Assembly Bill A9249

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9249
 
                           I N  A S S E M B L Y
 
                             February 22, 2024
                                ___________
 
 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 and the civil
   service 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
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS THAT COVER AT LEAST EIGHTY-FIVE PERCENT  OF  THE  MATERNITY
 CASES OF SUCH INSURER.
   (III)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS  THAT  COVER  AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY
 CASES 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-
 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
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14117-02-4
              

 A. 9249                             2
 
 ARRANGEMENTS THAT COVER AT LEAST EIGHTY-FIVE PERCENT  OF  THE  MATERNITY
 CASES OF SUCH INSURER.
   (III)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS  THAT  COVER  AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY
 CASES 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
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS THAT COVER AT LEAST EIGHTY-FIVE PERCENT  OF  THE  MATERNITY
 CASES OF SUCH INSURER.
   (III)  BY  DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS  THAT  COVER  AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY
 CASES 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
 AND/OR BIRTHING CENTERS THAT PROVIDE VALUE-BASED ARRANGEMENTS THAT COVER
 AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY CASES  OF  SUCH  ORGANIZA-
 TION.
   (C)  BY  DECEMBER  THIRTY-FIRST,  TWO THOUSAND TWENTY-SIX, EACH HEALTH
 MAINTENANCE ORGANIZATION  SHALL  ENTER  INTO  CONTRACTS  WITH  HOSPITALS
 AND/OR BIRTHING CENTERS THAT PROVIDE VALUE-BASED ARRANGEMENTS THAT COVER
 AT  LEAST  NINETY-FIVE  PERCENT OF THE MATERNITY CASES OF SUCH ORGANIZA-
 TION.
   § 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 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
 AND  HOSPITAL  AND/OR  BIRTHING  CENTER  SHALL  ENTER  INTO  VALUE-BASED
 ARRANGEMENTS  THAT  COVER  AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY
 CASES OF EACH INSURER.
 A. 9249                             3
 
   (C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER AND
 HOSPITAL AND/OR BIRTHING CENTER SHALL ENTER  INTO  VALUE-BASED  ARRANGE-
 MENTS  THAT COVER AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY CASES OF
 SUCH INSURER.
   §  6. This act shall take effect on the forty-fifth day after it shall
 have become a law. 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 date.