bill's require-
ments to purchase insurance as an experience-rated group.

 
SUMMARY OF SPECIFIC PROVISIONS:

Section one of the legislation would amend subparagraph (1) of
subsection (c) of section 4325 of the insurance law to insert a new
subdivision (N-1) to recognize Medicaid accountable care organizations
that have received a certificate of authority from the department of
health pursuant to Article 29-G of the public health law.

Sections two and three of the legislation would amend the provisions of
the insurance law governing community rating to except insurance
products issued to Medicaid accountable care organizations under
4325(cXN-1) provided they meet all of the following qualifications:

* The group is comprised of at least 150 member employers;

* The collective number of individuals insured under the policy exceeds
500 persons;

* Each employer in the group is enrolled as a provider in the State's
Medicaid program; and

* Each employer in the group can demonstrate an annual payer mix in
which Medicaid represents 60% or more of annual revenues.

Section four of the legislation establishes an effective date.

 
JUSTIFICATION:


Health care providers serving predominantly Medicaid populations provide
a tremendous service to underserved communities, but they do so with
limited margins. The cost of providing health care to their own employ-
ees can become challenging. This is true even for larger groups of
providers who join together to as a Medicaid accountable care organiza-
tion (ACO). Medicaid ACOs must be approved by the State Department of
Health, and must drive quality for Medicaid beneficiaries and efficien-
cies for the Medicaid program. There are currently about ten Medicaid
ACOs that have been issued a certificate of authority in the State.

Recognizing these ACO's commitments to the State Medicaid program and
the people across the State served by the Medicaid program, this bill
would allow Medicaid ACOs that meet certain requirements to be recog-
nized as a group and be experience-rated, rather than to make available
community-rated plans to its members. This measure would recognize the
challenges faced by these providers and create a mechanism to allow the
limited number of Medicaid ACOs that otherwise meet the bill's require-
ments to purchase insurance as an experience-rated group. As providers
of care to underserved communities face growing costs, rates that fail
to keep pace with inflation, and growing demand, this type of measure
will help enable providers that can prove they serve a high proportion
of Medicaid consumers and engage in high quality programs will help
stabilize costs for these providers.

 
LEGISLATIVE HISTORY:

S9622/A10601 of 2023-24: Referred to Insurance

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE D TE:

This act shall take effect immediately.

2025-S2113 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2113
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                             January 15, 2025
                                ___________
 
 Introduced  by  Sens. COONEY, SKOUFIS -- read twice and ordered printed,
   and when printed to be committed to the Committee on Insurance
 
 AN ACT to amend the insurance law, in relation to allowing for  Medicaid
   accountable  care  organizations  to  purchase experience-rated health
   insurance for their members

   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Paragraph 1 of subsection (c) of section 4235 of the insur-
 ance law is amended by adding a new subparagraph (O) as follows:
   (O)  A  POLICY  ISSUED  TO  AN  ACCOUNTABLE CARE ORGANIZATION ISSUED A
 CERTIFICATE OF AUTHORIZATION PURSUANT TO ARTICLE  TWENTY-NINE-E  OF  THE
 PUBLIC  HEALTH  LAW,  OR TO A TRUSTEE OR TRUSTEES OF A FUND ESTABLISHED,
 CREATED OR MAINTAINED FOR THE BENEFIT OF MEMBERS OF ONE OR MORE ACCOUNT-
 ABLE CARE ORGANIZATIONS ISSUED A CERTIFICATE OF  AUTHORIZATION  PURSUANT
 TO ARTICLE TWENTY-NINE-E OF THE PUBLIC HEALTH LAW, ALL OF WHOSE ELIGIBLE
 MEMBERS  HAVE  THE  SAME  PROFESSION,  TRADE  OR  OCCUPATION PROVIDED OR
 RELATED TO THE PROVISION OF HEALTH CARE, WHICH  ASSOCIATION  OR  ASSOCI-
 ATIONS  HAVE  BEEN  ORGANIZED  AND MAINTAINED IN GOOD FAITH FOR PURPOSES
 PRINCIPALLY OTHER THAN THAT OF OBTAINING  INSURANCE  AND  HAVE  BEEN  IN
 ACTIVE  EXISTENCE  FOR  AT  LEAST  TWO  YEARS.  THE  POLICY SHALL INSURE
 MEMBERS, OR EMPLOYEES OF MEMBERS, OF SUCH ACCOUNTABLE CARE  ORGANIZATION
 OR ORGANIZATIONS FOR THE BENEFIT OF PERSONS OTHER THAN EMPLOYERS AND THE
 ACCOUNTABLE CARE ORGANIZATION OR ORGANIZATIONS, OR ANY OFFICIALS, REPRE-
 SENTATIVES,  TRUSTEES  OR AGENTS THEREOF AND SHALL PROVIDE FOR THE ISSU-
 ANCE OF A CERTIFICATE TO THE PERSONS  INSURED  OR  SUCH  BENEFICIARY  AS
 EVIDENCE  OF  SUCH  INSURANCE. THE MEMBERS OR EMPLOYEES ELIGIBLE FOR THE
 INSURANCE UNDER THE POLICY SHALL BE ALL THE MEMBERS, OR ALL THE  MEMBERS
 AND  THEIR  EMPLOYEES, OR ALL OF ANY CLASS OR CLASSES THEREOF DETERMINED
 BY CONDITIONS PERTAINING TO THEIR EMPLOYMENT OR TO THE ACCOUNTABLE  CARE
 ORGANIZATION  MEMBERSHIP  OR  BOTH. THE PREMIUMS FOR THE POLICY SHALL BE
 PAID FROM THE ACCOUNTABLE CARE ORGANIZATION OR MEMBERS' FUNDS, OR PARTLY
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03606-01-5

