BILL NUMBER: S6650
SPONSOR: WEBB
 
TITLE OF BILL:
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
 
PURPOSE:
The purpose of this bill is to require all types of health insurance to
enter value-based arrangements for maternity coverage for at least nine-
ty five percent of the maternity cases of each insurer.
 
SUMMARY OF PROVISIONS:
Section 1 adds a new subparagraph c to paragraph 10 of subsection (i) of
section 3216 of the insurance law to define "value-based arrangement".
It also further defines a negative outcome as a c- section on a low risk
individual.
Section 2 adds an amendment to paragraph 5 of subsection (k) of section
3221 of the insurance law to define "value-based arrangement". It also
further defines a negative outcome as a c-section on a low risk individ-
ual.
Section 3 amends paragraph 1 of subsection c of section 4303 of the
insurance law to add a new subparagraph d which defines "value-based
arrangement". It also further defines a negative outcome as a c- section
on a low risk individual.
Section 4 adds a new subdivision 6 of section 4406 of the public health
law to require a health maintenance organization reimburse and pay for
maternity care through a value-based arrangement. It also defines a
"value-based arrangement." It further defines a negative outcome as a
0-section on a low risk individual.
Sections 5 add as new subdivision 10 to section 162 of the civil service
law to require any contract entered into for maternity care be organized
and paid for through a value-based arrangement. It also defines a
"value-based arrangement". It further defines a negative outcome as a
c-section on a low risk individual.
Section 6 establishes the effective date. Such effective date shall be
45 days after enactment.
 
JUSTIFICATION:
Since the 1970s, the c-section rate in this country has increased by 500
percent, where 1 in 3 babies are born via c-section today. Despite this
growing trend, research demonstrates there is no evidence that cesarean
births provide any benefit to the mother or newborn when the procedure
is not required, in fact, it is quite the opposite.
Currently, the c-section rate in New York State is approximately 34.1
percent, which slightly exceeds the national average and greatly exceeds
the World Health Organization and the Center for Disease Control's (CDC)
ideal rate of 10-15 percent. Importantly, cesarean birth rates vary
greatly across hospitals, ranging between 7% and 70% depending on what
hospital a birthing person goes to.
Studies have found that cesarean birth rates in hospitals are directly
linked to higher maternal death rates and higher costs for healthcare.
The increase in cesarean rates in the U.S. is linked to an increase in
maternal deaths overall as the procedure can lead to neonatal respir-
atory problems and maternal health complications. In fact, cesareans can
account for three of the top six leading causes of maternal mortality
hemorrhage, complications of anesthesia, and infection.
Additionally, there is an alarming disparity in cesarean birth rates
among different birthing populations. Black birthing people are more
likely to receive a cesarean overall and they are also more likely to
undergo repeated cesareans compared to other birthing people, which
further increases the risk of mortality. In fact, in the U.S., black
birthing people are 4 times more likely to die from pregnancy-related
complications than white birthing people. In 2023, America's Health
Rankings (AHR) reported that of the 50 states, New York is ranked 49th
for the highest rate of low-risk c-sections. A cesarean delivery is
considered "low-risk" if a single infant is delivered head first at full
term to a mother who has not given birth before. AHR further reported
that between 2019 and 2021, the rate of low-risk cesarean delivery
increased 6 percent in NYS and only 3 percent nationally. Low-risk cesa-
rean deliveries were higher among Black birthing people.
With the rate of c-sections steadily rising in New York State over the
last several years, more needs to be done to reverse this trend.
Value-based arrangements have the potential to reduce the number of
medically unnecessary procedures, like c-sections, and the negative
health outcomes that often follow. Value-based arrangements reward
health care providers with incentive payments for the quality of care
they give to people, not the quantity.
This bill would define a "value-based arrangement" as an arrangement
that financially rewards certain positive health outcomes and financial-
ly penalizes certain negative outcomes, where a negative outcome
includes performing a c-section on a low-risk individual. The bill
further requires every type of insurance to enter into a value-based
arrangement with hospitals and birthing centers in the state. By Decem-
ber 2026, each insurer and hospital and/or birthing center shall enter
value-based arrangements with eight five percent of the insurer's mater-
nity cases, increasing to ninety-five percent of the insurer's maternity
cases by December 31, 2027. For some birthing people, a c-section is the
best and safest option for both the mother and the baby. However, the
rate of low-risk c-sections performed in New York is unexplainable and ò
when compounded with the negative maternal health outcomes we see in
this state, the rate of this procedure is inexcusable.
 
LEGISLATIVE HISTORY:
S9013 04/09/24 Referred to Insurance / A9249
02/22/24 Referred to insurance
 
FISCAL IMPLICATIONS:
To be determined.
 
EFFECTIVE DATE:
Sections 1, 3, and 4 of the bill would take effect immediately. The
remaining sections would take effect April 1, 2027.

Statutes affected:
S6650: 3216 insurance law, 3216(i) insurance law, 3221 insurance law, 3221(k) insurance law, 4303 insurance law, 4303(c) insurance law, 4406 public health law, 162 civil service law