New YorkA 100072025-2026 Regular SessionHouseWALLET

Enacts into law major components of legislation necessary to implement the state health and mental hygiene budget for the 2026-2027 state fiscal year

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Bill Overview

Analyzed Economic Effects

71 provisions identified: 43 benefits, 13 costs, 15 mixed.

Fewer approval delays for addiction medicines

Qualifying health plans covering addiction medicines cannot require prior approval for initial or renewed detoxification or maintenance prescriptions. Covered medicines include buprenorphine, methadone, long-acting injectable naltrexone, and opioid-overdose reversal medicines. The protection applies to qualifying individual, small-group, and large-group coverage. Medicines must be legally prescribed, dispensed, or authorized, and the protection does not override another law's prohibition.

Medicaid cancer center access and treatment funding

Approved health organizations must cover qualifying National Cancer Institute-designated centers within their service area. Centers must hold a New York health department license and agree to serve enrollees. Inpatient and outpatient payments must meet at least the applicable fee-for-service Medicaid rate and payment method. The covered-service definition also includes dental and vision services defined by the health commissioner. Separately, eligible breast and cervical cancer treatment receives up to $2.1 million in state-share funding each budget year, April 1, 2026–March 31, 2029.

Stronger coverage for outpatient addiction treatment

Comprehensive health plans must cover outpatient addiction diagnosis, detoxification, and rehabilitation under parity rules. Large-group plans cap copayments and coinsurance at primary-care visit levels; otherwise-covered family members can receive up to 20 visits yearly. Qualifying in-network New York addiction facilities avoid prior approval and concurrent review for four continuous weeks, up to 28 visits. Facilities must send treatment-start notice and an initial plan within two business days; qualifying in-network crisis centers also receive review protections. Collected mental health and addiction parity penalties go into the state fund established under State Finance Law § 99-hh.

Stronger insurance coverage for addiction treatment

Covered comprehensive health policies and contracts must cover inpatient and outpatient addiction treatment, including detoxification and rehabilitation. Coverage includes unlimited medically necessary residential care, with financial requirements and limits no stricter than predominant medical or surgical benefits. At qualifying participating New York facilities, the first 28 inpatient days require no prior approval or ongoing insurer review. Facilities must report admission and the initial plan within two business days, review care daily, and provide a written discharge plan. Otherwise-covered family members also get up to 20 outpatient family-treatment visits per policy or calendar year, subject to the policy's visit limit.

More Medicaid funding for care providers

Beginning April 1, 2026, the law authorizes Medicaid payment increases totaling up to $706 million for hospitals. It also authorizes up to $480 million for nursing homes and $20 million for assisted living programs. Federally qualified health centers have a separate increase capped at $80 million for each applicable state budget year. These increases require state health and budget approval, federal matching funds, and compliance with the law's payment-program requirements. The money goes to providers, not directly to patients.

Medicaid family coverage and payment protections

Beginning April 1, 2026, pregnant people and infants under one qualify through this Medicaid category at the MAGI-equivalent income limit of 200% of the federal poverty line. For children ages one through 18, the limit is 133%; both limits depend on family size. These standard-coverage clauses no longer list presumptive eligibility as a separate qualifying route. Medicaid also pays for specified care and supplies for otherwise eligible pregnant people while federal matching funds are available. Payment remains protected when federal funding is unavailable solely because of immigration status.

New Medicaid long-term care review rules

Beginning January 1, 2027, New York can review past medical expenses over the maximum retroactive period federal law allows. This replaces the specified three months before the application month. For long-term care eligibility, the law states a 60-month look-back for people in institutions. It states a 30-month look-back for people outside institutions, subject to federal approval.

Health assessments support early intervention funding

For calendar years 2027–2029, the gross statewide health assessment amount is $1.085 billion annually. Each year, $40 million goes to governments based on their shares of early-intervention costs Medicaid does not reimburse. Shares use the latest available 12 months of spending data. Regional reconciliation rules continue through December 31, 2029, using a $1.085 billion annual collection threshold for 2022–2029. Reductions to regional allocations pause until officials determine $65 million in qualifying excess collections is reserved for the health resources fund. Collections at or below the applicable thresholds remain subject to regional adjustments.

