The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10031
 
                           I N  A S S E M B L Y
 
                              April 29, 2022
                                ___________
 
 Introduced  by  M.  of  A.  GOTTFRIED  --  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.

                                                            LBD13877-03-2
 A. 10031                            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.