Bill > S00705

This bill establishes a "site-neutral payment policy" for certain low-complexity, routine medical services, meaning healthcare providers will be reimbursed the same amount for a similar service regardless of where it's performed, aiming to align payment rates across different healthcare settings like hospitals and physician offices. "Applicable services" are defined as outpatient or ambulatory services that can be safely provided in various settings, including those already paid by Medicare on a site-neutral basis, specific services identified by the Medicare Payment Advisory Commission (MedPAC), or others designated by the commissioner as safe for lower-cost settings. Healthcare providers are prohibited from charging more than 150% of the Medicare non-hospital rate or a negotiated rate, whichever is lower, for these services, and cannot bill using institutional claim forms when a professional claim form is appropriate, preventing duplicate billing. The bill also mandates that insurers and health plans cannot reimburse providers for applicable services at rates exceeding these limits or for improperly billed services, with penalties for violations. Furthermore, it requires the Department of Health to publish an annual report on ambulatory service spending trends and cost drivers, including the impact of these new pricing rules, and allows for public comment on rate filings for insurance policies and contracts, with the superintendent's determination to reflect these reduced provider payments.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S705