Health funding continues alongside assessments and surcharges

The law extends Health Care Reform Act assessments, allowances, surcharges, and pool distributions to December 31, 2029, rather than December 31, 2026. It directs $765 million annually from health care initiatives pool funds accumulated through December 31, 2028. Another $191.25 million comes from funds accumulated January 1–March 31, 2029. After expiration, qualifying collections, proceedings, and distributions tied to earlier acts or patient services can continue. Authorized program and grant money can still be spent until exhausted.

Hospital aid continues with reductions and exclusions

Beginning April 1, 2026, the law continues hospital indigent-care funding through December 31, 2029, subject to federal matching funds. Annual major-public-hospital aid is $139.4 million before a $113.4 million aggregate reduction beginning in 2025; this category excludes New York City Health and Hospitals Corporation hospitals. Other eligible hospitals receive $969.9 million before aggregate reductions of $150 million in 2020–2022 and $235.4 million in 2023–2029, with specified enhanced safety net exemptions. A $64.6 million pool supports non-major-public hospitals that qualified as enhanced safety net hospitals on April 1, 2020, and face indigent-care-pool reductions. One percent of available funds is reserved for financial-assistance compliance.

Added Medicaid supports for chronic health limits

The law includes added services and supports for eligible approved-organization enrollees with chronic illness or limits on daily activities. Their main purpose must be helping people live or work in a setting they choose. Settings include homes, workplaces, and provider-owned or controlled residences. The health commissioner must define the supports, and federal approval is required. Enrollees must qualify under Social Services Law section 366(1)(g)(1).

Behavioral health payment support continues through 2031

New York continues higher managed-care payments for eligible Medicaid outpatient and other non-inpatient behavioral health services through March 31, 2031. This includes eligible care inside and outside New York City and for patients under 21. Plans must pay eligible licensed providers using specified Medicaid fees; total increases cannot exceed available funding. State transfers require budget approval, and Medicaid fee approval can include alternative-payment requirements with specified waivers. Child Health Plus outpatient behavioral health fees also continue through March 31, 2031, with health department approval required for negotiated alternatives.

Better behavioral health networks and directories

Covered health plans must have enough mental health and addiction-treatment providers and offer a suitable choice. Networks must include specified residential services, assertive community treatment, critical time intervention, and mobile crisis services. Network reviews occur at approval, at least every three years, and when a plan seeks a larger service area. Directories must list facility affiliations and limits on provider availability. Providers must maintain update processes for network changes, material information changes, appropriate intervals, and insurer requests.

Equivalent Medicaid benefits outside managed care

Beginning January 1, 2027, a specified Medicaid eligibility group receives equivalent managed-care benefits through fee-for-service coverage. This includes benefits available through managed care on January 1, 2023, that later moved to fee-for-service. The rule applies to people eligible under Social Services Law section 366(1)(g)(4)(a).

Faster decisions and protected addiction treatment coverage

For policies issued, renewed, or modified starting January 1, 2027, qualifying inpatient addiction-treatment requests receive decisions within 24 hours. Requests submitted at least 24 hours before discharge cannot be denied for medical necessity or missing prior approval while pending. After denial, both expedited internal and external appeals must be filed within 24 hours to keep that protection; decisions are due within 24 hours. Addiction reviews also require qualified reviewers and age-appropriate, evidence-based tools; New York treatment uses a state-designated tool. Separately, certified requests involving possible court-ordered mental health or addiction care require a decision and phone notice within 72 hours, followed by written notice within three business days.

School health centers keep funding and coverage

The law removes the delay blocking school health center services for medical assistance recipients through managed care. From April 1, 2026, through March 31, 2029, eligible centers keep up to $5.288 million each state budget year. Those reserved funds can accumulate across years, including investment income. A separate grant program continues up to $2.644 million yearly during that period, subject to appropriations. Providers share those grants based on their share of total enrollment.

Temporary health workers gain fee protections

Temporary health staffing agencies cannot charge workers placement or connection fees or restrict their job opportunities. They also cannot charge damages, employment fees, or other compensation when a health care entity hires the worker directly. This protection covers permanent employees, contractors, and contingent workers. Agencies must verify applicable licensing, training, and continuing-education standards as a condition of registration.