 S. 2113                             2
 
 FROM SUCH FUNDS AND PARTLY FROM FUNDS CONTRIBUTED BY THE  INSURED  INDI-
 VIDUALS, OR FROM FUNDS WHOLLY CONTRIBUTED BY THE INSURED INDIVIDUALS.  A
 POLICY  ON  WHICH ALL OR PART OF THE PREMIUM IS TO BE DERIVED FROM FUNDS
 CONTRIBUTED  BY THE INSURED INDIVIDUALS SPECIFICALLY FOR THEIR INSURANCE
 MUST INSURE AT LEAST FIFTY PERCENT OF THE THEN ELIGIBLE INDIVIDUALS OR A
 MINIMUM OF FIVE HUNDRED INDIVIDUALS, WHICHEVER IS LESS, EXCLUDING ANY AS
 TO WHOM EVIDENCE OF INDIVIDUAL INSURABILITY IS NOT SATISFACTORY  TO  THE
 INSURER.  A POLICY ON WHICH NO PART OF THE PREMIUM IS TO BE DERIVED FROM
 FUNDS CONTRIBUTED BY THE  INSURED  INDIVIDUALS  SPECIFICALLY  FOR  THEIR
 INSURANCE  MUST COVER ALL ELIGIBLE INDIVIDUALS, EXCLUDING ANY AS TO WHOM
 EVIDENCE OF INDIVIDUAL INSURABILITY IS NOT SATISFACTORY TO THE  INSURER.
 IN  EVERY CASE THE POLICY MUST COVER AT LEAST ONE HUNDRED INDIVIDUALS AT
 DATE OF ISSUE. THE INSURANCE COVERAGE ON  EMPLOYEES  INSURED  UNDER  THE
 POLICY  SHALL  BE  BASED UPON SOME PLAN PRECLUDING INDIVIDUAL SELECTION.
 HOWEVER, WITH RESPECT TO SUCH FUND, OR ACCOUNTABLE CARE ORGANIZATION  OR
 ACCOUNTABLE  CARE  ORGANIZATIONS,  SUCH  A  PLAN  MAY PERMIT A NUMBER OF
 SELECTIONS BY THE FUND, ACCOUNTABLE  CARE  ORGANIZATION  OR  ACCOUNTABLE
 CARE ORGANIZATIONS IF THE SELECTIONS OFFERED UTILIZE CONSISTENT PLANS OF
 COVERAGE  SO  THAT  THE  RESULTING  PLANS  OF  COVERAGE  ARE REASONABLE.
 FURTHERMORE, SUCH A PLAN MAY  PERMIT  A  LIMITED  NUMBER  OF  SELECTIONS
 OFFERED  BY  EMPLOYEES  OR  MEMBERS  IF  THE  SELECTIONS OFFERED UTILIZE
 CONSISTENT PLANS OF COVERAGE FOR INDIVIDUAL GROUP MEMBERS  SO  THAT  THE
 RESULTING  PLANS  OF  COVERAGE  ARE  REASONABLE. IF A POLICY DIVIDEND IS
 DECLARED OR A REDUCTION IN RATE IS MADE UNDER SUCH A POLICY, THE EXCESS,
 IF ANY, OF THE AGGREGATE DIVIDENDS OR RATE REDUCTIONS UNDER  THE  POLICY
 OVER THE AGGREGATE EXPENDITURE FOR INSURANCE UNDER SUCH POLICY MADE FROM
 THE  ACCOUNTABLE CARE ORGANIZATION OR EMPLOYER FUNDS, INCLUDING EXPENDI-
 TURES MADE IN CONNECTION WITH ADMINISTRATION OF SUCH  POLICY,  SHALL  BE
 APPLIED BY THE POLICYHOLDER FOR THE SOLE BENEFIT OF THE INSURED INDIVID-
 UALS.  A  POLICY  ISSUED  PURSUANT  TO THIS SUBPARAGRAPH SHALL PROVIDE A
 CONVERSION PRIVILEGE  NO  LESS  FAVORABLE  THAN  THAT  PROVIDED  FOR  IN
 SUBSECTION  (E) OF SECTION THREE THOUSAND TWO HUNDRED TWENTY-ONE OF THIS
 CHAPTER.
   § 2. Subsection (g) of section 3231 of the insurance law,  as  amended
 by  section  70 of part D of chapter 56 of the laws of 2013, paragraph 1
 as amended by chapter 12 of the laws of 2016,  is  amended  to  read  as
 follows:
   (g)  (1)  UNLESS  OTHERWISE  DESCRIBED  IN  PARAGRAPH  THREE  OF  THIS
 SUBSECTION: (A) This section shall also apply to policies  issued  to  a
 group  defined  in  subsection  (c) of section four thousand two hundred
 thirty-five of this chapter, including but not limited to an association
 or trust of employers, if the group includes one or more member  employ-
 ers  or  other  member  groups  having one hundred or fewer employees or
 members exclusive of spouses and dependents.  For  a  policy  issued  or
 renewed  on  or after January first, two thousand fourteen, if the group
 includes one or more member small group employers eligible for  coverage
 subject  to this section, then such member employers shall be classified
 as small groups for rating purposes and the remaining members  shall  be
 rated  consistent  with  the  rating  rules applicable to such remaining
 members pursuant to paragraph two of this subsection. (B) Subparagraph A
 of this paragraph shall not apply to either  the  renewal  of  a  policy
 issued  to  a group or the issuance, between January first, two thousand
 sixteen and December thirty-first, two thousand sixteen,  of  a  policy,
 and  any  renewal thereof, to a group, provided that the following three
 requirements are met: (I) the group had been issued a policy that was in
 effect on July first, two thousand fifteen; (II) the  group  had  member
 S. 2113                             3
 
