BILL NUMBER: S9622
SPONSOR: COONEY
 
TITLE OF BILL:
An act to amend the insurance law, in relation to allowing for Medicaid
accountable care organizations to purchase experience-rated health
insurance for their members
 
PURPOSE:
Health care providers serving predominantly Medicaid populations provide
a tremendous service to underserved communities, but they do so with
limited margins. The cost of providing health care to their own employ-
ees can become challenging. This is true even for larger groups of
providers who join together as a Medicaid accountable care organization
(AC0). Medicaid ACOs must be approved by the State Department of Health,
and must drive quality for Medicaid beneficiaries and efficiencies for
the Medicaid program. There are currently about ten Medicaid ACOs that
have been issued a certificate of authority in the State.
Recognizing these ACO's commitments to the State Medicaid program and
the people across the State served by the Medicaid program, this bill
would allow Medicaid ACOs that meet certain requirements to be recog-
nized as a group and be experience-rated, rather than to make available
community-rated plans to its members. This measure would recognize the
challenges faced by these providers and create a mechanism to allow the
limited number of Medicaid ACOs that otherwise meet the bill's require-
ments to purchase insurance as an experience-rated group.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section one of the legislation would amend subparagraph (1) of
subsection (c) of section 4325 of the insurance law to insert a new
subdivision (N-1) to recognize Medicaid accountable care organizations
that have received a certificate of authority from the department of
health pursuant to Article 29-G of the public health law.
Sections two and three of the legislation would amend the provisions of
the insurance law governing community rating to except insurance
products issued to Medicaid accountable care organizations under
4325(c)(N-1) provided they meet all of the following qualifications:
* The group is comprised of at least 150 member employers;
* The collective number of individuals insured under the policy exceeds
500 persons;
* Each employer in the group is enrolled as a provider in the State's
Medicaid program; and
* Each employer in the group can demonstrate an annual payer mix in
which Medicaid represents 60% or more of annual revenues.
Section four of the legislation establishes an effective date.
 
JUSTIFICATION:
Health care providers serving predominantly Medicaid populations provide
a tremendous service to underserved communities, but they do so with
limited margins. The cost of providing health care to their own employ-
ees can become challenging. This is true even for larger groups of
providers who join together to as a Medicaid accountable care organiza-
tion (ACO). Medicaid ACOs must be approved by the State Department of
Health, and must drive quality for Medicaid beneficiaries and efficien-
cies for the Medicaid program. There are currently about ten Medicaid
ACOs that have been issued a certificate of authority in the State.
Recognizing these ACO's commitments to the State Medicaid program and
the people across the State served by the Medicaid program, this bill
would allow Medicaid ACOs that meet certain requirements to be recog-
nized as a group and be experience-rated, rather than to make available
community-rated plans to its members. This measure would recognize the
challenges faced by these providers and create a mechanism to allow the
limited number of Medicaid ACOs that otherwise meet the bill's require-
ments to purchase insurance as an experience-rated group. As providers
of care to underserved communities face growing costs, rates that fail
to keep pace with inflation, and growing demand, this type of measure
will help enable providers that can prove they serve a high proportion
of Medicaid consumers and engage in high quality programs will help
stabilize costs for these providers.
 
LEGISLATIVE HISTORY:
New legislation
 
FISCAL IMPLICATIONS:
To be determined.
 
EFFECTIVE DATE:
This act shall take effect immediately.

Statutes affected:
S9622: 4317 insurance law, 4317(d) insurance law