Underserved-area doctors retain loan repayment help

From April 1, 2026, through March 31, 2029, physician loan repayment receives up to $1.705 million annually. Awards prioritize up to 25 teaching-hospital-trained physicians who enter and remain in eligible primary care or specialty practices in underserved communities. One-third of available funding goes to New York City and two-thirds elsewhere. At least half must go to physicians identified by general hospitals. The law does not set each physician's award amount.

Two state funding allocations continue

The law continues an allocation of $23.836 million each state budget year through March 31, 2029. It also continues up to $96.6 million yearly from April 1, 2026, through March 31, 2029. The supplied provisions do not identify either allocation's recipients or purpose. No specific household benefit can be determined from these amounts alone.

Direct-care worker recruitment funding continues through 2029

From April 1, 2026, through March 31, 2029, New York continues up to $136 million yearly in state-share direct-care recruitment and retention funding. Total Medicaid rate adjustments under that program cannot exceed $340 million per state budget year. Federal matching funds and a state-district agreement are required; the district must include a city with over one million people. Providers must use these funds for non-supervisory personal care workers or other workers directly caring for patients. Separately, the tobacco control and insurance initiatives pool supports up to $50 million yearly in state-share recruitment and retention rate increases for listed home care, hospice, and managed long-term care providers, subject to appropriations.

Health facilities regain some capital payments

Beginning April 1, 2026, eligible health facilities no longer face an additional 10% cut to their capital-cost payments. The separate 5% cut remains unchanged. This applies to rates for patients whose care is paid by state agencies, except at pediatric residential health care facilities.

Hospital malpractice insurance funding continues

From April 1, 2026, through March 31, 2029, transfers to the hospital excess liability pool continue. The tobacco control and insurance initiatives pool supplies up to $127.4 million each state budget year. This supports excess malpractice insurance, pool administration, and risk management. The law does not specify an effect on household health bills.

Three health funding streams continue

From April 1, 2026, through March 31, 2029, the law continues three annual funding amounts. It authorizes up to $100 million under a public health provision and up to $28.5 million under a social services provision. A separate health-pool allocation provides $8.5 million each state budget year. The supplied provisions do not identify the specific services or recipients, so household benefits cannot be determined.

Medicaid transition services stay outside managed care

Starting March 31, 2026, Medicaid managed care cannot provide nursing home diversion and transition services under the federal waiver. This restriction lasts until at least January 1, 2028. It does not itself end eligibility for those services through other arrangements. The law also keeps traumatic brain injury waiver services outside managed care.

Shorter Medicaid coverage protection for young children

Beginning July 1, 2026, eligible children keep Medicaid through the earlier of two month-end dates. One is the last day of the month 12 months after an eligibility decision or renewal. The other is the last day of the month they turn 19. Subject to federal requirements, this replaces the longer protection that some children under six had until their sixth birthday.

Stricter evidence rules for Medicaid biomarker tests

Beginning April 1, 2026, Medicaid biomarker testing must meet listed evidence standards to guide diagnosis, treatment, management, or monitoring. These include FDA test indications, tests indicated for FDA-approved drugs, Medicare coverage decisions, or nationally recognized clinical guidelines. Peer-reviewed studies alone no longer provide a separate coverage basis. Testing still faces standard coverage and medical-necessity review. It must use a participating in-network lab with CLIA certification or a CLIA waiver.

Medicaid rate increases depend on fund balances

Beginning April 1, 2026, specified 2025 and 2026 Medicaid rate increases depend on available healthcare stability fund money. The budget director determines whether projected balances are sufficient. When balances are insufficient, the health commissioner must act to suspend or terminate the increases, with budget director approval. The increases stay suspended or terminated until sufficient balances are determined to be available.

Residential care facilities face extended payment reductions

Effective April 1, 2026, the law extends statewide residential health-care facility payment-reduction calculations through 2029. The health commissioner calculates annual targets using Medicare and eligible Medicaid days of care. For 2028 and 2029, the reduction percentage is multiplied by $102 million to calculate the statewide reduction amount. The reduction percentage is zero when the target is at least three percentage points above the statewide base. These are facility payment rules, not direct charges to residents.

