NYS Council Press Release & More State Budget News

April 19, 2024

Good afternoon,

It is our understanding that lawmakers will vote on 3 of the remaining 6 budget bills today and tomorrow – the Health/Mental Hygiene budget bill being one of three to be voted on today.

PLEASE SEE THE ATTACHED PRESS RELEASE FROM THE NYS COUNCIL REGARDING THE COMMERCIAL RATE MANDATE PROVISION! Feel free to share it far and wide.

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Here’s more information from the Health/Mental Hygiene budget bill that will be voted on by members of the legislature at some point today:

Commercial rate mandate is in!! Part AA of the HMH Article VII budget bill (attached) and below:

…..amended by adding a new subparagraph (J) to read as follows:
(J) This subparagraph shall apply to facilities in this state that are licensed, certified, or otherwise authorized by the office of addiction services and supports for the provision of outpatient, intensive outpatient, outpatient rehabilitation and opioid treatment that are participating in the insurer’s provider network. Reimbursement for covered outpatient treatment provided by such facilities shall be at rates negotiated between the insurer and the participating facility, provided that such rates are not less than the rates that would be paid for such treatment pursuant to the medical assistance program under title eleven of article five of the social services law. For the purposes of this subparagraph, the rates that would be paid for such treatment pursuant to the medical assistance program under title eleven of article five of the social services law shall be the rates with an effective date of April first of the preceding year, which shall be established prior to October first of the preceding calendar year. Prior to the submission on premium rate filings and applications, the superintendent shall provide insurers with guidance on factors to consider in calculating the impact of rate changes for the purposes of submitting premium rate filings and applications to the superintendent for the subsequent policy year. To the extent that the rates with an effective date of April first differ from the estimated rates incorporated in premium rate filings and applications, insurers may account for such differences in future premium rate filings and applications submitted to the superintendent for approval.

§ 2. Paragraph 35 of subsection (i) of section 3216 of the insurance 11 law is amended by adding a new subparagraph (K) to read as follows:
(K) This subparagraph shall apply to outpatient treatment provided in a facility issued an operating certificate by the commissioner of mental health pursuant to the provisions of article thirty-one of the mental hygiene law, or in a facility operated by the office of mental health, or in a crisis stabilization center licensed pursuant to section 36.01 of the mental hygiene law, that is participating in the insurer’s provider network. Reimbursement for covered outpatient treatment provided by such a facility shall be at rates negotiated between the insurer and the participating facility, provided that such rates are not less than the rates that would be paid for such treatment pursuant to the medical assistance program under title eleven of article five of the social services law. For the purposes of this subparagraph, the rates that would be paid for such treatment pursuant to the medical assistance program under title eleven of article five of the social services law shall be the rates with an effective date of April first of the preceding year, which shall be established prior to October first of the preceding calendar year. Prior to the submission of premium rate filings and applications, the superintendent shall provide insurers with guidance on factors to consider in calculating the impact of rate changes for the purposes of submitting premium rate filings and applications to the superintendent for the subsequent policy year. To the extent that the rates with an effective date of April first differ from the estimated rates incorporated in premium rate filings and applications, 35 insurers may account for such differences in future premium rate filings and applications submitted to the superintendent for approval. 37 § 3. Paragraph 5 of subsection (l) of section 3221 of the insurance 38 law is amended by adding a new subparagraph (K) to read as follows:

