Bill > A10159

This bill establishes a "managed long term care high acuity stabilization pool" with up to $50 million for the state fiscal year starting April 1, 2026, to financially support managed long term care plans, which are organizations that provide comprehensive health and long-term care services to individuals who need ongoing assistance. This pool is specifically designed for plans that excel in quality measures set by the department and serve a large number of members with very complex needs or who use a high volume of services. To be eligible for payments from this pool, a plan's medical loss ratio, which is the percentage of premium revenue spent on actual medical care and quality improvements, must exceed a threshold set by the commissioner, not to exceed 92%, after accounting for final premium rates and risk adjustments. Payments from the pool are intended to cover costs exceeding this threshold and will not be used to increase a plan's profit margins, nor will they be included in future premium rate calculations, serving instead as a supplemental and temporary support mechanism that does not replace the commissioner's duty to set sound premium rates. The bill also includes an appropriation of $50 million to the department of health for the purpose of implementing these provisions.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A10159