Higher provider payments prioritize frontline staff

From April 1, 2026, through March 31, 2027, eligible programs receive a targeted 2.7% increase on eligible payment amounts. It covers listed mental health, disability, addiction, nutrition outreach, foster care, and community services for older adults. Funding depends on appropriations, state budget approval, and federal approval where required. The 2.7% includes other wage and cost-of-living increases in place April 1, excluding federal pandemic relief. Local governments and direct-contract providers must certify that staffing needs or critical operating costs come before executive compensation increases. Agencies can recover money used against these rules, including by reducing other payments owed.

Hospital payments change for capital costs

Beginning April 1, 2026, hospital Medicaid capital add-ons are reduced by 10%, instead of the previous 20%. Add-ons from payment reviews are also reduced by 10%, while amounts hospitals must repay increase by 10%. These adjustments depend on federal financial participation. The law also continues hospital quality, sole-community, and capital payment rules through March 31, 2029.

Provider increases capped at 2.7 percent

For April 1, 2026–March 31, 2027, the law provides a contingent, targeted 2.7% increase for eligible programs and providers. Agencies generally cannot add new inflation or cost-of-living increases beyond that amount. The 2.7% includes newly applied inflation, cost-of-living, and trend factors. Federal COVID-19 relief payments are excluded. Children and family services may receive additional trend or staff-retention increases.

Adult homes can keep serving nonresidents

Effective April 1, 2026, the law continues authority to provide services to nonresidents through July 1, 2029. This applies to adult homes, residences for adults, and enriched housing programs. The extension does not specify the services or their costs.

HIV drug assistance funding continues

New York continues up to $41.05 million each state budget year for its AIDS Drug Assistance Program. Funding covers April 1, 2026, through March 31, 2029. The money pays drug benefits for eligible recipients in the HIV uninsured care program. The law does not set an amount for each person or change the stated eligibility rules.

Medicaid and pharmacy rules continue through 2029

From April 1, 2026, through March 31, 2029, the law continues specified Medicaid managed-care and medical-assistance rules. It also continues participating-pharmacy payment and prescription-drug coverage provisions, and related comprehensive health-services provisions. Specified managed-care amendments apply only to programs approved on or after April 1, 2026. These extensions do not state new household costs, covered-drug lists, or benefit amounts.

Medical indemnity payments get another year

The law keeps affected Medical Indemnity Fund payment provisions in effect through June 1, 2027. They were scheduled to expire June 1, 2026. The extension does not state payment amounts or detailed eligibility changes.

Medical students retain scholarship program funding

From April 1, 2026, through March 31, 2029, medicine and science scholarship programs receive up to $1.605 million annually. Funding goes through the Associated Medical Schools of New York. It includes existing and new post-baccalaureate programs for minority and economically disadvantaged students and encourages participation by all state medical schools. The organization must report annually on spending. Individual award amounts are not specified.

Temporary health and education rules continue

Public-health waiver authority and a separate act effective April 1, 2022, now expire April 1, 2028, instead of 2026. Six sections of another act effective April 1, 2022, continue until July 1, 2030, instead of 2026. A separate act's sections 2–4 and Education Law § 6542(7)(l) also continue until July 1, 2030. Education Law § 6801 amendments remain subject to their own expiration and reversion; section 1-a then takes effect. The supplied text does not explain these rules' full contents or their effects on households.

Electronic prescription rules stay in place

Beginning April 1, 2026, specified electronic-prescription rules continue until June 1, 2029. The extension covers sections one and two of New York's 2016 electronic-prescriptions act. The supplied text does not detail those requirements or identify changes to medication access or patient costs.

Epinephrine providers gain emergency liability protection

Beginning June 1, 2026, practitioners who prescribe, dispense, or provide epinephrine devices gain protection from certain damage claims. It covers claims arising from device use by unpaid volunteer first-aid or emergency responders, or from defective equipment. Practitioners remain liable for their own negligence, gross negligence, or intentional misconduct.