39 (K) This subparagraph shall apply to outpatient treatment provided in 40 a facility issued an operating certificate by the commissioner of mental health pursuant to the provisions of article thirty-one of the mental hygiene law, or in a facility operated by the office of mental health, or in a crisis stabilization center licensed pursuant to section 36.01 of the mental hygiene law, that is participating in the insurer’s provider network. Reimbursement for covered outpatient treatment provided by such a facility shall be at rates negotiated between the insurer and the participating facility, provided that such rates are not less than the rates that would be paid for such treatment pursuant to the medical assistance program under title eleven of article five of the social services law. For the purposes of this subparagraph, the rates that would be paid for such treatment pursuant to the medical assistance program under title eleven of article five of the social services law shall be the rates with an effective date of April first of the preceding year, which shall be established prior to October first of the preceding calendar year. Prior to the submission of premium rate filings and applications, the superintendent shall provide insurers with guidance on factors to consider in calculating the impact of rate changes for the purposes of submitting premium rate filings and applications to the superintendent for the subsequent policy year. To the extent that the rates with an effective date of April first differ from the estimated rates incorporated in premium rate filings and applications, 6 insurers may account for such differences in future premium rate 7 filings and applications submitted to the superintendent for approval. 8 § 4. Paragraph 7 of subsection (l) of section 3221 of the insurance 9 law is amended by adding a new subparagraph (J) to read as follows:

10 (J) This subparagraph shall apply to facilities in this state that are 11 licensed, certified, or otherwise authorized by the office of addiction 12 services and supports for the provision of outpatient, intensive outpa- 13 tient, outpatient rehabilitation and opioid treatment that are partic- 14 ipating in the insurer’s provider network. Reimbursement for covered 15 outpatient treatment provided by such facilities shall be at rates nego- 16 tiated between the insurer and the participating facility, provided that 17 such rates are not less than the rates that would be paid for such 18 treatment pursuant to the medical assistance program under title eleven 19 of article five of the social services law. For the purposes of this 20 subparagraph, the rates that would be paid for such treatment pursuant 21 to the medical assistance program under title eleven of article five of 22 the social services law shall be the rates with an effective date of 23 April first of the preceding year, which shall be established prior to 24 October first of the preceding calendar year. Prior to the submission of 25 premium rate filings and applications, the superintendent shall provide 26 insurers with guidance on factors to consider in calculating the impact 27 of rate changes for the purposes of submitting premium rate filings and 28 applications to the superintendent for the subsequent policy year. To 29 the extent that the rates with an effective date of April first differ 30 from the estimated rates incorporated in premium rate filings and 31 applications, insurers may account for such differences in future 32 premium rate filings and applications submitted to the superintendent 33 for approval.

34 § 5. Subsection (g) of section 4303 of the insurance law is amended by 35 adding a new paragraph 12 to read as follows:
36 (12) This paragraph shall apply to outpatient treatment provided in a 37 facility issued an operating certificate by the commissioner of mental 38 health pursuant to the provisions of article thirty-one of the mental 39 hygiene law, or in a facility operated by the office of mental health, 40 or in a crisis stabilization center licensed pursuant to section 36.01 41 of the mental hygiene law, that is participating in the corporation’s 42 provider network. Reimbursement for covered outpatient treatment 43 provided by such facility shall be at rates negotiated between the 44 corporation and the participating facility, provided that such rates 45 are not less than the rates that would be paid for such treatment pursu- 46 ant to the medical assistance program under title eleven of article five 47 of the social services law. For the purposes of this paragraph, the 48 rates that would be paid for such treatment pursuant to the medical 49 assistance program under title eleven of article five of the social 50 services law shall be the rates with an effective date of April first of 51 the preceding year, which shall be established prior to October first of 52 the preceding calendar year. Prior to the submission of premium rate 53 filings and applications, the superintendent shall provide corporations 54 with guidance on factors to consider in calculating the impact of rate 55 changes for the purposes of submitting premium rate filings and applica- 56 tions to the superintendent for the subsequent policy year. To theextent that the rates with an effective date of April first differ from 2 the estimated rates incorporated in premium rate filings and applica- 3 tions, corporations may account for such differences in future premium 4 rate filings and applications submitted to the superintendent for 5 approval.

