BILL NUMBER: S1634
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the insurance law and the social services law, in
relation to primary care investment
 
PURPOSE OR GENERAL ID OF BILL:
This bill aims to enhance the role of primary care in New York's current
healthcare delivery to improve the general health of residents and avoid
more costly health interventions down the road.
 
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 of the bill amends the Insurance Law, to create a new section
3217-k, to require plans and payors to annually report to the Department
of Financial Services (DFS) the percentage of the plan or payor's over-
all annual healthcare spending that is constituted primary care spend-
ing. DFS and the Department of Health (DOH) would collaborate to provide
an annual report to the Legislature on this primary care spending data.
DFS and DOH would be required to post the information on their respec-
tive websites. The section would also require that beginning on April 1,
2027, and every subsequent year after, each plan or payor that reports
less than 12.5% of total expenditures, in the previous year, is on
primary care services would have to provide the Superintendent of DFS a
plan to increase its spending on primary care by 1% of its total overall
spending. This would continue each year on April 1st until the plan or
payor has reported that its spending on primary care has met or exceeded
12.5%. This section would grant the Commissioner of Health (COH) and
Superintendent of DFS authority to make regulations to effectuate this
section. Additionally, under this section, no plan or payor would be
required to report or publicly disclose spe cific rates of reimbursement
for any specific primary care services. No plan or payor would be
authorized to require any healthcare provider to report additional data
or information.
Section 2 of the bill amends the Social Services Law, to create new
section 368-g, to require Medicaid-managed care plans and fee-for-ser-
vice payors to annually report the percentage of the plan or payor's
overall annual healthcare spending that constituted primary care spend-
ing to DOH. The section would also require that beginning on April 1,
2026, each plan or payor that reports less than 12.5% of total expendi-
tures, in the previous year, are on primary care services would have to
provide the COH a plan to increase its spending on primary care by 1% of
its total overall spending. This would continue each year on April 1st
until the plan or payor has reported that its spending on primary care
has met or exceeded 12.5%. This section would grant the Commissioner of
DOH and Superintendent of DFS authority to make regulations to effectu-
ate the section. Additionally, under this section, no plan or payor
would be required to report or publicly disclose specific rates of
reimbursement for any specific primary care services. No plan or payor
would be authorized to require any healthcare provider to report addi-
tional data or information.
Section 3 establishes an immediate effective date.
 
JUSTIFICATION:
Primary care should be a person's first contact with the health care
system when seeking care. It understands and maintains wellness, and
focuses on identifying, preventing, and treating illness before it
becomes a chronic condition. Research shows that an increase of Just one
primary care provider per 10,000 people can generate 5.5% fewer hospital
visits, 11% fewer emergency department visits, and 7% fewer surgeries.
We know that health systems oriented towards primary care simply func-
tion better. Yet, it is estimated that as lithe as 5% of U.S. healthcare
spending goes toward primary care. New York spends more per capita on
health care than the national average but consistently ranks below many
other states in key health indicators. This is indicative of a lack of
access to primary care and an overall underinvestment by the state.
Currently, at least ten states have acted to rebalance their healthcare
spending through legislative, regulatory, or executive means. This bill
would define, measure, and report on current primary care spending in
New York. It would also establish tangible metrics for primary care
spending in the state and lay out a process for achieving those goals.
By establishing these metrics this bill would help shift the balance of
healthcare spending in the State to place a greater emphasis on proac-
tive and preventative primary care services. This would serve to
improve the overall health of the residents of New York and potentially
avoid more costly medical interventions that can be avoided.
 
PRIOR LEGISLATIVE HISTORY:
2023-24: S1197-B Rivera / A8592 Paulin - Committed to Finance
2021-22: S6534-C Rivera / A7230-B Gottfried - Vetoed memo .55
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
Immediately.