Requires health care plans and payors to have a minimum of twelve and one-half percent of their total expenditures on physical and mental health annually be for primary care services.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1915A
SPONSOR: Paulin 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:
The purpose of this bill is 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 would amend the Insurance Law to require plans and
payors to annually report to the Department of Financial Services (DFS)
the percentage of the plan or payor's overall annual healthcare spending
that constituted primary care spending. DFS and the Department of Health
(DOH) would collaborate to provide an annual report to the Legislature
on this primary care spending data and would be required to post the
information on their respective websites. The section would also require
that beginning on April 1, 2026, each plan or payor that reports less
than 12.5% of total expenditures, in the previous year, are 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 spend-
ing. 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 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 pl an or payor would be
authorized to require any healthcare provider to report additional data
or information.
Section 2 of the bill would amend the Social Services Law to require
Medicaid managed care plans and fee-for services payors to annually
report to the percentage of the plan or payor's overall annual health-
care spending that constituted primary care spending 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 expenditures, in the previ-
ous 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 Superinten-
dent of DFS authority to make regulations to effectuate 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 additional data or informa-
tion.
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. Primary care is understanding and maintaining
wellness as well as 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 function better. Yet, it is estimated that as little as 5% of
U.S. healthcare spending goes toward primary care. New York currently
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 and underinvestment in primary
care.
Currently, at least ten states have acted to rebalance their healthcare
spending through legislative, regulatory, or executive means. This bill
will define, measure, and report on current primary care spending in New
York. It will also establish tangible metrics for primary care spending
in the state and lays out a process for achieving those goals. By estab-
lishing these metrics this bill will help shift the balance of health-
care spending in the State to place a greater emphasis on proactive and
preventative primary care services. This will serve to improve the over-
all health of the residents of New York and potentially avoid more cost-
ly medical interventions that can be avoided.
PRIOR LEGISLATIVE HISTORY:
2021-2022: S6534C Rivera / A7230B Gottfried - Vetoed
FISCAL IMPLICATIONS:
Undetermined.
EFFECTIVE DATE:
Immediately.
