S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6266
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                               March 7, 2025
                                ___________
 
 Introduced  by Sens. SALAZAR, ADDABBO, CLEARE, FERNANDEZ, PARKER -- read
   twice and ordered printed, and when printed to  be  committed  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD05282-01-5
              

 S. 6266                             2
 
 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.
 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.