New York 2025-2026 Regular Session

New York Assembly Bill A01359

Introduced
1/9/25  
Refer
1/9/25  

Caption

Requires the commissioner of health to set rates of payment for medical assistance for needy persons to reflect more current base year information.

Summary

Bill A01359 aims to amend the public health law and social services law in New York State concerning the rates of payment for medical assistance services provided to needy individuals. The bill mandates that the commissioner of health establish payment rates that are reasonably related to the costs of efficiently produced hospital and health-related services. Furthermore, it stipulates that these rates should not be based on data or calculations older than four years, ensuring that reimbursement rates reflect current economic conditions and operational costs of service providers.

Impact

The bill's passage would significantly impact the reimbursement methodologies for hospitals and health service providers under the medical assistance program. By requiring that payment rates be based on more recent data, the legislation aims to ensure that providers receive adequate compensation that aligns with current operational costs. This change could lead to improved financial stability for healthcare facilities, particularly those serving low-income populations, and may enhance the quality of care provided to Medicaid recipients.

Sentiment

The general sentiment surrounding Bill A01359 appears to be supportive, as it addresses the need for timely and adequate reimbursement rates for medical services. Stakeholders in the healthcare sector, including hospitals and service providers, have expressed a desire for updated payment structures that reflect current costs. However, there may be concerns regarding the administrative burden of implementing these changes and ensuring compliance with the new requirements.

Contention

Notable points of contention may arise from the potential impact on state budgets and the financial implications for managed care organizations. Some lawmakers and budget analysts might argue that while updating payment rates is necessary, it could lead to increased expenditures for the state, which may require careful consideration of funding sources. Additionally, there may be differing opinions on how to balance the needs of healthcare providers with the fiscal responsibilities of the state.

Companion Bills

No companion bills found.

Previously Filed As

NY A09509

Requires the office of addiction services and supports and the office of mental health to publish information for calculation of rates paid for certain treatment pursuant to the medical assistance program in a form an manner prescribed by the commissioner of the office of addiction services and supports or the commissioner of mental health, as applicable.

NY S08800

Requires the office of addiction services and supports and the office of mental health to publish information for calculation of rates paid for certain treatment pursuant to the medical assistance program in a form an manner prescribed by the commissioner of the office of addiction services and supports or the commissioner of mental health, as applicable.

NY S09638

Directs the commissioner of social services to authorize the payment of medical assistance funds for rapid whole genome sequencing for persons under twenty-one years of age under certain medical circumstances.

RI H6373

Requires the executive office of health and human services to increase Medicaid payment rates for primary care services furnished by primary care providers to be commensurate with Medicare rates.

NY S00614

Provides for enrollment of eligible incarcerated persons in the medical assistance for needy persons program; provides for enrollment of incarcerated individuals in other medical assistance programs, where eligible.

NY A00269

Provides for enrollment of eligible incarcerated persons in the medical assistance for needy persons program; provides for enrollment of incarcerated individuals in other medical assistance programs, where eligible.

MN SF4267

Commissioner authority clarification to impose sanctions against individuals or entities that receive payments from medical assistance or provide goods or services for which payment is made from medical assistance

WI AB1225

Direct payments for Medical Assistance, Medical Assistance reimbursement rates, care coordination services under the Medical Assistance program, grants for community primary care and outreach, and making an appropriation. (FE)

MN HF4068

Commissioner's authority to impose sanctions against individuals or entities that receive payments from medical assistance or provide goods or services for which payment is made from medical assistance clarified, and medical assistance sanctions and monetary recovery provision recodified.

NY A10007

Enacts into law major components of legislation necessary to implement the state health and mental hygiene budget for the 2026-2027 state fiscal year; extends provisions requiring the quarterly assessment of known and projected department of health state fund Medicaid expenditures (Part A); extends certain health provisions (Part B); extends certain provisions of law relating to the health care reform act; extends provisions relating to the distribution of pool allocations and graduate medical education; extends provisions relating to health care initiative pool distributions; extends payment provisions for general hospitals; and extends provisions relating to assessments on covered lives (Part C); relates to insurance coverage for medical malpractice paid for by funds from the hospital excess liability pool; extends portions of the New York Health Care Reform Act of 1996 (Part D); relates to temporary health care services agencies and protecting individuals engaged to provide health care services by such agencies (Part J); relates to capital rate reductions for nursing homes (Part L); clarifies Medicaid requirements for biomarker testing (Part M); relates to hospital and nursing home fee-for-service reimbursement rates (Part O); directs the commissioners of the office of mental health, office for people with developmental disabilities, office of addiction services and supports, office of temporary and disability assistance, office of children and family services and the director of the state office for the aging to establish a state fiscal year 2026-2027 targeted inflationary increase for projecting for the effects of inflation upon rates of payments, contracts, or any other form of reimbursement for certain programs and services; requires such commissioners and director to provide funding to support a 4.0% targeted inflationary increase for such programs and services (Part P); relates to the effectiveness of provisions of law relating to Medicaid management; removes certain provisions providing for lower minimum amounts of certain state aid for the city of New York than the rest of the state (Part T); extends provisions of law relating to general hospital reimbursement for annual rates for behavioral services; extends provisions of law relating to increasing Medicaid payments to providers through managed care organizations and providing equivalent fees through an ambulatory patient group methodology (Part U); ensures services provided in school-based health centers are not provided to medical assistance recipients through managed care programs (Part V); extends the effectiveness of the requirement that upon the closure or transfer of a state-operated individualized residential alternative (Part W); extends the care demonstration program (Part X); sunsets certain hospital capital rate add-on adjustments (Part Y); creates an essential plan contingency fund to maintain access to health care coverage for Essential Plan enrollees in the event that the federal government does not approve certain waiver submission necessary to make funds available by July 1, 2026, in the amount not to exceed $2,400,000,000 (Part Z).

Similar Bills

No similar bills found.