 employers,  who,  on  or  after  July  first, two thousand fifteen, have
 between fifty-one and one hundred employees, exclusive  of  spouses  and
 dependents; and (III) the group is either: (i) comprised entirely of one
 or  more  municipal corporations or districts (as such terms are defined
 in section one hundred nineteen-n of the general municipal law); or (ii)
 comprised entirely of nonpublic schools providing education in any grade
 from pre-kindergarten through twelfth grade.
   (2) [If]  UNLESS  OTHERWISE  DESCRIBED  IN  PARAGRAPH  THREE  OF  THIS
 SUBSECTION,  IF  a policy is issued to a group defined in subsection (c)
 of section four  thousand  two  hundred  thirty-five  of  this  chapter,
 including  an association group, that includes one or more individual or
 individual proprietor members, for rating  purposes  the  insurer  shall
 include  such  members  in  its individual pool of risks in establishing
 premium rates for such members.
   (3) THIS SUBSECTION SHALL NOT APPLY TO A  POLICY  ISSUED  TO  A  GROUP
 DEFINED  IN  SUBPARAGRAPH  (O)  OF  PARAGRAPH  ONE  OF SUBSECTION (C) OF
 SECTION FOUR THOUSAND TWO HUNDRED THIRTY-FIVE OF THIS CHAPTER,  EVEN  IF
 THE  GROUP  INCLUDES ONE OR MORE MEMBER EMPLOYERS OR OTHER MEMBER GROUPS
 WHICH HAVE ONE HUNDRED OR FEWER EMPLOYEES OR MEMBERS EXCLUSIVE OF SPOUS-
 ES AND DEPENDENTS, IF THE FOLLOWING CRITERIA ARE MET:
   (A) THE GROUP IS COMPRISED  OF  AT  LEAST  ONE  HUNDRED  FIFTY  MEMBER
 EMPLOYERS;
   (B)  THE  COLLECTIVE  NUMBER  OF  INDIVIDUALS INSURED UNDER THE POLICY
 EXCEEDS FIVE HUNDRED PERSONS;
   (C) EACH EMPLOYER IN THE GROUP  IS  ENROLLED  AS  A  PROVIDER  IN  THE
 STATE'S MEDICAID PROGRAM; AND
   (D)  EACH EMPLOYER IN THE GROUP CAN DEMONSTRATE AN ANNUAL PAYER MIX IN
 WHICH MEDICAID REPRESENTS SIXTY PERCENT OR MORE OF ANNUAL REVENUES.
   § 3. Paragraph 1 of subsection (d) of section 4317  of  the  insurance
 law,  as amended by chapter 12 of the laws of 2016, is amended and a new
 paragraph 4 is added to read as follows:
   (1) (A) [This] UNLESS OTHERWISE DESCRIBED IN PARAGRAPH  FOUR  OF  THIS
 SUBSECTION,  THIS  section  shall  also  apply to a contract issued to a
 group defined in subsection (c) of section  four  thousand  two  hundred
 thirty-five of this chapter, including but not limited to an association
 or  trust of employers, if the group includes one or more member employ-
 ers or other member groups having one  hundred  or  fewer  employees  or
 members  exclusive  of  spouses and dependents. For a contract issued or
 renewed on or after January first, two thousand fourteen, if  the  group
 includes  one or more member small group employers eligible for coverage
 subject to this section, then such member employers shall be  classified
 as  small  groups for rating purposes and the remaining members shall be
 rated consistent with the rating  rules  applicable  to  such  remaining
 members pursuant to paragraph two of this subsection. (B) Subparagraph A
 of  this  paragraph  shall not apply to either the renewal of a contract
 issued to a group or the issuance, between January first,  two  thousand
 sixteen  and December thirty-first, two thousand sixteen, of a contract,
 and any renewal thereof, to a group, provided that the  following  three
 requirements  are met: (I) the group had been issued a contract that was
 in effect on July first, two thousand fifteen; (II) the group had member
 employers, who, on or after  July  first,  two  thousand  fifteen,  have
 between  fifty-one  and  one hundred employees, exclusive of spouses and
 dependents; and (III) the group is either: (i) comprised entirely of one
 or more municipal corporations or districts (as such terms  are  defined
 in section one hundred nineteen-n of the general municipal law); or (ii)
 S. 2113                             4
 
