Directs the department of health to establish an alternative payment methodology (APM) for federally qualified health centers to preserve and improve patient access to fertility care.
Summary
This bill directs the New York State Department of Health to create an alternative payment methodology (APM) for federally qualified health centers (FQHCs) to help preserve and improve access to fertility care for Medicaid patients. The APM is tied to state plan authority and is intended to supplement, not replace, existing FQHC reimbursement under the prospective payment system (PPS) or other payment arrangements.
The bill specifically requires the department to reimburse FQHCs for the difference between what they paid to acquire certain eligible injectable fertility drugs through the federal 340B program and what those drugs would have cost at average wholesale acquisition cost during calendar year 2024. The covered drugs are limited to gonadotropins, GnRH antagonists, and GnRH agonists. The measure takes effect immediately.
Impact
The bill would create a new state Medicaid payment mechanism for FQHCs, increasing reimbursement for the acquisition of specified fertility medications dispensed to Medicaid patients. It would affect the Department of Health’s administration of state plan amendment authority and would provide additional payments on top of existing PPS or other APM payments, potentially improving FQHC financial capacity to offer fertility-related services and medication access.
Sentiment
Based on the bill text and the absence of recorded committee debate or votes in the provided materials, the measure appears to be framed as a targeted access-to-care bill with a generally supportive policy rationale. Its stated purpose is to preserve and improve fertility care access, suggesting a positive orientation toward expanding treatment availability for Medicaid patients served by FQHCs.
Contention
No committee transcripts or vote history were provided, so no direct opposition or negotiated concerns can be identified from the record here. Potential points of contention, based on the bill’s structure, could include the cost to the state Medicaid program, the narrow focus on specific injectable fertility drugs, and the use of 340B pricing and a retrospective 2024 reimbursement calculation, but these issues are not documented in the supplied discussion materials.
Same As
Directs the department of health to establish an alternative payment methodology (APM) for federally qualified health centers to preserve and improve patient access to fertility care.
Directs the department of health to establish an alternative payment methodology (APM) for federally qualified health centers to preserve and improve patient access to fertility care.
Directs the department of health to establish an alternative payment methodology (APM) for federally qualified health centers to preserve and improve patient access to fertility care.
Directs the department of health to establish an alternative payment methodology (APM) for federally qualified health centers to preserve and improve patient access to fertility care.
Requires insurance companies to establish and maintain API to facilitate patient and provider access to health information; includes patient access, provider directory and payer to payer exchange.
Requires Medicaid and NJ FamilyCare managed care organizations to offer patient-centered medical home model or other alternative payment model to primary care providers.
Patient-Centered Care program established, direct state payments to health care providers authorized, contracting with administrative services organizations authorized, conforming changes made, and money appropriated.