STATE OF NEW YORK ________________________________________________________________________ 9249 IN ASSEMBLY February 22, 2024 ___________ 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 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-five 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-six 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. 26 (ii) By December thirty-first, two thousand twenty-five each insurer 27 and hospital and/or birthing center shall enter into value-based EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD14117-02-4
A. 9249 2 1 arrangements that cover at least eighty-five percent of the maternity 2 cases of such insurer. 3 (iii) By December thirty-first, two thousand twenty-six 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 § 3. Paragraph 1 of subsection (c) of section 4303 of the insurance 8 law is amended by adding a new subparagraph (D) to read as follows: 9 (D)(i) Coverage provided by this paragraph shall be organized and paid 10 for through a value-based arrangement pursuant to the schedule set forth 11 in this subparagraph. "Value-based arrangement" shall mean an arrange- 12 ment that financially rewards certain positive outcomes and financially 13 penalizes certain negative outcomes. For the purposes of this section, 14 a negative outcome shall include a c-section on a low risk individual. 15 (ii) By December thirty-first, two thousand twenty-five each insurer 16 and hospital and/or birthing center shall enter into value-based 17 arrangements that cover at least eighty-five percent of the maternity 18 cases of such insurer. 19 (iii) By December thirty-first, two thousand twenty-six each insurer 20 and hospital and/or birthing center shall enter into value-based 21 arrangements that cover at least ninety-five percent of the maternity 22 cases of such insurer. 23 § 4. Section 4406 of the public health law is amended by adding a new 24 subdivision 6 to read as follows: 25 6. (a) A health maintenance organization which provides coverage for 26 maternity care shall reimburse and pay for such coverage through a 27 value-based arrangement pursuant to the schedule contained in this 28 subdivision. "Value-based arrangement" shall mean an arrangement that 29 financially rewards certain positive outcomes and financially penalizes 30 certain negative outcomes. For the purposes of this section, a negative 31 outcome shall include a c-section on a low risk individual. 32 (b) By December thirty-first, two thousand twenty-five, each health 33 maintenance organization shall enter into contracts with hospitals 34 and/or birthing centers that provide value-based arrangements that cover 35 at least eighty-five percent of the maternity cases of such organiza- 36 tion. 37 (c) By December thirty-first, two thousand twenty-six, each health 38 maintenance organization shall enter into contracts with hospitals 39 and/or birthing centers that provide value-based arrangements that cover 40 at least ninety-five percent of the maternity cases of such organiza- 41 tion. 42 § 5. Section 162 of the civil service law is amended by adding a new 43 subdivision 10 to read as follows: 44 10. (a) Any contract entered into under this section shall require 45 that coverage for maternity care shall be organized and paid for through 46 a value-based arrangement pursuant to the schedule contained in para- 47 graphs (b) and (c) of this subdivision. "Value-based arrangement" shall 48 mean an arrangement that financially rewards certain positive outcomes 49 and financially penalizes certain negative outcomes. For the purposes 50 of this section a negative outcome shall include a c-section on a low 51 risk individual. 52 (b) By December thirty-first, two thousand twenty-five, each insurer 53 and hospital and/or birthing center shall enter into value-based 54 arrangements that cover at least eighty-five percent of the maternity 55 cases of each insurer.
A. 9249 3 1 (c) By December thirty-first, two thousand twenty-six each insurer and 2 hospital and/or birthing center shall enter into value-based arrange- 3 ments that cover at least ninety-five percent of the maternity cases of 4 such insurer. 5 § 6. This act shall take effect on the forty-fifth day after it shall 6 have become a law. Effective immediately the addition, amendment and/or 7 repeal of any rule or regulation necessary for the implementation of 8 this act on its effective date are authorized to be made and completed 9 on or before such date.