S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8592
 
                           I N  A S S E M B L Y
 
                             January 12, 2024
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Insurance
 
 AN  ACT  to  amend  the  insurance  law  and the social services law, in
   relation to primary care investment
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The insurance law is amended by adding a new section 3217-k
 to read as follows:
   §  3217-K.  PRIMARY  CARE  SPENDING.  (A) DEFINITIONS. AS USED IN THIS
 SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (1) "OVERALL HEALTHCARE SPENDING" MEANS THE TOTAL COST OF CARE FOR THE
 PATIENT POPULATION OF A PAYOR OR PROVIDER ENTITY FOR  A  GIVEN  CALENDAR
 YEAR,  WHERE  COST  IS  CALCULATED  FOR  SUCH YEAR AS THE SUM OF (A) ALL
 CLAIMS-BASED SPENDING PAID TO PROVIDERS BY PUBLIC AND PRIVATE PAYORS AND
 (B) ALL NON-CLAIM PAYMENTS FOR SUCH YEAR, INCLUDING, BUT NOT LIMITED TO,
 INCENTIVE PAYMENTS AND CARE COORDINATION PAYMENTS.
   (2) "PLAN OR PAYOR" MEANS EVERY  INSURANCE  ENTITY  PROVIDING  MANAGED
 CARE PRODUCTS, INDIVIDUAL COMPREHENSIVE ACCIDENT AND HEALTH INSURANCE OR
 GROUP OR BLANKET COMPREHENSIVE ACCIDENT AND HEALTH INSURANCE, AS DEFINED
 IN THIS CHAPTER, CORPORATION ORGANIZED UNDER ARTICLE FORTY-THREE OF THIS
 CHAPTER  PROVIDING COMPREHENSIVE HEALTH INSURANCE, ENTITY LICENSED UNDER
 ARTICLE FORTY-FOUR OF THIS CHAPTER PROVIDING COMPREHENSIVE HEALTH INSUR-
 ANCE, EVERY OTHER PLAN OVER WHICH THE DEPARTMENT HAS  JURISDICTION,  AND
 EVERY THIRD-PARTY PAYOR PROVIDING HEALTH COVERAGE.
   (3)  "PRIMARY  CARE" MEANS INTEGRATED, ACCESSIBLE HEALTHCARE, PROVIDED
 BY CLINICIANS ACCOUNTABLE FOR ADDRESSING MOST OF A PATIENT'S  HEALTHCARE
 NEEDS,  DEVELOPING A SUSTAINED PARTNERSHIP WITH PATIENTS, AND PRACTICING
 IN THE CONTEXT OF FAMILY AND COMMUNITY.
   (4) "PRIMARY CARE SERVICES" MEANS SERVICES PROVIDED IN AN  OUTPATIENT,
 NON-EMERGENCY  SETTING BY OR UNDER THE SUPERVISION OF A PHYSICIAN, NURSE
 PRACTITIONER, PHYSICIAN ASSISTANT, OR MIDWIFE, WHO IS PRACTICING GENERAL
 PRIMARY CARE IN THE FOLLOWING FIELDS, INCLUDING AS EVIDENCED BY  BILLING
 AND  REPORTING  CODES: FAMILY PRACTICE; GENERAL PEDIATRICS; PRIMARY CARE
 INTERNAL MEDICINE; PRIMARY CARE OBSTETRICS; OR PRIMARY CARE  GYNECOLOGY.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD03591-04-3
 A. 8592                             2
 
 BEHAVIORAL  OR  MENTAL  HEALTH  AND  SUBSTANCE USE DISORDER SERVICES ARE
 INCLUDED IN PRIMARY CARE SERVICES WHEN INTEGRATED INTO  A  PRIMARY  CARE
 SETTING,  INCLUDING  WHEN  PROVIDED  BY A BEHAVIORAL HEALTHCARE PSYCHIA-
 TRIST,  SOCIAL  WORKER  OR PSYCHOLOGIST. PRIMARY CARE SERVICES SHALL NOT
 INCLUDE INPATIENT SERVICES, EMERGENCY  DEPARTMENT  SERVICES,  AMBULATORY
 SURGICAL CENTER SERVICES, OR SERVICES PROVIDED IN AN URGENT CARE SETTING
 THAT ARE BILLED WITH NON-PRIMARY CARE BILLING AND REPORTING CODES.
