Assembly Bill A10159

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   10159
 
                           I N  A S S E M B L Y
 
                             February 12, 2026
                                ___________
 
 Introduced by M. of A. PAULIN -- read once and referred to the Committee
   on Health
 
 AN ACT to establish the managed long term care high acuity stabilization
   pool; and making an appropriation therefor
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Managed Long Term Care High Acuity Stabilization Pool.  (a)
 Establishment. There is hereby established within  amounts  appropriated
 for  the medical assistance program a managed long term care high acuity
 stabilization pool in an amount not  to  exceed  fifty  million  dollars
 ($50,000,000) for the state fiscal year commencing April 1, 2026.
   (b) Purpose. The managed long term care high acuity stabilization pool
 shall be used to support managed long term care plans that:
   i. demonstrate high performance on quality measures established by the
 department; and
   ii. serve a disproportionately high share of members with complex long
 term care needs or high service utilization.
   (c)  Eligibility  and  Use of Funds. i. Payments from the managed long
 term care high acuity stabilization pool may be made  only  to  eligible
 managed  long-term care plans whose medical loss ratios exceed a thresh-
 old established by the commissioner, not to  exceed  92  percent,  after
 application  of final premium rates and risk adjustment for the applica-
 ble rating period.
   ii. Pool payments shall be limited to the amount necessary  to  offset
 costs  above  such  threshold  and  shall  not  be used to increase plan
 margins beyond such level.
   (d) Administration. The commissioner of health may establish criteria,
 methodologies, and reporting requirements for distribution of funds from
 the managed long term care high  acuity  stabilization  pool,  including
 specific  quality  performance  standards,  acuity or utilization bench-
 marks, and safeguards to ensure fiscal accountability.
   (e) Limitations. i. Payments under this section shall not be  incorpo-
 rated into base premium rates.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14709-03-6
              

 A. 10159                            2
 
   ii.  Nothing  in this section shall be construed to create an entitle-
 ment to payment.
   (f)  Relationship  to  Rate  Setting.  The managed long term care high
 acuity stabilization pool is intended as a supplemental and transitional
 mechanism and shall not supplant the commissioner of health's obligation
 to establish actuarially sound premium rates.
   § 2. The sum of fifty million dollars ($50,000,000), or so much there-
 of as may be necessary, is hereby  appropriated  to  the  department  of
 health  out  of  any moneys in the state treasury in the general fund to
 the credit of the managed long term care high acuity stabilization pool,
 not otherwise appropriated, and  made  immediately  available,  for  the
 purpose of carrying out the provisions of this act. Such moneys shall be
 payable  on  the audit and warrant of the comptroller on vouchers certi-
 fied or approved by the commissioner of health in the manner  prescribed
 by law.
   § 3. This act shall take effect immediately.