Assembly Bill A4860

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4860
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             February 6, 2025
                                ___________
 
 Introduced by M. of A. RAJKUMAR -- read once and referred to the Commit-
   tee on Health
 
 AN  ACT  to  amend  the  social  services  law, in relation to capitated
   payments under medical assistance for needy persons
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  Section  367-a  of  the social services law is amended by
 adding a new subdivision 13 to read as follows:
   13. (A) ANY INCONSISTENT  PROVISION  OF  THIS  CHAPTER  OR  OTHER  LAW
 NOTWITHSTANDING,  ON  AND  AFTER THE EFFECTIVE DATE OF THIS SUBDIVISION,
 ALL PAYMENTS WITH RESPECT  TO  MEDICAL  ASSISTANCE  SHALL  BE  CAPITATED
 PAYMENTS.
   (B) THE COMMISSIONER MAY DEVELOP AND ASSIGN PATIENTS RATING CATEGORIES
 BASED ON RISK FOR THE PURPOSES OF DEVELOPING REIMBURSEMENT METHODOLOGIES
 AND PAYMENTS UNDER THIS SUBDIVISION.
   §  2.  Section 364-j of the social services law is amended by adding a
 new subdivision 3-a to read as follows:
   3-A. SPECIAL CONTRACT PROVISIONS. ANY CAPITATION  PAYMENT  SYSTEM  FOR
 MEDICAL  ASSISTANCE UNDER THIS ARTICLE MAY INCLUDE CONTRACT ARRANGEMENTS
 THAT FURTHER ADJUST THE PAYMENT AMOUNTS, INCLUDING BUT  NOT  LIMITED  TO
 INCENTIVE ARRANGEMENTS, PASS-THROUGH PAYMENTS, RISK CORRIDOR MECHANISMS,
 OR WITHHOLD ARRANGEMENTS AS DEFINED BY 42 CFR 438.6.
   § 3.  No later than one year after the effective date of this act, the
 commissioner  of health shall provide drafts of legislation necessary to
 convert all payments under the  medical  assistance  for  needy  persons
 program  from  fee-for-service  payments  to  capitated payments, to the
 governor, the temporary president of the senate and the speaker  of  the
 assembly.
   §  4.  This  act shall take effect immediately, provided that sections
 one and two of this act shall take effect five years after  such  effec-
 tive  date;  and provided, further, that the amendments to section 364-j
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD08580-01-5
              

 A. 4860                             2
 
 of the social services law, made by section two of this act,  shall  not
 affect  the  repeal of such section, and shall be deemed repealed there-
 with. Effective immediately, the commissioner of health shall make regu-
 lations  and  take other actions, including applying for federal waivers
 and submitting state Medicaid plan amendments, reasonably  necessary  to
 implement the provisions of this act.