§ 2807-ff. New York managed care organization provider tax. 1. The
commissioner, subject to the approval of the director of the budget,
shall: apply for a waiver or waivers of the broad-based and uniformity
requirements related to the establishment of a New York managed care
organization provider tax (the "MCO provider tax") in order to secure
federal financial participation for the costs of the medical assistance
program; and, subject to approval by the centers for Medicare and
Medicaid services, impose the MCO provider tax as an assessment upon
insurers, health maintenance organizations, and managed care
organizations (collectively referred to as "health plan") offering the
following plans or products:

(a) Medical assistance program coverage provided by managed care
providers pursuant to section three hundred sixty-four-j of the social
services law;

(b) A health insurance plan serving individuals enrolled pursuant to
title one-A of article twenty-five of this chapter;

(c) Essential plan coverage certified pursuant to title eleven-D of
article five of the social services law;

(d) Coverage purchased on the New York insurance exchange established
pursuant to section two hundred sixty-eight-b of this chapter; or

(e) Any other comprehensive coverage subject to articles thirty-two,
forty-two and forty-three of the insurance law, or article forty-four of
this chapter.

2. The MCO provider tax shall comply with all relevant provisions of
federal laws, rules and regulations.

3. The department shall post on its website the MCO provider tax
approval letter by the centers for Medicare and Medicaid services (the
"approval letter").

4. A health plan, as defined in subdivision one of this section, shall
pay the MCO provider tax for each calendar year as follows:

(a) For Medicaid member months below two hundred fifty thousand member
months, a health plan shall pay one hundred twenty-six dollars per
member month;

(b) For Medicaid member months greater than or equal to two hundred
fifty thousand member months but less than five hundred thousand member
months, a health plan shall pay eighty-eight dollars per member month;

(c) For Medicaid member months greater than or equal to five hundred
thousand member months, a health plan shall pay twenty-five dollars per
member month;

(d) For essential plan member months less than two hundred fifty
thousand member months, a health plan shall pay thirteen dollars per
member month;

(e) For essential plan member months greater than or equal to two
hundred fifty thousand member months, a health plan shall pay seven
dollars per member month;

(f) For non-essential plan non-Medicaid member months, consisting of
the populations covered by the products described in paragraphs (b),
(d), and (e) of subdivision one of this section, less than two hundred
fifty thousand member months, a health plan shall pay two dollars per
member month; and

(g) For non-essential plan non-Medicaid member months greater than or
equal to two hundred fifty thousand member months, a health plan shall
pay one dollar and fifty cents per member month.

5. A health plan shall remit the MCO provider tax due pursuant to this
section to the commissioner or their designee quarterly or at a
frequency defined by the commissioner.

6. Funds accumulated from the MCO provider tax, including interest and
penalties, shall be deposited and credited by the commissioner, or the
commissioner's designee, to the healthcare stability fund established in
section ninety-nine-ss of the state finance law.

7. (a) Every health plan subject to the approved MCO provider tax
shall submit reports in a form prescribed by the commissioner to
accurately disclose information required to implement this section.

(b) If a health plan fails to file reports required pursuant to this
subdivision within sixty days of the date such reports are due and after
notification of such reporting delinquency, the commissioner may assess
a civil penalty of up to ten thousand dollars for each failure;
provided, however, that such civil penalty shall not be imposed if the
health plan demonstrates good cause for the failure to timely file such
reports.

8. (a) If a payment made pursuant to this section is not timely,
interest shall be payable in the same rate and manner as defined in
subdivision eight of section twenty-eight hundred seven-j of this
article.

(b) The commissioner may waive a portion or all of either the interest
or penalties, or both, assessed under this section if the commissioner
determines, in their sole discretion, that the health plan has
demonstrated that imposition of the full amount of the MCO provider tax
pursuant to the timelines applicable under the approval letter has a
high likelihood of creating an undue financial hardship for the health
plan or creates a significant financial difficulty in providing needed
services to Medicaid beneficiaries. In addition, the commissioner may
waive a portion or all of either the interest or penalties, or both,
assessed under this section if the commissioner determines, in their
sole discretion, that the health plan did not have the information
necessary from the department to pay the tax required in this section.
Waiver of some or all of the interest or penalties pursuant to this
subdivision shall be conditioned on the health plan's agreement to make
MCO provider tax payments on an alternative schedule developed by the
department that takes into account the financial situation of the health
plan and the potential impact on the delivery of services to Medicaid
beneficiaries.

(c) Overpayment by or on behalf of a health plan of a payment shall be
applied to any other payment due from the health plan pursuant to this
section, or, if no payment is due, at the election of the health plan,
shall be applied to future payments or refunded to the health plan.
Interest shall be paid on overpayments from the date of overpayment to
the date of crediting or refunding at the rate determined in accordance
with this subdivision only if the overpayment was made at the direction
of the commissioner. Interest under this paragraph shall not be paid if
the amount thereof is less than one dollar.

9. Payments and reports submitted or required to be submitted to the
commissioner pursuant to this section by a health plan shall be subject
to audit by the commissioner for a period of six years following the
close of the calendar year in which such payments and reports are due,
after which such payments shall be deemed final and not subject to
further adjustment or reconciliation, including through offset
adjustments or reconciliations made by a health plan; provided, however,
that nothing in this section shall be construed as precluding the
commissioner from pursuing collection of any such payments which are
identified as delinquent within such six-year period, or which are
identified as delinquent as a result of an audit commenced within such
six-year period, or from conducting an audit of any adjustment or
reconciliation made by a health plan, or from conducting an audit of
payments made prior to such six-year period which are found to be
commingled with payments which are otherwise subject to timely audit
pursuant to this section.

10. In the event of a merger, acquisition, establishment, or any other
similar transaction that results in the transfer of health plan
responsibility for all enrollees under this section from a health plan
to another health plan or similar entity, and that occurs at any time
during which this section is effective, the resultant health plan or
similar entity shall be responsible for paying the full tax amount as
provided in this section that would have been the responsibility of the
health plan to which that full tax amount was assessed upon the
effective date of any such transaction. If a merger, acquisition,
establishment, or any other similar transaction results in the transfer
of health plan responsibility for only some of a health plan's enrollees
under this section but not all enrollees, the full tax amount as
provided in this section shall remain the responsibility of that health
plan to which that full tax amount was assessed.