A 4860: Requires capitated payments under the medical assistance program.

  
  STATE OF NEW YORK ________________________________________________________________________ 4860 2025-2026 Regular Sessions  IN ASSEMBLY February 6, 2025 ___________ Introduced by M. of A. RAJKUMAR -- read once and referred to the Commit- tee on Health AN ACT to amend the social services law, in relation to capitated payments under medical assistance for needy persons The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 367-a of the social services law is amended by 2 adding a new subdivision 13 to read as follows: 3 13. (a) Any inconsistent provision of this chapter or other law 4 notwithstanding, on and after the effective date of this subdivision, 5 all payments with respect to medical assistance shall be capitated 6 payments. 7 (b) The commissioner may develop and assign patients rating categories 8 based on risk for the purposes of developing reimbursement methodologies 9 and payments under this subdivision. 10 § 2. Section 364-j of the social services law is amended by adding a 11 new subdivision 3-a to read as follows: 12 3-a. Special contract provisions. Any capitation payment system for 13 medical assistance under this article may include contract arrangements 14 that further adjust the payment amounts, including but not limited to 15 incentive arrangements, pass-through payments, risk corridor mechanisms, 16 or withhold arrangements as defined by 42 CFR 438.6. 17 § 3. No later than one year after the effective date of this act, the 18 commissioner of health shall provide drafts of legislation necessary to 19 convert all payments under the medical assistance for needy persons 20 program from fee-for-service payments to capitated payments, to the 21 governor, the temporary president of the senate and the speaker of the 22 assembly. 23 § 4. This act shall take effect immediately, provided that sections 24 one and two of this act shall take effect five years after such effec- 25 tive date; and provided, further, that the amendments to section 364-j EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD08580-01-5 
 A. 4860 2 1 of the social services law, made by section two of this act, shall not 2 affect the repeal of such section, and shall be deemed repealed there- 3 with. Effective immediately, the commissioner of health shall make regu- 4 lations and take other actions, including applying for federal waivers 5 and submitting state Medicaid plan amendments, reasonably necessary to 6 implement the provisions of this act.