Bill > A02140

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 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 paid by Medicare on a site-neutral basis, services identified by specific coding systems (HCPCS codes) and payment classifications (APCs) recommended by the Medicare Payment Advisory Commission (MedPAC), or other services deemed appropriate by the Commissioner of Health for lower-cost settings. Healthcare providers, excluding certain facilities like federally qualified health centers and distressed hospitals, are prohibited from charging more than 150% of the Medicare non-hospital rate or a negotiated rate with a health benefit plan for these applicable services, and cannot bill using institutional claim forms when a professional claim form is appropriate. The bill also mandates annual reporting on spending trends and cost drivers for ambulatory services, requires insurers and health plans to adhere to these payment limits, and imposes penalties for violations, with provisions for rate adjustments to reflect these reduced provider payments.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A2140