Assembly Bill A9312

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9312
 
                        2025-2026 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             December 10, 2025
                                ___________
 
 Introduced by M. of A. SLATER -- read once and referred to the Committee
   on Health
 
 AN  ACT  to  amend  the  public health law, in relation to strengthening
   transparency regarding Medicaid network adequacy and protecting  bene-
   ficiaries from disruptions in care
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. This act shall be known and may be cited as  the  "Medicaid
 network access protection act".
   § 2. The legislature finds that:
   1. Medicaid represents the state's largest expenditure, yet many bene-
 ficiaries  face difficulty accessing primary and specialty care, partic-
 ularly in the Hudson Valley and other suburban and rural regions.
   2. Recent decisions by large healthcare systems - including Optum - to
 withdraw from Medicaid and Medicare Advantage networks highlight system-
 ic vulnerabilities and the need for stronger oversight to ensure  conti-
 nuity of care and prevent taxpayer-funded access erosion.
   3.  Medicaid  policy  has  prioritized  coverage  expansion  without a
 publicly available,  transparent  evaluation  of  whether  reimbursement
 levels and program structures support real-world access to providers.
   4.  Emergency  room  utilization increases significantly when patients
 cannot obtain routine care, driving up costs for the system and  strain-
 ing hospital capacity.
   5. Expanded transparency regarding Medicaid network adequacy is neces-
 sary  to ensure Medicaid dollars are used to provide accessible, contin-
 uous patient care.
   It is therefore the intent of this act  to  ensure  New  Yorkers  have
 timely  access  to care and that Medicaid funding is used effectively to
 provide enrollees with access to care,  regardless  of  where  they  are
 located in the state.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD14130-01-5
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   §  3.  The public health law is amended by adding a new section 4403-h
 to read as follows:
   §  4403-H. NETWORK ADEQUACY REVIEWS. 1. THE COMMISSIONER, IN CONSULTA-
 TION WITH THE SUPERINTENDENT OF FINANCIAL SERVICES, THE COMMISSIONER  OF
 ADDICTION  SERVICES AND SUPPORTS, AND THE COMMISSIONER OF MENTAL HEALTH,
 SHALL:
   (A) ANNUALLY UPDATE NETWORK ADEQUACY GUIDELINES.
   (B) QUARTERLY PUBLICLY PUBLISH THE RESULTS OF THE DEPARTMENT'S NETWORK
 ADEQUACY SURVEYS OF  MANAGED  CARE  ORGANIZATIONS  ON  THE  DEPARTMENT'S
 WEBSITE  AND,  WITHIN  THIRTY  DAYS  OF SUCH PUBLICATION, THE DEPARTMENT
 SHALL ALSO PUBLISH A SUMMARY OF SUCH SURVEY. SUCH RESULTS SHALL HAVE ANY
 PERSONALLY IDENTIFIABLE INFORMATION OF PATIENTS  AND  PROVIDERS  REMOVED
 PRIOR TO BEING PUBLISHED.
   2. ANY ORGANIZATION WITHDRAWING FROM A MEDICAID MANAGED CARE ORGANIZA-
 TION  OR  MEDICARE  ADVANTAGE  NETWORK SHALL PROVIDE A MINIMUM OF NINETY
 DAYS' NOTICE TO THE DEPARTMENT, THE DEPARTMENT  OF  FINANCIAL  SERVICES,
 AND  ALL PATIENTS COVERED UNDER SUCH PLAN AND WHO HAVE RECEIVED SERVICES
 FROM THE ORGANIZATION IN THE PAST YEAR.
   § 4. Subparagraph 1 of paragraph (e) of subdivision 6 of section  4403
 of  the public health law, as amended by section 10 of subpart B of part
 AA of chapter 57 of the laws of 2022, is amended to read as follows:
   (1) If an enrollee's health care provider leaves  the  health  mainte-
 nance  organization's  network of providers for reasons other than those
 for which the provider would not be eligible to receive a hearing pursu-
 ant to paragraph a of subdivision  two  of  section  forty-four  hundred
 six-d of this chapter, the health maintenance organization shall provide
 written  notice  to  the  enrollee  of the provider's disaffiliation and
 permit the enrollee to continue an ongoing course of treatment with  the
 enrollee's current health care provider during a transitional period of:
 (i)  [ninety]  ONE HUNDRED EIGHTY days from the later of the date of the
 notice to the enrollee of the provider's disaffiliation from the  organ-
 ization's network or the effective date of the provider's disaffiliation
 from  the organization's network; or (ii) if the enrollee is pregnant at
 the time of the provider's disaffiliation, the duration of the pregnancy
 and post-partum care directly related to the delivery.
   § 5. Paragraph (f) of subdivision 6 of  section  4403  of  the  public
 health  law,  as added by chapter 705 of the laws of 1996, is amended to
 read as follows:
   (f) If a new enrollee whose health care provider is not  a  member  of
 the  health  maintenance  organization's provider network enrolls in the
 health maintenance  organization,  the  organization  shall  permit  the
 enrollee  to continue an ongoing course of treatment with the enrollee's
 current health care provider during  a  transitional  period  of  up  to
 [sixty]  ONE  HUNDRED EIGHTY days from the effective date of enrollment,
 if (i) the enrollee has a life-threatening disease  or  condition  or  a
 degenerative and disabling disease or condition or (ii) the enrollee has
 entered  the  second  trimester  of  pregnancy  at the effective date of
 enrollment, in which case the  transitional  period  shall  include  the
 provision  of  post-partum  care directly related to the delivery. If an
 enrollee elects to continue  to  receive  care  from  such  health  care
 provider  pursuant  to  this paragraph, such care shall be authorized by
 the health maintenance organization for the transitional period only  if
 the  health  care  provider  agrees (A) to accept reimbursement from the
 health maintenance organization at rates established by the health main-
 tenance organization as payment in full, which rates shall  be  no  more
 than  the  level of reimbursement applicable to similar providers within
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 the health maintenance organization's network for such services; (B)  to
 adhere  to  the organization's quality assurance requirements and agrees
 to provide to the organization necessary medical information related  to
 such  care;  and  (C) to otherwise adhere to the organization's policies
 and procedures including, but not limited to procedures regarding refer-
 rals and obtaining pre-authorization and a treatment  plan  approved  by
 the  organization.  In  no  event  shall  this paragraph be construed to
 require a health maintenance organization to provide coverage for  bene-
 fits  not otherwise covered or to diminish or impair pre-existing condi-
 tion limitations contained within the subscriber's contract.
   § 6. This act shall take effect immediately.