STATE OF NEW YORK ________________________________________________________________________ 9013 IN SENATE April 9, 2024 ___________ 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-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
S. 9013 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.
S. 9013 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.