6 § 6. Subsection (l) of section 4303 of the insurance law is amended by 7 adding a new paragraph 10 to read as follows:
8 (10) This paragraph shall apply to facilities in this state that are 9 licensed, certified, or otherwise authorized by the office of addiction

10 services and supports for the provision of outpatient, intensive outpa- 11 tient, outpatient rehabilitation and opioid treatment that are partic- 12 ipating in the corporation’s provider network. Reimbursement for covered 13 outpatient treatment provided by such facilities shall be at rates nego- 14 tiated between the corporation and the participating facility, provided 15 that such rates are not less than the rates that would be paid for such 16 treatment pursuant to the medical assistance program under title eleven 17 of article five of the social services law. For the purposes of this 18 paragraph, the rates that would be paid for such treatment pursuant to 19 the medical assistance program under title eleven of article five of the 20 social services law shall be the rates with an effective date of April 21 first of the preceding year, which shall be established prior to October 22 first of the preceding calendar year. Prior to the submission of premium 23 rate filings and applications, the superintendent shall provide corpo- 24 rations with guidance on factors to consider in calculating the impact 25 of rate changes for the purposes of submitting premium rate filings and 26 applications to the superintendent for the subsequent policy year. To 27 the extent that the rates with an effective date of April first differ 28 from the estimated rates incorporated in premium rate filings and 29 applications, corporations may account for such differences in future 30 premium rate filings and applications submitted to the superintendent 31 for approval.

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

COLA is as we described previously. 1.5% flexible, 1.7% that excludes c-suite and a few other CFR positions. We sent language to all members on Wednesday. See attached document, Part FF.
Telehealth payment parity for Article 31 and Article 32 programs is extended two years – to April 1, 2026 here. we have not seen language that adds FQHCs &/or D&TCs to the list of provider types that can benefit from this provision.

§ 5. Section 7 of part V of chapter 57 of the laws  of  2022  amending
30  the  public  health  law and the insurance law relating to reimbursement
31  for commercial and Medicaid services provided via telehealth, is amended
32  to read as follows:

33 § 7. This act shall take effect immediately and shall be deemed to have been in full force and effect on and after April 1, 2022; provided, however, this act shall expire and be deemed repealed on and after April 1, [2024] 2026. There is language in the HMH budget bill authorizing the state to pursue the MCO Tax here. It authorizes NYS to pursue the MCO Provider Tax and (pending approval from CMS) creates a Healthcare Stability Fund and requires use of the funds (from the MCO Tax) subject to legislative approval and appropriation:

2807-ff. New York managed care organization provider tax. 1. The commissioner, subject to the approval of the director of the budget, shall: apply for a waiver or waivers of the broad-based and uniformity requirements related to the establishment of a New York managed care organization provider tax (the “MCO provider tax”) in order to secure federal financial participation for the costs of the medical assistance program; issue regulations to implement the MCO provider tax; and, subject to approval by the centers for medicare and medicaid services, impose the MCO provider tax as an assessment upon insurers, health maintenance organizations, and managed care organizations offering the following plans or products:

(a) Medical assistance program coverage provided by managed care providers pursuant to section three hundred sixty-four-j of the social services law;
(b) A child health insurance plan certified pursuant to section twenty-five hundred eleven of this chapter;

(c) Essential plan coverage certified pursuant to section three hundred sixty-nine-gg of the social services law;
(d) Coverage purchased on the New York insurance exchange established pursuant to section two hundred sixty-eight-b of this chapter; or

(e) Any other comprehensive coverage subject to articles thirty-two, forty-two and forty-three of the insurance law, or article forty-four of this chapter.
2. The MCO provider tax shall comply with all relevant provisions of federal laws, rules and regulations.

§ 2. The state finance law is amended by adding a new section 99-rr to read as follows:
§ 99-rr. Healthcare stability fund. 1. There is hereby established in the joint custody of the state comptroller and the commissioner of taxation and finance a special fund to be known as the “healthcare stability fund” (“fund”).

2. The fund shall consist of monies received from the imposition of the centers for medicare and medicaid services-approved MCO provider tax established pursuant to section twenty-eight hundred seven-ff of the public health law, and all other monies appropriated, credited, or transferred thereto from any other fund or source pursuant to law.