   (5)  "PRIMARY  CARE  SPENDING"  MEANS ANY EXPENDITURE OF FUNDS MADE BY
 THIRD PARTY PAYORS, PUBLIC ENTITIES, OR THE STATE, FOR  THE  PURPOSE  OF
 PAYING  FOR  PRIMARY  CARE  SERVICES  DIRECTLY  OR PAYING TO IMPROVE THE
 DELIVERY OF PRIMARY CARE. PRIMARY CARE  SPENDING  INCLUDES  ALL  PAYMENT
 METHODS,  SUCH  AS  FEE-FOR-SERVICE, CAPITATION, INCENTIVES, VALUE-BASED
 PAYMENTS OR OTHER METHODOLOGIES, AND ALL  NON-CLAIM  PAYMENTS  INCLUDING
 BUT  NOT  LIMITED  TO INCENTIVE PAYMENTS AND CARE COORDINATION PAYMENTS.
 ANY SPENDING SHALL BE ADJUSTED APPROPRIATELY TO EXCLUDE ANY  PORTION  OF
 THE  EXPENDITURE  THAT IS REASONABLY ATTRIBUTED TO INPATIENT SERVICES OR
 OTHER NON-PRIMARY CARE SERVICES.
   (B) REPORTING. (1) BEGINNING ON APRIL FIRST, TWO THOUSAND TWENTY-FIVE,
 EACH PLAN OR PAYOR AS DEFINED IN THIS SECTION SHALL ANNUALLY  REPORT  TO
 THE  DEPARTMENT  THE  PERCENTAGE  OF  THE PLAN OR PAYOR'S OVERALL ANNUAL
 HEALTHCARE SPENDING THAT CONSTITUTED PRIMARY CARE SPENDING.
   (2) NOTHING HEREIN SHALL REQUIRE  ANY  PLAN  OR  PAYOR  TO  REPORT  OR
 PUBLICLY  DISCLOSE  ANY SPECIFIC RATES OF REIMBURSEMENT FOR ANY SPECIFIC
 PRIMARY CARE SERVICES.
   (3) NO PLAN OR PAYOR SHALL REQUIRE ANY HEALTHCARE PROVIDER TO  PROVIDE
 ADDITIONAL  DATA  OR  INFORMATION  IN  ORDER  TO  FULFILL THIS REPORTING
 REQUIREMENT.
   (C) REGULATION AND PUBLICATION. (1) THE COMMISSIONER OF HEALTH AND THE
 SUPERINTENDENT SHALL EACH PROMULGATE CONSISTENT REGULATIONS TO CARRY OUT
 THE PROVISIONS OF THIS SECTION, INCLUDING BUT  NOT  LIMITED  TO  SETTING
 DEADLINES  FOR  THE  REPORTING  REQUIRED  IN  THIS SECTION, AND ADOPTING
 FURTHER SPECIFIC DEFINITIONS OF THE  PRIMARY  CARE  SERVICES  FOR  WHICH
 COSTS  MUST  BE  REPORTED UNDER THIS SECTION, INCLUDING SPECIFIC BILLING
 AND REPORTING CODES.
   (2) THE DEPARTMENT OF HEALTH AND THE DEPARTMENT SHALL TOGETHER PROVIDE
 AN ANNUAL REPORT TO THE LEGISLATURE WITH A SUMMARY OF THE  PRIMARY  CARE
 SPENDING  DATA  REQUIRED IN THIS SECTION, AND SHALL ALSO MAKE THE REPORT
 PUBLICLY AVAILABLE ON BOTH  AGENCIES'  WEBSITES,  NO  LATER  THAN  THREE
 MONTHS  AFTER THE DATA HAS BEEN COLLECTED. THE FIRST ANNUAL REPORT SHALL
 PROVIDE THE SPENDING  INFORMATION  WITHOUT  IDENTIFYING  ANY  INDIVIDUAL
 PAYOR  OR PLAN'S PRIMARY CARE SPENDING. EACH YEAR THEREAFTER, THE REPORT
 SPENDING DATA SHALL BE PUBLISHED INCLUDING INFORMATION SPECIFIC TO  EACH
 PLAN OR PAYOR.
