Amd §§3216, 3221 & 4303, Ins L; amd §4406, Pub Health L; amd §162, Civ Serv L; amd §364-j, Soc Serv L
Requires contracts for insurance and medical assistance to provide value-based care for maternity coverage; defines value-based care as an arrangement that financially rewards certain positive outcomes and financially penalizes certain negative outcomes.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A2371
SPONSOR: Paulin TITLE OF BILL:
An act to amend the insurance law, the public health law, the civil
service law and the social services 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 SPECIFIC 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 add 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
c-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 which 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 deliv-
ered headfirst 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 cesarean deliveries were higher among Black birth-
ing 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, FQHCs providing maternity services, and
birthing centers in the state. By December 2025, each insurer and hospi-
tal and/or birthing center shall enter value-based arrangements with
eight five percent of the insurer's maternity cases, increasing to nine-
ty-five percent of the insurer's maternity cases by December 31, 2026.
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 inexplainable and when compounded with the
negative maternal health outcomes we see in this state, the rate of this
procedure is inexcusable.
PRIOR LEGISLATIVE HISTORY:
A.9249. of 2024, referred to /insurance /Same as S. 9013 of 2024,
referred to insurance.
FISCAL IMPLICATIONS:
To be determined.
EFFECTIVE DATE:
This act shall take effect on the forty-fifth day after it shall have
become a law.
STATE OF NEW YORK
________________________________________________________________________
2371
2025-2026 Regular Sessions
IN ASSEMBLY
January 16, 2025
___________
Introduced by M. of A. PAULIN -- read once and referred to the Committee
on Insurance
AN ACT to amend the insurance law, the public health law, the civil
service law and the social services law, in relation to value-based
care for maternity coverage
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Paragraph 10 of subsection (i) of section 3216 of the
2 insurance law is amended by adding a new subparagraph (C) to read as
3 follows:
4 (C)(i) Coverage provided by this paragraph shall be organized and paid
5 for through a value-based arrangement pursuant to the schedule set forth
6 in this subparagraph. "Value-based arrangement" shall mean an arrange-
7 ment that financially rewards certain positive outcomes and financially
8 penalizes certain negative outcomes. For the purposes of this section,
9 a negative outcome shall include a c-section on a low risk individual.
10 (ii) By December thirty-first, two thousand twenty-five each insurer
11 shall enter into value-based arrangements with hospitals, federally
12 qualified health centers providing maternity services, and/or birthing
13 centers that provide at least eighty-five percent of the maternity care
14 for enrollees of such insurer.
15 (iii) By December thirty-first, two thousand twenty-six each insurer
16 shall enter into value-based arrangements with hospitals, federally
17 qualified health centers providing maternity services, and/or birthing
18 centers that provide at least ninety-five percent of the maternity care
19 for enrollees of such insurer.
20 § 2. Paragraph 5 of subsection (k) of section 3221 of the insurance
21 law is amended by adding a new subparagraph (C) to read as follows:
22 (C)(i) Coverage provided by this paragraph shall be organized and paid
23 for through a value-based arrangement pursuant to the schedule set forth
24 in this subparagraph. "Value-based arrangement" shall mean an arrange-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05808-01-5
A. 2371 2
1 ment that financially rewards certain positive outcomes and financially
2 penalizes certain negative outcomes. For the purposes of this section,
3 a negative outcome shall include a c-section on a low risk individual.
4 (ii) By December thirty-first, two thousand twenty-five each insurer
5 shall enter into value-based arrangements with hospitals, federally
6 qualified health centers providing maternity services, and/or birthing
7 centers that provide at least eighty-five percent of the maternity care
8 of enrollees of such insurer.
9 (iii) By December thirty-first, two thousand twenty-six each insurer
10 shall enter into value-based arrangements with hospitals, federally
11 qualified health centers providing maternity services, and/or birthing
12 centers that provide at least ninety-five percent of the maternity care
13 of enrollees of such insurer.
14 § 3. Paragraph 1 of subsection (c) of section 4303 of the insurance
15 law is amended by adding a new subparagraph (D) to read as follows:
16 (D)(i) Coverage provided by this paragraph shall be organized and paid
17 for through a value-based arrangement pursuant to the schedule set forth
18 in this subparagraph. "Value-based arrangement" shall mean an arrange-
19 ment that financially rewards certain positive outcomes and financially
20 penalizes certain negative outcomes. For the purposes of this section,
21 a negative outcome shall include a c-section on a low risk individual.