3. Notwithstanding any provision of law to the contrary and subject toavailable legislative appropriation and approval of the director of the budget, monies of the fund may be available for:

(a) funding the non-federal share of increased capitation payments to managed care providers, as defined in section three hundred sixty-four-j of the social services law, for the medical assistance program, pursuant 14 to a plan developed and approved by the director of the budget;

(b) funding the non-federal share of the medical assistance program, including supplemental support for the delivery of health care services to medical assistance program enrollees and quality incentive programs; (c) reimbursement to the general fund for expenditures incurred in the medical assistance program, including, but not limited to, reimbursement pursuant to a savings allocation plan established in accordance with 21 section ninety-two of part H of chapter fifty-nine of the laws of two thousand eleven, as amended; and

23 (d) transfer to the capital projects fund, or any other capital projects fund of the state to support the delivery of health care services.
26 4. Monies disbursed from the fund shall be exempt from the calculation of department of health state funds medicaid expenditures under subdivision one of section ninety-two of part H of chapter fifty-nine of the laws of two thousand eleven, as amended.

30 5. Monies in such fund shall be kept separate from and shall not be commingled with any other monies in the custody of the comptroller or the commissioner of taxation and finance. Any monies of the fund not required for immediate use may, at the discretion of the comptroller, in consultation with the director of the budget, be invested by the comptroller in obligations of the United States or the state. Any income earned by the investment of such monies shall be added to and become a part of and shall be used for the purposes of such fund.

6. The director of the budget shall provide quarterly reports to the speaker of the assembly, the temporary president of the senate, the chair of the senate finance committee and the chair of the assembly ways and means committee, on the receipts and distributions of the healthcare stability fund, including an itemization of such receipts and disbursements, the historical and projected expenditures, and the projected fund 44 balance.

45    § 3. Paragraphs (g) and (h) of subdivision 1 of section 2807-y of  the
46  public health law, as added by section 67 of part B of chapter of the
47  laws  of  2005,  are amended and a new paragraph (i) is added to read as
48  follows:

49 (g) section thirty-six hundred fourteen-a of this chapter; [and]50 (h) section three hundred sixty-seven-i of the social services law[.]; and
52 (i) section twenty-eight hundred seven-ff of this article.
53 § 4. This act shall take effect immediately and shall be deemed to have been in full force and effect on and after April 1, 2024.

Take-out cocktails

Looks like Gov. Hochul and legislative leaders reached an agreement to temporarily extend the law that permits take-out cocktails that was set to expire. The governor had originally sought to make the pandemic-era rule permanent. The final language extends the provision for an additional five years. The budget will also permit the sale of alcohol at movie theaters statewide.Part BB – CPEP Authorization extended through July 1 2027

Notwithstanding any other provision of law, the commissioner of mental health shall, until July 1, [2024] 2027, be solely authorized, in [his or her] such commissioner’s discretion, to designate those general hospitals, local governmental units and voluntary agencies which may apply and be considered for the approval and issuance of an operating certificate pursuant to article 31 of the mental hygiene law for the operation of a comprehensive psychiatric emergency program.

47 § 21. This act shall take effect immediately, and sections one, two and four through twenty of this act shall remain in full force and effect, until July 1, [2024] 2027, at which time the amendments and additions made by such sections of this act shall be deemed to be repealed, and any provision of law amended by any of such sections of this act shall revert to its text as it existed prior to the effective date of this act.

54    § 2. This act shall take effect immediately.

The final budget requires 20 hours of prenatal leave, not up to 40 as previously proposed. See updated summary below.

Part M – Establish Paid Prenatal Leave to provide eligible pregnant employees the ability to take 20 additional hours of leave in a 52 week calendar period for prenatal medical appointments in addition to New York’s current 12 weeks of Paid Family Leave. Leave for prenatal visits could be taken in hourly increments. The proposal shall not be construed to require an employer to pay an employee for unused paid prenatal leave upon termination, resignation, retirement or other separation from employment. This will take effect on and after January 1, 2025. – INCLUDED