 comprised entirely of nonpublic schools providing education in any grade
 from pre-kindergarten through twelfth grade.
   (4)  THIS  SUBSECTION  SHALL  NOT  APPLY TO A POLICY ISSUED TO A GROUP
 DEFINED IN PARAGRAPH (O) OF SUBSECTION (C) OF SECTION FOUR THOUSAND  TWO
 HUNDRED  THIRTY-FIVE  OF THIS CHAPTER, EVEN IF THE GROUP INCLUDES ONE OR
 MORE MEMBER EMPLOYERS OR OTHER MEMBER GROUPS WHICH HAVE ONE  HUNDRED  OR
 FEWER  EMPLOYEES  OR MEMBERS EXCLUSIVE OF SPOUSES AND DEPENDENTS, IF THE
 FOLLOWING CRITERIA ARE MET:
   (A) THE GROUP IS COMPRISED  OF  AT  LEAST  ONE  HUNDRED  FIFTY  MEMBER
 EMPLOYERS;
   (B)  THE  COLLECTIVE  NUMBER  OF  INDIVIDUALS INSURED UNDER THE POLICY
 EXCEEDS FIVE HUNDRED PERSONS;
   (C) EACH EMPLOYER IN THE GROUP  IS  ENROLLED  AS  A  PROVIDER  IN  THE
 STATE'S MEDICAID PROGRAM; AND
   (D)  EACH EMPLOYER IN THE GROUP CAN DEMONSTRATE AN ANNUAL PAYER MIX IN
 WHICH MEDICAID REPRESENTS SIXTY PERCENT OR MORE OF ANNUAL REVENUES.
   § 4. This act shall take effect on the one hundred eightieth day after
 it shall have become a law; provided, however, that  the  amendments  to
 paragraph  (1)  of  subsection  (g) of section 3231 and paragraph (1) of
 subsection (d) of section 4317 of the insurance law made by sections two
 and three of this act shall not affect the expiration of such paragraphs
 and shall be deemed to expire therewith.

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Senate Bill S2113

Sponsored By

Current Bill Status - In Senate Committee Insurance Committee

co-Sponsors

2025-S2113 (ACTIVE) - Details

2025-S2113 (ACTIVE) - Summary

2025-S2113 (ACTIVE) - Sponsor Memo

2025-S2113 (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S2113

Share this bill

Sponsored By

Jeremy Cooney

Current Bill Status - In Senate Committee Insurance Committee

co-Sponsors

James Skoufis

2025-S2113 (ACTIVE) - Details

2025-S2113 (ACTIVE) - Summary

2025-S2113 (ACTIVE) - Sponsor Memo

2025-S2113 (ACTIVE) - Bill Text download pdf

Comments