Bill > S01634

This bill mandates that health insurance plans and other payors, which include entities providing managed care, accident and health insurance, or comprehensive health insurance, must allocate a minimum of twelve and one-half percent of their total annual expenditures on physical and mental health towards primary care services. Primary care is defined as integrated, accessible healthcare provided by clinicians who build partnerships with patients, consider their family and community context, and coordinate their care, specifically including services like family practice, general pediatrics, internal medicine, and obstetrics/gynecology when delivered in an outpatient, non-emergency setting by qualified professionals. This requirement also extends to Medicaid managed care providers and those covering Medicaid fee-for-service, ensuring that a significant portion of healthcare spending is directed towards foundational care. If a plan or payor falls below this twelve and one-half percent threshold, they will be required to submit a plan to increase their primary care spending by at least one percent annually until the target is met, with reporting on their progress. Importantly, any spending shifts resulting from this bill should not lead to increased premiums or cost-sharing for insured individuals.

Business and Industry, Health and Social Services

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