Bill > S09169

This bill establishes a "managed long term care high acuity stabilization pool" with up to $50 million for the state fiscal year beginning April 1, 2026, to financially support managed long term care plans that excel in quality measures set by the department and serve a significant number of individuals with complex needs or high service usage. "Managed long term care plans" are organizations that coordinate and deliver long-term care services to individuals who are eligible for both Medicare and Medicaid. Funds from this pool can only be given to eligible plans whose "medical loss ratios" (the percentage of premiums spent on healthcare services rather than administrative costs or profit) exceed a threshold of 92%, after accounting for premium adjustments and risk factors. These payments are intended to cover costs exceeding that threshold and not to increase a plan's profit margin, with the commissioner of health authorized to set specific criteria for distribution, including quality standards and benchmarks for complexity or usage, and safeguards for financial accountability. Importantly, these payments will not be included in future premium rate calculations and do not create an entitlement to payment, serving instead as a supplemental and temporary support that does not replace the commissioner's duty to set sound premium rates.

Budget and Finance

https://www.nysenate.gov/legislation/bills/2025/S9169