   (D)  PRIMARY CARE SPENDING. (1) BEGINNING ON APRIL FIRST, TWO THOUSAND
 TWENTY-SIX, EACH PLAN OR PAYOR THAT REPORTS LESS THAN  TWELVE  AND  ONE-
 HALF  PERCENT OF ITS TOTAL EXPENDITURES ON PHYSICAL AND MENTAL HEALTH IS
 PRIMARY CARE SPENDING, AS DEFINED BY THIS  SECTION,  SHALL  ADDITIONALLY
 SUBMIT TO THE SUPERINTENDENT A PLAN TO INCREASE PRIMARY CARE SPENDING AS
 A  PERCENTAGE  OF  ITS TOTAL OVERALL HEALTHCARE SPENDING BY AT LEAST ONE
 PERCENT EACH YEAR. BEGINNING ON APRIL FIRST, TWO  THOUSAND  TWENTY-SEVEN
 AND  ON  APRIL  FIRST  OF EVERY SUBSEQUENT YEAR AFTER SUCH PLAN HAS BEEN
 SUBMITTED, AND UNTIL SUCH TIME AS THE PLAN OR PAYOR'S  REPORTED  PRIMARY
 CARE  SPENDING  IS  EQUAL TO OR MORE THAN TWELVE AND ONE-HALF PERCENT OF
 THAT PLAN OR PAYOR'S OVERALL HEALTHCARE SPENDING, THE  PLAN  OR  PAYOR'S
 ANNUAL  REPORTING  SHALL  INCLUDE  INFORMATION REGARDING STEPS THAT HAVE
 BEEN TAKEN TO INCREASE ITS PROPORTION OF PRIMARY CARE SPENDING.
 A. 8592                             3
 
   (2) THE COMMISSIONER OF HEALTH  AND  THE  SUPERINTENDENT  MAY  JOINTLY
 ISSUE  GUIDELINES OR PROMULGATE REGULATIONS REGARDING THE AREAS ON WHICH
 PRIMARY CARE SPENDING COULD BE INCREASED, INCLUDING BUT NOT LIMITED TO:
   (A) REIMBURSEMENT;
   (B) CAPACITY-BUILDING, TECHNICAL ASSISTANCE AND TRAINING;
   (C)  UPGRADING  TECHNOLOGY, INCLUDING ELECTRONIC HEALTH RECORD SYSTEMS
 AND TELEHEALTH CAPABILITIES;
   (D) INCENTIVE PAYMENTS, INCLUDING BUT NOT LIMITED  TO  PER-MEMBER-PER-
 MONTH,  VALUE-BASED-PAYMENT  ARRANGEMENTS, SHARED SAVINGS, QUALITY-BASED
 PAYMENTS, RISK-BASED PAYMENTS; AND
   (E) TRANSITIONING TO VALUE-BASED-PAYMENT ARRANGEMENTS.
   § 2. The social services law is amended by adding a new section  368-g
 to read as follows:
   §  368-G.  PRIMARY  CARE  SPENDING.  1.  DEFINITIONS.  AS USED IN THIS
 SECTION THE  TERMS  "OVERALL  HEALTHCARE  SPENDING",  "PLAN  OR  PAYOR",
 "PRIMARY  CARE",  "PRIMARY  CARE  SERVICES"  AND "PRIMARY CARE SPENDING"
 SHALL HAVE THE SAME MEANINGS AS SUCH TERMS ARE DEFINED IN SECTION  THIR-
 TY-TWO HUNDRED SEVENTEEN-K OF THE INSURANCE LAW.
   2.  REPORTING. (A) BEGINNING ON APRIL FIRST, TWO THOUSAND TWENTY-FIVE,
 EACH MEDICAID MANAGED CARE PROVIDER UNDER SECTION THREE  HUNDRED  SIXTY-
 FOUR-J  OF THIS TITLE AND ANY PAYOR THAT PROVIDES COVERAGE THROUGH MEDI-
 CAID FEE-FOR-SERVICE, AS SUCH TERM IS DEFINED IN PARAGRAPH (E) OF SUBDI-
 VISION THIRTY-EIGHT OF SECTION  TWO  OF  THIS  CHAPTER,  SHALL  ANNUALLY
 REPORT TO THE DEPARTMENT THE PERCENTAGE OF THE PROVIDER'S OVERALL ANNUAL
 HEALTHCARE SPENDING THAT CONSTITUTED PRIMARY CARE SPENDING.
   (B) NOTHING HEREIN SHALL REQUIRE ANY MEDICAID MANAGED CARE PROVIDER TO
 REPORT  OR PUBLICLY DISCLOSE ANY SPECIFIC RATES OF REIMBURSEMENT FOR ANY
 SPECIFIC PRIMARY CARE SERVICES.
   (C) NO MEDICAID MANAGED CARE PROVIDER  SHALL  REQUIRE  ANY  HEALTHCARE
 PROVIDER  TO  PROVIDE ADDITIONAL DATA OR INFORMATION IN ORDER TO FULFILL
 THIS REPORTING REQUIREMENT.
