N.Y. PBH Law § 2807-FF — New York Code / Act PBH / Article 28 / Section 2807-FF
New York managed care organization provider tax
Status: in_force

§ 2807-ff. New York managed care organization provider tax. 1. The\ncommissioner, subject to the approval of the director of the budget,\nshall: apply for a waiver or waivers of the broad-based and uniformity\nrequirements related to the establishment of a New York managed care\norganization provider tax (the "MCO provider tax") in order to secure\nfederal financial participation for the costs of the medical assistance\nprogram; and, subject to approval by the centers for Medicare and\nMedicaid services, impose the MCO provider tax as an assessment upon\ninsurers, health maintenance organizations, and managed care\norganizations (collectively referred to as "health plan") offering the\nfollowing plans or products:\n  (a) Medical assistance program coverage provided by managed care\nproviders pursuant to section three hundred sixty-four-j of the social\nservices law;\n  (b) A health insurance plan serving individuals enrolled pursuant to\ntitle one-A of article twenty-five of this chapter;\n  (c) Essential plan coverage certified pursuant to title eleven-D of\narticle five of the social services law;\n  (d) Coverage purchased on the New York insurance exchange established\npursuant to section two hundred sixty-eight-b of this chapter; or\n  (e) Any other comprehensive coverage subject to articles thirty-two,\nforty-two and forty-three of the insurance law, or article forty-four of\nthis chapter.\n  1-a. On or after April first, two thousand twenty-six, the\ncommissioner, subject to the approval of the director of the budget,\nshall apply for an amendment of the MCO provider tax, subject to\napproval by the centers for Medicare and Medicaid services, to impose an\namended MCO provider tax as an assessment upon health plans no sooner\nthan January first, two thousand twenty-seven, as established in\nparagraph (b) of subdivision four of this section.\n  2. The MCO provider tax shall comply with all relevant provisions of\nfederal laws, rules and regulations.\n  3. The department shall post on its website the MCO provider tax\napproval letter by the centers for Medicare and Medicaid services (the\n"approval letter").\n  4. (a) Prior to January first, two thousand twenty-seven, a health\nplan, as defined in subdivision one of this section, shall pay the MCO\nprovider tax for each calendar year as follows:\n  (i) For Medicaid member months below two hundred fifty thousand member\nmonths, a health plan shall pay one hundred twenty-six dollars per\nmember month;\n  (ii) For Medicaid member months greater than or equal to two hundred\nfifty thousand member months but less than five hundred thousand member\nmonths, a health plan shall pay eighty-eight dollars per member month;\n  (iii) For Medicaid member months greater than or equal to five hundred\nthousand member months, a health plan shall pay twenty-five dollars per\nmember month;\n  (iv) For essential plan member months less than two hundred fifty\nthousand member months, a health plan shall pay thirteen dollars per\nmember month;\n  (v) For essential plan member months greater than or equal to two\nhundred fifty thousand member months, a health plan shall pay seven\ndollars per member month;\n  (vi) For non-essential plan non-Medicaid member months, consisting of\nthe populations covered by the products described in paragraphs (b),\n(d), and (e) of subdivision one of this section, less than two hundred\nfifty thousand member months, a health plan shall pay two dollars per\nmember month; and\n  (vii) For non-essential plan non-Medicaid member months greater than\nor equal to two hundred fifty thousand member months, a health plan\nshall pay one dollar and fifty cents per member month.\n  (b) Effective January first, two thousand twenty-seven, subject to any\nrequired approvals by the centers for Medicare and Medicaid services, a\nhealth plan, as defined in subdivision one of this section, shall pay\nthe MCO provider tax for each calendar year at a rate of 0.35% of the\nhealth plan's total premium revenue.\n  5. A health plan shall remit the MCO provider tax due pursuant to this\nsection to the commissioner or their designee quarterly or at a\nfrequency defined by the commissioner.\n  6. Funds accumulated from the MCO provider tax, including interest and\npenalties, shall be deposited and credited by the commissioner, or the\ncommissioner's designee, to the healthcare stability fund established in\nsection ninety-nine-ss of the state finance law.