S T A T E O F N E W Y O R K
________________________________________________________________________
2371--A
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 -- recommitted to the Committee on Insurance in accord-
ance with Assembly Rule 3, sec. 2 -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee
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 (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-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 EIGHTY-FIVE PERCENT OF THE MATERNITY CARE
FOR ENROLLEES OF SUCH INSURER.
(III) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SEVEN, EACH INSUR-
ER 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:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05808-03-6
A. 2371--A 2
(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-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 EIGHTY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEES OF SUCH INSURER.
(III) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SEVEN, EACH INSUR-
ER 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 (E) to read as follows:
(E)(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-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 EIGHTY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEES OF SUCH INSURER.
(III) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SEVEN, EACH INSUR-
ER 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.
§ 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-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 EIGHTY-FIVE PERCENT OF THE MATERNITY CARE FOR ENROLLEES OF SUCH
ORGANIZATION.
(C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SEVEN, 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.
A. 2371--A 3
§ 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-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 EIGHTY-FIVE PERCENT OF THE MATERNITY CARE
OF ENROLLEES OF SUCH INSURER.
(C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SEVEN, 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 41 to read as follows:
41. (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-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 EIGHTY-FIVE PERCENT OF THE MATER-
NITY CARE OF ENROLLEES OF THE MANAGED CARE PROVIDER.
(C) BY DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-SEVEN, 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.