June 7, 2024

Last week Emil Slane, Joe Katagiri and Pieter Barnett from OMH joined us for our Thursday morning meeting during which time we talked about the plan for implementation of Part AA – the commercial rate mandate that was enacted as part of the new state budget.

One question that did NOT come up during the meeting but came up subsequently, has to do with the language at the end of the Part AA provision that states:

    § 7. This act shall take effect January 1, 2025  and  shall  apply  to  policies and contracts issued, renewed, modified, altered, or amended on  and after such date. 

Specifically, the question that came up today is whether this language is referring to policies and contracts between the plan and the provider or between the plan and the policyholder.  Important question so I sought clarification from OMH.  

Leaders at OMH told me that the language (which is apparently standard insurance language but it certainly didn’t come from us) is referring to policies and contracts between the plan and the policy holder not the policies/contracts between the plan and the network provider.  It is my understanding thatproviders do not receive information from plans re: when a policyholder has renewed a contract and so this makes it incumbent on the plan to be in compliance with the new law. We will need to redouble our efforts to hold the plans for complying with the new law and the state to carry out robust surveillance, monitoring and enforcement of the provision.  I guess the upside here is that it is not incumbent on providers to renegotiate their contracts based on the passage of this law.  Again, it will be incumbent upon the plans to honor the law, and the state to hold them accountable.  

We will talk more about this on Thursday.