Local public health receives higher reimbursement

The state reimbursement minimum becomes 36% of eligible local core public health spending above the municipality's base grant. New York City's minimum rises from 20% to 36%. Reimbursable fringe benefits remain capped at 50% of eligible personnel costs. Municipalities need approved state-aid applications, and reimbursement depends on the annual appropriation.

Nonpublic schools strengthen defibrillator safety rules

People operating automated external defibrillators in nonpublic schools must complete training approved by state health or emergency medical authorities. Existing exceptions remain for specified practitioners, lawful prescription use, and unpaid good-faith first aid. Schools must register each device's existence, location, and type with the Health Department, replacing regional council notification. Every use on a patient must be reported immediately to local emergency responders or a public safety answering point.

Plate fees support dental access programs

Effective April 1, 2025, the former Percy T. Phillips Educational Foundation fund becomes the New York State Dental Foundation Fund. It supports the foundation's dental education and public access programs. Of each applicable $30 annual vehicle plate service charge, $20 goes into the fund. Payments require the health commissioner's approval and certification; this provision does not increase the plate charge.

Public defibrillators get training and tracking

Beginning June 1, 2026, public defibrillator providers must offer approved CPR and automated external defibrillator training. At least one associated person must know how to use and routinely maintain the device. Providers must register each device's location and type, and the state must publish an electronic database. Every use on a patient must be reported immediately to the local emergency response system or public safety answering point. Providers must also report use data to the state, which must add available response and outcome information to tracking programs without patient identifiers.

State health data systems continue

Beginning April 1, 2026, the law continues two statewide health data systems through March 31, 2029. They are the Statewide Health Information Network of New York and the Statewide Planning and Research Cooperative System. These systems support health information sharing and health care planning. The provision does not specify new funding or changes to patient coverage or costs.

Addiction treatment providers gain payment protection

Insurers must negotiate covered outpatient addiction-treatment payments no lower than New York's Medicaid benchmark. This covers outpatient, intensive outpatient, rehabilitation, and opioid treatment at participating facilities authorized by the state's addiction-services office. The benchmark uses the Medicaid rate effective April 1 of the previous year, set before that year's October 1. This is a provider payment floor, not a direct payment to patients.

Clinics keep support for unpaid care

The law continues up to $48 million annually for unpaid care at diagnostic and treatment centers. It also continues an additional $7.5 million annually for unpaid care at voluntary nonprofit centers. Both funding streams run from April 1, 2026, through March 31, 2029. Funds go to centers under the state's uncompensated-care distribution rules, not directly to patients.

Emergency care and poison funding continues

From April 1, 2026, through March 31, 2029, the law continues three emergency health funding streams each state budget year. It authorizes up to $19.6597 million for emergency medical services training, within approved spending amounts. It also authorizes up to $3 million for poison control centers and $2.9 million for emergency health provider aid. The commissioner can award emergency aid only when vital for patient safety, staff retention, threatened facility operations, public health, or another emergency. These funds support services and providers, not direct household checks.

Extra public drug rebates continue

Beginning April 1, 2026, the health commissioner can continue negotiating extra manufacturer drug rebates through March 31, 2029. Eligible drugs include specified classes and other drugs with federal rebate arrangements and state clinical criteria. Agreements cannot run beyond the rebate authority's expiration or repeal. A separate part of the state's supplemental drug rebate framework continues through March 31, 2032. The supplied provisions do not set patient savings or change cost-sharing.

Health facility restructuring support continues

The law continues transfers of up to $19.6 million each state budget year for health facility restructuring. Funding covers April 1, 2026, through March 31, 2029. The Budget Director can approve smaller transfers to account for federal 1115 waiver funds directed to the same program. The money supports facility restructuring, not direct household payments.

Health oversight and quality funding continues

From April 1, 2026, through March 31, 2029, up to $11.1 million annually is available for health compliance audits. The audits check whether payors and providers follow specified state health laws. Over the same period, the medical conduct office retains authority to use funds for patient health information and quality improvement. That authority does not include a stated new appropriation.