\n  7. (a) Every health plan subject to the approved MCO provider tax\nshall submit reports in a form prescribed by the commissioner to\naccurately disclose information required to implement this section.\n  (b) If a health plan fails to file reports required pursuant to this\nsubdivision within sixty days of the date such reports are due and after\nnotification of such reporting delinquency, the commissioner may assess\na civil penalty of up to ten thousand dollars for each failure;\nprovided, however, that such civil penalty shall not be imposed if the\nhealth plan demonstrates good cause for the failure to timely file such\nreports.\n  8. (a) If a payment made pursuant to this section is not timely,\ninterest shall be payable in the same rate and manner as defined in\nsubdivision eight of section twenty-eight hundred seven-j of this\narticle.\n  (b) The commissioner may waive a portion or all of either the interest\nor penalties, or both, assessed under this section if the commissioner\ndetermines, in their sole discretion, that the health plan has\ndemonstrated that imposition of the full amount of the MCO provider tax\npursuant to the timelines applicable under the approval letter has a\nhigh likelihood of creating an undue financial hardship for the health\nplan or creates a significant financial difficulty in providing needed\nservices to Medicaid beneficiaries. In addition, the commissioner may\nwaive a portion or all of either the interest or penalties, or both,\nassessed under this section if the commissioner determines, in their\nsole discretion, that the health plan did not have the information\nnecessary from the department to pay the tax required in this section.\nWaiver of some or all of the interest or penalties pursuant to this\nsubdivision shall be conditioned on the health plan's agreement to make\nMCO provider tax payments on an alternative schedule developed by the\ndepartment that takes into account the financial situation of the health\nplan and the potential impact on the delivery of services to Medicaid\nbeneficiaries.\n  (c) Overpayment by or on behalf of a health plan of a payment shall be\napplied to any other payment due from the health plan pursuant to this\nsection, or, if no payment is due, at the election of the health plan,\nshall be applied to future payments or refunded to the health plan.\nInterest shall be paid on overpayments from the date of overpayment to\nthe date of crediting or refunding at the rate determined in accordance\nwith this subdivision only if the overpayment was made at the direction\nof the commissioner. Interest under this paragraph shall not be paid if\nthe amount thereof is less than one dollar.\n  9. Payments and reports submitted or required to be submitted to the\ncommissioner pursuant to this section by a health plan shall be subject\nto audit by the commissioner for a period of six years following the\nclose of the calendar year in which such payments and reports are due,\nafter which such payments shall be deemed final and not subject to\nfurther adjustment or reconciliation, including through offset\nadjustments or reconciliations made by a health plan; provided, however,\nthat nothing in this section shall be construed as precluding the\ncommissioner from pursuing collection of any such payments which are\nidentified as delinquent within such six-year period, or which are\nidentified as delinquent as a result of an audit commenced within such\nsix-year period, or from conducting an audit of any adjustment or\nreconciliation made by a health plan, or from conducting an audit of\npayments made prior to such six-year period which are found to be\ncommingled with payments which are otherwise subject to timely audit\npursuant to this section.\n  10. In the event of a merger, acquisition, establishment, or any other\nsimilar transaction that results in the transfer of health plan\nresponsibility for all enrollees under this section from a health plan\nto another health plan or similar entity, and that occurs at any time\nduring which this section is effective, the resultant health plan or\nsimilar entity shall be responsible for paying the full tax amount as\nprovided in this section that would have been the responsibility of the\nhealth plan to which that full tax amount was assessed upon the\neffective date of any such transaction. If a merger, acquisition,\nestablishment, or any other similar transaction results in the transfer\nof health plan responsibility for only some of a health plan's enrollees\nunder this section but not all enrollees, the full tax amount as\nprovided in this section shall remain the responsibility of that health\nplan to which that full tax amount was assessed.\n