Bill Text: NY A08877 | 2023-2024 | General Assembly | Introduced

---

Bill Title: Requires notice and additional review for managed care providers of the methodologies and fee schedules and other materials used for determining medicaid reimbursement rates.

Spectrum: Partisan Bill (Democrat 3-0)

Status: (Introduced) 2024-03-05 - reported referred to ways and means [A08877 Detail]

Download: New_York-2023-A08877-Introduced.html

---

                STATE OF NEW YORK
        ________________________________________________________________________

                                          8877

                   IN ASSEMBLY

                                    January 26, 2024
                                       ___________

        Introduced by M. of A. PAULIN -- read once and referred to the Committee
          on Health

        AN  ACT  to  amend the social services law, in relation to determination
          and approval of reimbursement rates for managed care  providers  under
          medicaid

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Paragraph (c) of subdivision 18 of  section  364-j  of  the
     2  social  services  law, as added by section 55 of part B of chapter 57 of
     3  the laws of 2015, is amended to read as follows:
     4    (c) The department [of health] shall require the  independent  actuary
     5  selected  pursuant  to  paragraph  (b)  of this subdivision to provide a
     6  complete actuarial memorandum, along with all actuarial assumptions made
     7  and all other data, materials and methodologies used in the  development
     8  of  rates,  to managed care providers thirty days prior to submission of
     9  such rates to  the  centers  for  medicare  and  medicaid  services  for
    10  approval.  The  actuarial  memorandum  shall  include (i) any additional
    11  materials submitted to the centers for medicare  and  medicaid  services
    12  including  actuarial  certification  letters,  (ii)  any  correspondence
    13  between the state and the centers for  medicare  and  medicaid  services
    14  related  to  the  rates,  (iii)  other data, materials and methodologies
    15  considered but not used by the department  in  the  development  of  the
    16  rates, and (iv) any information required to be disclosed to managed care
    17  providers  or  the  public  under  federal  rules.  The department shall
    18  require the independent actuary to separately identify and present in  a
    19  collective  group  the  required material under each applicable subpara-
    20  graph (i) through (iv) of this paragraph.  Managed  care  providers  may
    21  request  that  the  department and its independent actuary conduct addi-
    22  tional review of the actuarial soundness of  the  rate  setting  process
    23  and/or  methodology.    Prior  to submission of rates to the centers for
    24  medicare and  medicaid  services  for  approval,  the  department  shall
    25  respond to any request from managed care providers for additional review
    26  of  the  actuarial soundness of the rate setting process or methodology,
    27  and in such response the department shall either:  (1)  agree  to  addi-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09075-01-3
        A. 8877                             2

     1  tional  review  and  delay  submission  of the rates for approval to the
     2  centers for medicare and medicaid services until the department's review
     3  is complete and shared with managed care providers, or (2)  decline  the
     4  requested  additional  review,  stating in writing clear reasons why the
     5  request is denied.
     6    § 2. Subdivision 18 of section 364-j of the  social  services  law  is
     7  amended by adding a new paragraph (f) to read as follows:
     8    (f)  The  department shall notify managed care providers of reimburse-
     9  ment rates prior to the effective date of such rates.
    10    § 3. This act shall take effect immediately; provided that the  amend-
    11  ments  to  section 364-j of the social services law made by sections one
    12  and two of this act shall not affect the  repeal  of  such  section  and
    13  shall expire and be deemed repealed therewith.