Final 2022-23 State Budget Enacted

On April 9, Governor Kathy Hochul and legislative leaders announced an agreement on a $220 billion state budget for 2022-23.

Health Insurance items in the final budget:

  • DFS Funding: The final budget modifies the Executive proposal to an all funds total of $396,967,000 with $84,788,000 allocated to the administration program; $92,903,000 allocated to the Banking program; and $219,276,000 allocated to the insurance program
  • Compliance with the Federal “No Surprises Act”. The final budget accepts the Executive proposal to include statutory revisions reflecting changes required by, or to be consistent with, the federal No Surprises Act (“NSA”) with respect to emergency medical services and surprise bills; external appeals law; and provider directories and continuity of care – with two modifications noted below. Despite strong opposition from providers, the requirement for dispute resolution entities to consider the median par rate in IDR disputes was accepted. Provisions also include amendments to the Insurance Law and Public Health Law to:
    • Incorporate the provider directory requirements of the NSA into the Insurance Law consistent with recent Circular Letters. The final budget modifies this proposal to require plans to reimburse non-participating providers for services when incorrect provider directory information is relied on – even where a member has no out-of-network benefits (the language intentionally does not indicate the actual amount that plans must pay the out of network provider) ;
    • Incorporate the continuity of care requirements of the NSA into the Insurance Law consistent with recent Circular Letters;
    • Incorporate requirements for providers to notify health plans of their provider directory information; and
    • Authorize the Superintendent to fine a health plan for violating federal law. The final budget modifies this proposal to limit the state’s fining authority to violations of the Consolidated Appropriations Act (e.g. the NSA, transparency language on quality and price, drug pricing, mental health parity etc.).
    • These provisions would take effect immediately.
  • Telehealth Parity. The final budget modifies the Executive proposal to (1) add licensed mental health practitioners to the definition of “telehealth providers”; (2) require DFS and DOH to issue a report on the impact of reimbursement for telehealth services; and (3) include provisions sunsetting the law two years after enactment. As proposed in the Executive Budget, the final budget establishes reimbursement parity by requiring health plans, including those in Medicaid, to reimburse providers for telehealth services on the same basis, and at the same rate, as services delivered in person. The new law does allow for payment variations for “costs not actually incurred in the provision of the telehealth services”, such as facility related costs. This proposal is set take effect retroactively to April 1, 2022 and will expire on April 1, 2024.
  • Utilization Review; Requests for Medical Records. The final budget accepts the Executive proposal to :
    • Amend the Insurance Law to apply the existing provider application and termination provisions to all types of health insurance policies, rather than just managed care contracts, and add requirements relating to facility applications and terminations. These provisions require notice of plans’ credentialing requirements, require plans to consult with facilities in establishing qualifications for participation, require plans to act on an application within 60 days of receipt of a complete application, and if additional information is necessary and received, make a determination within 21 days of receipt of the additional information.  This provision would apply to applications received 90 days after enactment.
    • Remove the exception for HMO products in the provisions prohibiting Plans from requesting entire medical records for prospective and concurrent utilization review. This provision would apply to services provided on and after 90 days after enactment.”
  • Provider and Facility Credentialing Applications. The final budget accepts the Executive proposal to apply the existing provider application and termination provisions to all types of health insurance policies, rather than just managed care contracts, and includes requirements relating to facility applications and terminations.
  • Coverage of Abortion Services. The final budget modifies the Executive proposal to align linguistically with the Senate One House proposal and require policies that provide hospital, surgical, or medical coverage – as well as maternity coverage – to also cover abortions without coinsurance. Deductibles may apply to enrollees in high-deductible health plans. Religious exemptions would be permissible. This provision will take effect on January 1, 2023, and apply to policies issued or renewed on and after that date.
  • Contracting with Cancer Centers. The final budget accepts the Executive proposal to require plans offering Medicaid, Essential Plan, and Qualified Health Plans to contract with national cancer institute-designated cancer centers at the same terms and conditions as similar network providers, with reimbursement at no less than the Medicaid FFS rate.

Health care access & affordability items in the final budget:

  • Expanding Eligibility for the Essential Plan (“EP”). The final budget accepts the Executive proposal to expand EP eligibility from 200 to 250 percent of the federal poverty level (“FPL”); provides continued coverage for women during pregnancy, and to women and newborns one year thereafter; and provides coverage for long term supports and services (“LTSS”).
  • Undocumented Seniors: The final budget adds a proposal to make eligible for Medicaid any person over the age of 65, regardless of immigration status.
  • “Prenatal and Post-natal Care. The final budget modifies the Executive proposal to , as proposed in the Assembly One House, specify that covered “pre-natal and post-partum care and services” shall include “nutrition services provided by certified dietitians and certified nutritionists; care coordination, case management, and peer support; patient navigation services; services provided by licensed clinical social workers; dyadic services; Bluetooth-enabled devices for remote patient monitoring; and other services determined by the Commissioner of Health.” The final budget does not include language extending coverage for pregnant individuals ineligible for Medicaid due to immigration status; but does:
    • Extend eligibility for postpartum women from 60 days to 12 months after pregnancy; and
    • Repeal the extension of EP post-partum coverage for certain individuals, as enacted as part of the SFY 22 NYS Budget.
  • Health Insurance Consumer Assistance Program: The final budget provides adds $1.734 million for the Community Services Society for the Community Health Advocates Consortium.

 

Lawmakers are on a two week break, returning to Albany on April 25. The Legislative Session is scheduled to wrap up on June 2.