Bill > S01634

This bill requires health insurance plans and payors, including Medicaid providers, to spend at least 12.5% of their total healthcare expenditures on primary care services annually, with a phased implementation approach. Starting in April 2026, these entities must report the percentage of their overall healthcare spending dedicated to primary care, which includes services provided by physicians, nurse practitioners, physician assistants, and midwives in outpatient settings across specialties like family practice, pediatrics, internal medicine, and integrated behavioral health. If a plan or payor falls below the 12.5% threshold, they must submit a plan to incrementally increase their primary care spending by at least 1% each year and report on their progress. The bill defines primary care broadly, encompassing comprehensive patient care, care coordination, and integrated mental health services. Importantly, the legislation mandates that these spending shifts cannot result in higher premiums or increased cost-sharing for individuals, and requires the health and financial services departments to publish annual reports summarizing the primary care spending data. The bill also provides guidelines for increasing primary care investments, such as improving reimbursement rates, building provider capacity, upgrading technology, and implementing value-based payment arrangements.

Business and Industry, Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/S1634