Health program administration funding continues

Through March 31, 2029, state officials can transfer specified health collections into designated Health Care Reform Act accounts. The money pays Health Department administration costs. Supported work includes provider payments, child health insurance, tobacco control, cancer services, and health care initiatives. Transfers and deposits cannot exceed amounts approved each year and must support the listed purposes.

Hospital payments continue with more delivery options

Beginning April 1, 2026, New York continues its inpatient hospital payment system through March 31, 2029. Hospitals must elect to participate; eligible services receive case-based payments per discharge using diagnosis-related groups. The law also expands delivery options for specified Medicaid payment increases enacted in 2024, 2025, or 2026. These options include higher fee-for-service or managed-care rates, lump sums, and state-directed payments. The increases remain subject to federal financial participation and the law's associated funding provisions.

Rural health access funding continues

The law continues up to $16.2 million each state budget year for rural health care delivery and access development. Funding runs from April 1, 2026, through March 31, 2029. The money supports rural health programs, rather than payments directly to rural households.

Treatment centers receive unpaid-care funding

Eligible nonprofit and public diagnostic and treatment centers receive additional funding for care that goes unpaid. Payments total $7.5 million in each calendar year 2026, 2027, and 2028. Another $1.6 million covers January 1 through March 31, 2029. Centers must qualify for the existing state distribution program, and payments follow its allocation method. The money goes to centers, not directly to patients.

Underserved communities retain physician recruitment funding

From April 1, 2026, through March 31, 2029, physician practice support receives up to $4.36 million annually. Funding supports doctors establishing or joining practices, and providers recruiting doctors, in communities the Commissioner identifies as underserved. One-third of available funds goes to New York City and two-thirds to the rest of the state. At least half must go to general hospitals. The law sets no amount per practice.

Medical research and workforce studies continue

From April 1, 2026, through March 31, 2029, clinical research and researcher training receive up to $8.612 million annually. Eligible consortia and teaching general hospitals receive funding, with two-thirds allocated to New York City and one-third elsewhere. A physician workforce study receives up to $487,000 each state budget year over the same period. It examines residency programs, future staffing needs, and community needs. The Commissioner must select study organizations through a competitive proposal process.

Health payment disputes face new exclusions

The law excludes services covered under New York's cited Medicaid managed-care provision from this independent payment-dispute process, including emergency services. Reviewers cannot award a fee when a plan proves an effective contract covered the same service at the same location. An award is also barred when the plan proves it issued the required prior-authorization decision identifying the service as out-of-network. Required disclosures must accompany that decision. These rules do not change Medicaid coverage itself.

Doctors face higher malpractice surcharge caps

The financial services regulator must set physician and surgeon malpractice insurance rates for the specified policy periods through June 30, 2027. Until July 1, 2027, annual surcharges are capped at 8% of the established rate. Beginning that day, the ceiling becomes 25% of the approved adequate rate. This permits higher surcharges but keeps a fixed ceiling. Surcharges can cover the specified projected shortfall only for as long as needed to satisfy it.

Hospitals face tighter capital payment calculations

Beginning April 1, 2026, general hospitals cannot count certain capital-related inpatient costs when calculating Medicaid volume adjustments. This applies to capital costs already included in budget-based payment rates. Rate adjustments under this provision generally cannot carry forward. An otherwise authorized volume adjustment for the hospital remains allowed.

More staffing businesses face agency rules

Temporary health care agency rules now expressly cover businesses that provide, arrange, or enable health care staffing. This includes vendor management systems and subcontracting arrangements that result in workers being engaged. A person directly owning at least a 10% voting interest in a controlling business also counts as a controlling person. Each agency violation of the law or its regulations counts separately for penalties and fines.

Psychologists lose a Medicaid payment floor

Psychologists lose the Medicaid payment floor tied to a patient's Medicare Part B coinsurance amount. This affects services covered by both programs for Medicaid recipients with Medicare Part B or qualified Medicare beneficiary status. The general Medicaid payment cap remains. The change concerns provider payments, not a new patient charge.

