S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7518
 
                        2025-2026 Regular Sessions
 
                             I N  S E N A T E
 
                              April 21, 2025
                                ___________
 
 Introduced  by  Sen.  CLEARE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law, in relation to payment rates  for
   managed long term care plans
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section 1. Subdivision 8 of section 4403-f of the public  health  law,
 as amended by section 21 of part B of chapter 59 of the laws of 2016, is
 amended to read as follows:
   8.  (A) Payment rates for managed long term care plan enrollees eligi-
 ble for medical assistance. The  commissioner  shall  establish  payment
 rates for services provided to enrollees eligible under title XIX of the
 federal  social  security  act.  Such  payment rates shall be subject to
 approval by the director of the division of the budget and shall reflect
 savings to both state and local governments when compared to costs which
 would be incurred by such program if enrollees were to receive  compara-
 ble health and long term care services on a fee-for-service basis in the
 geographic  region  in  which such services are proposed to be provided.
 Payment rates shall be risk-adjusted to take into account the character-
 istics of enrollees, or proposed enrollees, including, but  not  limited
 to:    frailty,  disability  level,  health  and functional status, age,
 gender, the nature of services provided to  such  enrollees,  and  other
 factors  as  determined  by the commissioner. The risk adjusted premiums
 may also be combined with  disincentives  or  requirements  designed  to
 mitigate  any incentives to obtain higher payment categories. In setting
 such payment rates, the commissioner shall consider costs borne  by  the
 managed  care  program to ensure actuarially sound and adequate rates of
 payment to ensure quality of care shall comply with all applicable  laws
 and regulations, state and federal, including regulations as to actuari-
 al soundness for medicaid managed care.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11720-01-5
 S. 7518                             2
              

 
   (B)  SUPPLEMENTAL  QUALITY  IMPROVEMENT  PAYMENTS.  (I) FOR THE PERIOD
 BEGINNING APRIL FIRST, TWO THOUSAND TWENTY-FIVE  THROUGH  MARCH  THIRTY-
 FIRST, TWO THOUSAND TWENTY-SIX, PAYMENT RATES FOR MANAGED LONG TERM CARE
 PLANS  SHALL BE ADJUSTED TO INCREASE PAYMENTS TO ALL PLANS THAT (1) HAVE
 RECEIVED  FOUR  OR  MORE  STAR  RATINGS FOR AN OVERALL SCORE IN THE MOST
 RECENTLY AVAILABLE MANAGED LONG  TERM  CARE  CONSUMER  REGIONAL  QUALITY
 GUIDE  PRODUCED  BY  THE DEPARTMENT ON APRIL FIRST, TWO THOUSAND TWENTY-
 FIVE, AND (2) HAVE A RELATIVE RISK SCORE GREATER THAN ONE AND  ONE-TENTH
 IN  EFFECT  ON  APRIL  FIRST, TWO THOUSAND TWENTY-FIVE. FUNDING FOR SUCH
 RATE INCREASES SHALL BE PROVIDED BY REDUCING PAYMENT RATES TO PLANS  NOT
 ELIGIBLE  FOR A RATE INCREASE PURSUANT TO THIS PARAGRAPH, BY ONE PERCENT
 OR THIRTY MILLION DOLLARS, WHICHEVER IS LESS.
   (II) ELIGIBLE PLANS SHALL RECEIVE AN AMOUNT  DETERMINED  BY  (1)  EACH
 ELIGIBLE  PLAN  ALLOCATED AN EQUAL SHARE OF SUCH FUNDING, AND (2) MULTI-
 PLYING THAT AMOUNT BY ONE HUNDRED PERCENT FOR EACH  ELIGIBLE  PLAN  THAT
 RECEIVED  A  RATING OF FIVE STARS IN THE MANAGED LONG TERM CARE CONSUMER
 REGIONAL QUALITY GUIDE, AND EIGHTY PERCENT FOR EACH ELIGIBLE  PLAN  THAT
 RECEIVED  A  RATING OF FOUR STARS IN THE MANAGED LONG TERM CARE CONSUMER
 REGIONAL QUALITY GUIDE.
   § 2. This act shall take effect immediately; provided,  however,  that
 the  amendments  to subdivision 8 of section 4403-f of the public health
 law made by section one of this act shall not affect the repeal of  such
 section and shall be deemed repealed therewith.