A 2371: Requires contracts for insurance and medical assistance to provide value-based care for maternity coverage; defines value-based care as an arrangement that financially rewards certain positive outcomes and financially penalizes certain negative outcomes.

  
  STATE OF NEW YORK ________________________________________________________________________ 2371 2025-2026 Regular Sessions  IN ASSEMBLY January 16, 2025 ___________ Introduced by M. of A. PAULIN -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, the public health law, the civil service law and the social services law, in relation to value-based care for maternity coverage The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Paragraph 10 of subsection (i) of section 3216 of the 2 insurance law is amended by adding a new subparagraph (C) to read as 3 follows: 4 (C)(i) Coverage provided by this paragraph shall be organized and paid 5 for through a value-based arrangement pursuant to the schedule set forth 6 in this subparagraph. "Value-based arrangement" shall mean an arrange- 7 ment that financially rewards certain positive outcomes and financially 8 penalizes certain negative outcomes. For the purposes of this section, 9 a negative outcome shall include a c-section on a low risk individual. 10 (ii) By December thirty-first, two thousand twenty-five each insurer 11 shall enter into value-based arrangements with hospitals, federally 12 qualified health centers providing maternity services, and/or birthing 13 centers that provide at least eighty-five percent of the maternity care 14 for enrollees of such insurer. 15 (iii) By December thirty-first, two thousand twenty-six each insurer 16 shall enter into value-based arrangements with hospitals, federally 17 qualified health centers providing maternity services, and/or birthing 18 centers that provide at least ninety-five percent of the maternity care 19 for enrollees of such insurer. 20 § 2. Paragraph 5 of subsection (k) of section 3221 of the insurance 21 law is amended by adding a new subparagraph (C) to read as follows: 22 (C)(i) Coverage provided by this paragraph shall be organized and paid 23 for through a value-based arrangement pursuant to the schedule set forth 24 in this subparagraph. "Value-based arrangement" shall mean an arrange- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05808-01-5 
 A. 2371 2 1 ment that financially rewards certain positive outcomes and financially 2 penalizes certain negative outcomes. For the purposes of this section, 3 a negative outcome shall include a c-section on a low risk individual. 4 (ii) By December thirty-first, two thousand twenty-five each insurer 5 shall enter into value-based arrangements with hospitals, federally 6 qualified health centers providing maternity services, and/or birthing 7 centers that provide at least eighty-five percent of the maternity care 8 of enrollees of such insurer. 9 (iii) By December thirty-first, two thousand twenty-six each insurer 10 shall enter into value-based arrangements with hospitals, federally 11 qualified health centers providing maternity services, and/or birthing 12 centers that provide at least ninety-five percent of the maternity care 13 of enrollees of such insurer. 14 § 3. Paragraph 1 of subsection (c) of section 4303 of the insurance 15 law is amended by adding a new subparagraph (D) to read as follows: 16 (D)(i) Coverage provided by this paragraph shall be organized and paid 17 for through a value-based arrangement pursuant to the schedule set forth 18 in this subparagraph. "Value-based arrangement" shall mean an arrange- 19 ment that financially rewards certain positive outcomes and financially 20 penalizes certain negative outcomes. For the purposes of this section, 21 a negative outcome shall include a c-section on a low risk individual. 22 (ii) By December thirty-first, two thousand twenty-five each insurer 23 shall enter into value-based arrangements with hospitals, federally 24 qualified health centers providing maternity services, and/or birthing 25 centers that provide at least eighty-five percent of the maternity care 26 of enrollees of such insurer. 27 (iii) By December thirty-first, two thousand twenty-six each insurer 28 shall enter into value-based arrangements with hospitals, federally 29 qualified health centers providing maternity services, and/or birthing 30 centers that provide at least ninety-five percent of the maternity care 31 of enrollee of such insurer. 32 § 4. Section 4406 of the public health law is amended by adding a new 33 subdivision 6 to read as follows: 34 6. (a) A health maintenance organization which provides coverage for 35 maternity care shall reimburse and pay for such coverage through a 36 value-based arrangement pursuant to the schedule contained in this 37 subdivision. "Value-based arrangement" shall mean an arrangement that 38 financially rewards certain positive outcomes and financially penalizes 39 certain negative outcomes. For the purposes of this section, a negative 40 outcome shall include a c-section on a low risk individual. 41 (b) By December thirty-first, two thousand twenty-five, each health 42 maintenance organization shall enter into contracts with hospitals, 43 federally qualified health centers providing maternity care, and/or 44 birthing centers that provide value-based arrangements that provide at 45 least eighty-five percent of the maternity care for enrollees of such 46 organization. 47 (c) By December thirty-first, two thousand twenty-six, each health 48 maintenance organization shall enter into contracts with hospitals, 49 federally qualified health centers providing maternity care, and/or 50 birthing centers that provide value-based arrangements that provide at 51 least ninety-five percent of the maternity care of enrollees of such 52 organization. 53 § 5. Section 162 of the civil service law is amended by adding a new 54 subdivision 10 to read as follows: 55 10. (a) Any contract entered into under this section shall require 56 that coverage for maternity care shall be organized and paid for through 
 A. 2371 3 1 a value-based arrangement pursuant to the schedule contained in para- 2 graphs (b) and (c) of this subdivision. "Value-based arrangement" shall 3 mean an arrangement that financially rewards certain positive outcomes 4 and financially penalizes certain negative outcomes. For the purposes 5 of this section a negative outcome shall include a c-section on a low 6 risk individual. 7 (b) By December thirty-first, two thousand twenty-five, each insurer 8 shall enter into value-based arrangements with hospitals, federally 9 qualified health centers providing maternity services, and/or birthing 10 centers that provide at least eighty-five percent of the maternity care 11 of enrollees of such insurer. 12 (c) By December thirty-first, two thousand twenty-six each insurer 13 shall enter into value-based arrangements with hospitals, federally 14 qualified health centers providing maternity services, and/or birthing 15 centers that provide at least ninety-five percent of the maternity care 16 of enrollees of such insurer. 17 § 6. Section 364-j of the social services law is amended by adding a 18 new subdivision 40 to read as follows: 19 40. (a) A managed care provider which provides coverage for maternity 20 care shall reimburse and pay for such coverage through a value- 21 based arrangement pursuant to the schedule contained in this 22 subdivision. "Value-based arrangement" shall mean an arrangement that 23 financially rewards certain positive outcomes and financially penalizes 24 certain negative outcomes. For the purposes of this section, a negative 25 outcome shall include a c-section on a low risk individual. 26 (b) By December thirty-first, two thousand twenty-five, each managed 27 care provider shall enter into value based arrangements with hospitals, 28 federally qualified health centers providing maternity services, and/or 29 birthing centers that provide at least eighty-five percent of the mater- 30 nity care of enrollees of the managed care provider. 31 (c) By December thirty-first, two thousand twenty-six, each managed 32 care provider shall enter into value-based arrangements with hospitals, 33 federally qualified health centers providing maternity services, and/or 34 birthing centers that provide at least ninety-five percent of the mater- 35 nity care of enrollees of the managed care provider. 36 § 7. This act shall take effect on the forty-fifth day after it shall 37 have become a law; provided, however, that the amendments to section 38 364-j of the social services law made by section six of this act shall 39 not affect the repeal of such section and shall be deemed repealed ther- 40 ewith. Effective immediately the addition, amendment and/or repeal of 41 any rule or regulation necessary for the implementation of this act on 42 its effective date are authorized to be made and completed on or before 43 such effective date.