S 6650: 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 ________________________________________________________________________ 6650 2025-2026 Regular Sessions  IN SENATE March 19, 2025 ___________ Introduced by Sen. WEBB -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law, the public health law and the civil service 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-six each insurer 11 and hospital and/or birthing center shall enter into value-based 12 arrangements that cover at least eighty-five percent of the maternity 13 cases of such insurer. 14 (iii) By December thirty-first, two thousand twenty-seven each insurer 15 and hospital and/or birthing center shall enter into value-based 16 arrangements that cover at least ninety-five percent of the maternity 17 cases of such insurer. 18 § 2. Paragraph 5 of subsection (k) of section 3221 of the insurance 19 law is amended by adding a new subparagraph (C) to read as follows: 20 (C)(i) Coverage provided by this paragraph shall be organized and paid 21 for through a value-based arrangement pursuant to the schedule set forth 22 in this subparagraph. "Value-based arrangement" shall mean an arrange- 23 ment that financially rewards certain positive outcomes and financially 24 penalizes certain negative outcomes. For the purposes of this section, 25 a negative outcome shall include a c-section on a low risk individual. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD05808-02-5 
 S. 6650 2 1 (ii) By December thirty-first, two thousand twenty-six each insurer 2 and hospital and/or birthing center shall enter into value-based 3 arrangements that cover at least eighty-five percent of the maternity 4 cases of such insurer. 5 (iii) By December thirty-first, two thousand twenty-seven each insurer 6 and hospital and/or birthing center shall enter into value-based 7 arrangements that cover at least ninety-five percent of the maternity 8 cases of such insurer. 9 § 3. Paragraph 1 of subsection (c) of section 4303 of the insurance 10 law is amended by adding a new subparagraph (D) to read as follows: 11 (D)(i) Coverage provided by this paragraph shall be organized and paid 12 for through a value-based arrangement pursuant to the schedule set forth 13 in this subparagraph. "Value-based arrangement" shall mean an arrange- 14 ment that financially rewards certain positive outcomes and financially 15 penalizes certain negative outcomes. For the purposes of this section, 16 a negative outcome shall include a c-section on a low risk individual. 17 (ii) By December thirty-first, two thousand twenty-six each insurer 18 and hospital and/or birthing center shall enter into value-based 19 arrangements that cover at least eighty-five percent of the maternity 20 cases of such insurer. 21 (iii) By December thirty-first, two thousand twenty-seven each insurer 22 and hospital and/or birthing center shall enter into value-based 23 arrangements that cover at least ninety-five percent of the maternity 24 cases of such insurer. 25 § 4. Section 4406 of the public health law is amended by adding a new 26 subdivision 6 to read as follows: 27 6. (a) A health maintenance organization which provides coverage for 28 maternity care shall reimburse and pay for such coverage through a 29 value-based arrangement pursuant to the schedule contained in this 30 subdivision. "Value-based arrangement" shall mean an arrangement that 31 financially rewards certain positive outcomes and financially penalizes 32 certain negative outcomes. For the purposes of this section, a negative 33 outcome shall include a c-section on a low risk individual. 34 (b) By December thirty-first, two thousand twenty-six, each health 35 maintenance organization shall enter into contracts with hospitals 36 and/or birthing centers that provide value-based arrangements that cover 37 at least eighty-five percent of the maternity cases of such organiza- 38 tion. 39 (c) By December thirty-first, two thousand twenty-seven, each health 40 maintenance organization shall enter into contracts with hospitals 41 and/or birthing centers that provide value-based arrangements that cover 42 at least ninety-five percent of the maternity cases of such organiza- 43 tion. 44 § 5. Section 162 of the civil service law is amended by adding a new 45 subdivision 10 to read as follows: 46 10. (a) Any contract entered into under this section shall require 47 that coverage for maternity care shall be organized and paid for through 48 a value-based arrangement pursuant to the schedule contained in para- 49 graphs (b) and (c) of this subdivision. "Value-based arrangement" shall 50 mean an arrangement that financially rewards certain positive outcomes 51 and financially penalizes certain negative outcomes. For the purposes 52 of this section a negative outcome shall include a c-section on a low 53 risk individual. 54 (b) By December thirty-first, two thousand twenty-six, each insurer 55 and hospital and/or birthing center shall enter into value-based 
 S. 6650 3 1 arrangements that cover at least eighty-five percent of the maternity 2 cases of each insurer. 3 (c) By December thirty-first, two thousand twenty-seven each insurer 4 and hospital and/or birthing center shall enter into value-based 5 arrangements that cover at least ninety-five percent of the maternity 6 cases of such insurer. 7 § 6. This act shall take effect on the forty-fifth day after it shall 8 have become a law. Effective immediately the addition, amendment and/or 9 repeal of any rule or regulation necessary for the implementation of 10 this act on its effective date are authorized to be made and completed 11 on or before such date.