S T A T E O F N E W Y O R K
________________________________________________________________________
2371
2025-2026 Regular Sessions
I N A S S E M B L Y
January 16, 2025
___________
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, the civil
service law and the social services 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
SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY CARE
FOR ENROLLEES OF SUCH INSURER.
(III) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY CARE
FOR ENROLLEES 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-
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05808-01-5
A. 2371 2
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
SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEES OF SUCH INSURER.
(III) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEES 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
SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEES OF SUCH INSURER.
(III) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEE 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,
FEDERALLY QUALIFIED HEALTH CENTERS PROVIDING MATERNITY CARE, AND/OR
BIRTHING CENTERS THAT PROVIDE VALUE-BASED ARRANGEMENTS THAT PROVIDE AT
LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY CARE FOR ENROLLEES OF SUCH
ORGANIZATION.
(C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX, EACH HEALTH
MAINTENANCE ORGANIZATION SHALL ENTER INTO CONTRACTS WITH HOSPITALS,
FEDERALLY QUALIFIED HEALTH CENTERS PROVIDING MATERNITY CARE, AND/OR
BIRTHING CENTERS THAT PROVIDE VALUE-BASED ARRANGEMENTS THAT PROVIDE AT
LEAST NINETY-FIVE PERCENT OF THE MATERNITY CARE OF ENROLLEES OF SUCH
ORGANIZATION.
§ 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. 2371 3
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
SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEES OF SUCH INSURER.
(C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX EACH INSURER
SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS, FEDERALLY
QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR BIRTHING
CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEES OF SUCH INSURER.
§ 6. Section 364-j of the social services law is amended by adding a
new subdivision 40 to read as follows:
40. (A) A MANAGED CARE PROVIDER 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 MANAGED
CARE PROVIDER SHALL ENTER INTO VALUE BASED ARRANGEMENTS WITH HOSPITALS,
FEDERALLY QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR
BIRTHING CENTERS THAT PROVIDE AT LEAST EIGHTY-FIVE PERCENT OF THE MATER-
NITY CARE OF ENROLLEES OF THE MANAGED CARE PROVIDER.
(C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SIX, EACH MANAGED
CARE PROVIDER SHALL ENTER INTO VALUE-BASED ARRANGEMENTS WITH HOSPITALS,
FEDERALLY QUALIFIED HEALTH CENTERS PROVIDING MATERNITY SERVICES, AND/OR
BIRTHING CENTERS THAT PROVIDE AT LEAST NINETY-FIVE PERCENT OF THE MATER-
NITY CARE OF ENROLLEES OF THE MANAGED CARE PROVIDER.
§ 7. This act shall take effect on the forty-fifth day after it shall
have become a law; provided, however, that the amendments to section
364-j of the social services law made by section six of this act shall
not affect the repeal of such section and shall be deemed repealed ther-
ewith. 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 effective date.