Senate Bill S8360

2023-2024 Legislative Session

Relates to the development and approval of reimbursement rates for managed care providers under medicaid

download bill text pdf

Sponsored By

Current Bill Status - In Senate Committee Health 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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2023-S8360 (ACTIVE) - Details

See Assembly Version of this Bill:
A8877
Current Committee:
Senate Health
Law Section:
Social Services Law
Laws Affected:
Amd §364-j, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
A7910

2023-S8360 (ACTIVE) - Summary

Requires notice and additional review for managed care providers of the methodologies and fee schedules and other materials used for determining medicaid reimbursement rates.

2023-S8360 (ACTIVE) - Sponsor Memo

2023-S8360 (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8360
 
                             I N  S E N A T E
 
                             January 22, 2024
                                ___________
 
 Introduced  by Sens. SKOUFIS, MAY, WEBB -- read twice and ordered print-
   ed, and when printed to be committed to the Committee on Health
 
 AN ACT to amend the social services law, in  relation  to  determination
   and  approval  of reimbursement rates for managed care providers under
   medicaid
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Paragraph  (c)  of subdivision 18 of section 364-j of the
 social services law, as added by section 55 of part B of chapter  57  of
 the laws of 2015, is amended to read as follows:
   (c)  The  department [of health] shall require the independent actuary
 selected pursuant to paragraph (b) of  this  subdivision  to  provide  a
 complete actuarial memorandum, along with all actuarial assumptions made
 and  all other data, materials and methodologies used in the development
 of rates, to managed care providers thirty days prior to  submission  of
 such  rates  to  the  centers  for  medicare  and  medicaid services for
 approval. THE ACTUARIAL MEMORANDUM  SHALL  INCLUDE  (I)  ANY  ADDITIONAL
 MATERIALS  SUBMITTED  TO  THE CENTERS FOR MEDICARE AND MEDICAID SERVICES
 INCLUDING  ACTUARIAL  CERTIFICATION  LETTERS,  (II)  ANY  CORRESPONDENCE
 BETWEEN  THE  STATE  AND  THE CENTERS FOR MEDICARE AND MEDICAID SERVICES
 RELATED TO THE RATES, (III)  OTHER  DATA,  MATERIALS  AND  METHODOLOGIES
 CONSIDERED  BUT  NOT  USED  BY  THE DEPARTMENT IN THE DEVELOPMENT OF THE
 RATES, AND (IV) ANY INFORMATION REQUIRED TO BE DISCLOSED TO MANAGED CARE
 PROVIDERS OR THE  PUBLIC  UNDER  FEDERAL  RULES.  THE  DEPARTMENT  SHALL
 REQUIRE  THE INDEPENDENT ACTUARY TO SEPARATELY IDENTIFY AND PRESENT IN A
 COLLECTIVE GROUP THE REQUIRED MATERIAL UNDER  EACH  APPLICABLE  SUBPARA-
 GRAPH  (I)  THROUGH  (IV)  OF THIS PARAGRAPH. Managed care providers may
 request THAT THE DEPARTMENT AND ITS INDEPENDENT  ACTUARY  CONDUCT  addi-
 tional  review  of  the  actuarial soundness of the rate setting process
 and/or methodology.  PRIOR TO SUBMISSION OF RATES  TO  THE  CENTERS  FOR
 MEDICARE  AND  MEDICAID  SERVICES  FOR  APPROVAL,  THE  DEPARTMENT SHALL
 RESPOND TO ANY REQUEST FROM MANAGED CARE PROVIDERS FOR ADDITIONAL REVIEW
 OF THE ACTUARIAL SOUNDNESS OF THE RATE SETTING PROCESS  OR  METHODOLOGY,
 AND  IN  SUCH  RESPONSE  THE DEPARTMENT SHALL EITHER: (1) AGREE TO ADDI-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

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