22 (ii) By December thirty-first, two thousand twenty-five each insurer
23 shall enter into value-based arrangements with hospitals, federally
24 qualified health centers providing maternity services, and/or birthing
25 centers that provide at least eighty-five percent of the maternity care
26 of enrollees of such insurer.
27 (iii) By December thirty-first, two thousand twenty-six each insurer
28 shall enter into value-based arrangements with hospitals, federally
29 qualified health centers providing maternity services, and/or birthing
30 centers that provide at least ninety-five percent of the maternity care
31 of enrollee of such insurer.
32 § 4. Section 4406 of the public health law is amended by adding a new
33 subdivision 6 to read as follows:
34 6. (a) A health maintenance organization which provides coverage for
35 maternity care shall reimburse and pay for such coverage through a
36 value-based arrangement pursuant to the schedule contained in this
37 subdivision. "Value-based arrangement" shall mean an arrangement that
38 financially rewards certain positive outcomes and financially penalizes
39 certain negative outcomes. For the purposes of this section, a negative
40 outcome shall include a c-section on a low risk individual.
41 (b) By December thirty-first, two thousand twenty-five, each health
42 maintenance organization shall enter into contracts with hospitals,
43 federally qualified health centers providing maternity care, and/or
44 birthing centers that provide value-based arrangements that provide at
45 least eighty-five percent of the maternity care for enrollees of such
46 organization.
47 (c) By December thirty-first, two thousand twenty-six, each health
48 maintenance organization shall enter into contracts with hospitals,
49 federally qualified health centers providing maternity care, and/or
50 birthing centers that provide value-based arrangements that provide at
51 least ninety-five percent of the maternity care of enrollees of such
52 organization.
53 § 5. Section 162 of the civil service law is amended by adding a new
54 subdivision 10 to read as follows:
55 10. (a) Any contract entered into under this section shall require
56 that coverage for maternity care shall be organized and paid for through
A. 2371 3
1 a value-based arrangement pursuant to the schedule contained in para-
2 graphs (b) and (c) of this subdivision. "Value-based arrangement" shall
3 mean an arrangement that financially rewards certain positive outcomes
4 and financially penalizes certain negative outcomes. For the purposes
5 of this section a negative outcome shall include a c-section on a low
6 risk individual.
7 (b) By December thirty-first, two thousand twenty-five, each insurer
8 shall enter into value-based arrangements with hospitals, federally
9 qualified health centers providing maternity services, and/or birthing
10 centers that provide at least eighty-five percent of the maternity care
11 of enrollees of such insurer.
12 (c) By December thirty-first, two thousand twenty-six each insurer
13 shall enter into value-based arrangements with hospitals, federally
14 qualified health centers providing maternity services, and/or birthing
15 centers that provide at least ninety-five percent of the maternity care
16 of enrollees of such insurer.
17 § 6. Section 364-j of the social services law is amended by adding a
18 new subdivision 40 to read as follows:
19 40. (a) A managed care provider which provides coverage for maternity
20 care shall reimburse and pay for such coverage through a value-
21 based arrangement pursuant to the schedule contained in this
22 subdivision. "Value-based arrangement" shall mean an arrangement that
23 financially rewards certain positive outcomes and financially penalizes
24 certain negative outcomes. For the purposes of this section, a negative
25 outcome shall include a c-section on a low risk individual.
26 (b) By December thirty-first, two thousand twenty-five, each managed
27 care provider shall enter into value based arrangements with hospitals,
28 federally qualified health centers providing maternity services, and/or
29 birthing centers that provide at least eighty-five percent of the mater-
30 nity care of enrollees of the managed care provider.
31 (c) By December thirty-first, two thousand twenty-six, each managed
32 care provider shall enter into value-based arrangements with hospitals,
33 federally qualified health centers providing maternity services, and/or
34 birthing centers that provide at least ninety-five percent of the mater-
35 nity care of enrollees of the managed care provider.
36 § 7. This act shall take effect on the forty-fifth day after it shall
37 have become a law; provided, however, that the amendments to section
38 364-j of the social services law made by section six of this act shall
39 not affect the repeal of such section and shall be deemed repealed ther-
40 ewith. Effective immediately the addition, amendment and/or repeal of
41 any rule or regulation necessary for the implementation of this act on
42 its effective date are authorized to be made and completed on or before
43 such effective date.