   3. PRIMARY CARE SPENDING. (A) BEGINNING ON APRIL FIRST,  TWO  THOUSAND
 TWENTY-SIX,  AND  IN  EACH  SUBSEQUENT  YEAR, EACH MEDICAID MANAGED CARE
 PROVIDER UNDER SECTION THREE HUNDRED SIXTY-FOUR-J OF THIS TITLE AND  ANY
 PAYOR  THAT  PROVIDES COVERAGE THROUGH MEDICAID FEE-FOR-SERVICE, AS SUCH
 TERM IS DEFINED IN PARAGRAPH (E) OF SUBDIVISION THIRTY-EIGHT OF  SECTION
 TWO  OF THIS CHAPTER, THAT REPORTS LESS THAN TWELVE AND ONE-HALF PERCENT
 OF ITS TOTAL EXPENDITURES ON PHYSICAL AND MENTAL HEALTH ARE  ON  PRIMARY
 CARE  SPENDING  SHALL  ADDITIONALLY SUBMIT TO THE COMMISSIONER A PLAN TO
 INCREASE PRIMARY CARE SPENDING AS A  PERCENTAGE  OF  ITS  TOTAL  OVERALL
 HEALTHCARE  SPENDING  BY  AT  LEAST  ONE PERCENT EACH YEAR. BEGINNING ON
 APRIL FIRST, TWO THOUSAND TWENTY-SEVEN,  AND  IN  EACH  SUBSEQUENT  YEAR
 THEREAFTER,  UNTIL  TWELVE  AND  ONE-HALF  PERCENT  OF  THAT PROVIDER OR
 PAYOR'S EXPENDITURES ARE ON PRIMARY CARE SPENDING, THE PAYOR OR  PROVID-
 ER'S  ANNUAL  REPORTING  UNDER THIS SECTION SHALL INCLUDE INFORMATION ON
 STEPS THAT HAVE BEEN TAKEN TO INCREASE THEIR PROPORTION OF PRIMARY  CARE
 SPENDING.
   (B)  THE COMMISSIONER AND THE SUPERINTENDENT OF FINANCIAL SERVICES MAY
 JOINTLY ISSUE GUIDELINES OR PROMULGATE REGULATIONS REGARDING  THE  AREAS
 ON WHICH SPENDING COULD BE INCREASED, INCLUDING BUT NOT LIMITED TO:
   (I) REIMBURSEMENT;
   (II) CAPACITY-BUILDING, TECHNICAL ASSISTANCE AND TRAINING;
   (III) UPGRADING TECHNOLOGY, INCLUDING ELECTRONIC HEALTH RECORD SYSTEMS
 AND TELEHEALTH CAPABILITIES;
 A. 8592                             4
 
   (IV)  INCENTIVE PAYMENTS, INCLUDING BUT NOT LIMITED TO PER-MEMBER-PER-
 MONTH, VALUE-BASED-PAYMENT ARRANGEMENTS, SHARED  SAVINGS,  QUALITY-BASED
 PAYMENTS, RISK-BASED PAYMENTS; AND
   (V) TRANSITIONING TO VALUE-BASED-PAYMENT ARRANGEMENTS.
   (C)  THE PROVISIONS OF THIS SECTION ARE SUBJECT TO COMPLIANCE WITH ALL
 APPLICABLE FEDERAL AND STATE LAWS AND REGULATIONS, INCLUDING THE CENTERS
 FOR MEDICARE AND MEDICAID SERVICES APPROVED MEDICAID STATE PLAN.  TO THE
 EXTENT REQUIRED BY FEDERAL LAW, THE COMMISSIONER SHALL SEEK ANY  FEDERAL
 APPROVALS NECESSARY TO IMPLEMENT THIS SECTION, INCLUDING, BUT NOT LIMIT-
 ED  TO,  ANY STATE-DIRECTED PAYMENTS, PERMISSIONS, STATE PLAN AMENDMENTS
 OR FEDERAL WAIVERS BY THE FEDERAL  CENTERS  FOR  MEDICARE  AND  MEDICAID
 SERVICES.  THE  COMMISSIONER  MAY  ALSO APPLY FOR APPROPRIATE WAIVERS OR
 STATE DIRECTED PAYMENTS UNDER FEDERAL LAW AND REGULATION OR  TAKE  OTHER
 ACTIONS TO SECURE FEDERAL FINANCIAL PARTICIPATION TO ASSIST IN PROMOTING
 THE OBJECTIVES OF THIS SECTION.
   § 3. This act shall take effect immediately.