Staffing agencies must document pay and contracts

Temporary health staffing agencies and subcontractors must keep written client contracts covering qualifications, notice procedures, billing, and agency rates. Agencies must retain contracts and invoices for six years and provide them to the Health Department upon request. Submitted contracts are exempt from state public-records disclosure. Quarterly reports must show bill rates, worker pay components, and how payments divide among compensation, profits, and administration. Reports also include workers' residence states and ZIP codes, clients, staffing counts, subcontractor details, and other commissioner-required information.

Health staffing agencies face profit limits

The Health Commissioner has authority to set and enforce limits on profits retained by temporary health staffing agencies. Limits can apply to all agencies or particular agency groups. The Department must consider sufficient staffing across jobs and regions when setting agency rates. It must review those rates periodically; the law sets no specific profit percentage.

Health plans pay a premium-based tax

Beginning January 1, 2027, New York's managed care tax charges covered health plans 0.35% of their total premium revenue. This change is subject to any required federal approval. Existing monthly per-member tax amounts continue before that date. The law does not directly set a household tax or insurance premium.

Uninsured patients face conditional dispute fees

Uninsured patients pay the independent dispute-process charge when the reviewer finds the physician's bill reasonable, unless payment causes hardship. The physician pays the process charge when the bill is unreasonable. The state's financial services regulator must set payment rules for hardship cases. The law does not specify the process charge amount.

Civil service plans gain dispute standards

New York brings Civil Service health benefit plans into its independent payment-dispute process. Reviewers generally choose the plan payment or provider fee closest to the local 50th-percentile allowed-payment benchmark. They can choose another amount for a tie or clear evidence that the benchmark is inappropriate. An award based on the provider's fee cannot exceed the 80th-percentile maximum fee. This special payment standard excludes specified physicians employed by hospitals, affiliated medical schools, or qualifying captive professional services corporations.

Dispute parties prepay and wait longer

These rules apply to payment disputes submitted starting the 90th day after the act became law. Out-of-network providers and health plans must pay the full process charge when applying or responding to requests for eligibility documents. Reviewers must hold payments separately and refund the prevailing party within 30 days after a decision or ineligibility rejection. The decision deadline grows from 30 to 45 business days after the reviewer receives all needed information.

Defibrillator access expands with safety duties

Beginning June 1, 2026, public-access providers can acquire and operate automated external defibrillators without collaborative agreements, following Health Department rules. Covered camps and youth sports programs must establish device plans within 180 days of that date. Plans must call for best efforts to have a trained adult at each camp, game, and practice. Training must meet state standards, cover operation and routine maintenance, and be completed within the preceding 24 months. Youth sports coverage applies to activities involving at least five teams; covered programs must also maintain, test, and report device uses and related data.

Clinician malpractice help carries shortfall risk

New York continues excess malpractice coverage or reimbursement for equivalent hospital-purchased coverage for July 1, 2026–June 30, 2027. Eligible doctors and dentists need hospital certification and required primary coverage or participation in a hospital coverage program. Applicants generally must have received full or partial pool-funded coverage in the year ending June 30, 2026. State officials assess funding sufficiency; hospitals can certify additional eligible clinicians under the proportional-share rule. If funds fall short, covered clinicians owe their allocated share, and nonpayment can lead to canceled coverage.

Health contracts gain no-bid extension options

Through August 19, 2027, the Health Commissioner can amend or extend qualifying existing contracts without competitive bidding or proposal requests. Contracts must predate the law's effective date and fall under the specified public health contracting authority. Contractors must remain qualified, and extensions must produce efficiency savings. The Department must request applications during the specified period and can terminate extensions early.

Medicaid caps payments for Medicare Advantage care

The law sets Medicaid payments when Medicare Advantage pays for covered care for eligible people also covered by Medicaid. The rule applies to Medicare Part B beneficiaries or qualified Medicare beneficiaries. Payment is based on the patient's Part B coinsurance amount. It is capped at the otherwise-payable Medicaid amount minus the amount payable under Part B. Ambulance services retain a minimum-payment protection tied to coinsurance.

Sponsors & Cosponsors

Sponsor

Budget
Affiliation unavailable

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 144 • No: 61

House vote • 5/27/2026

Assembly floor vote

Yes: 102 • No: 41

Senate vote • 5/27/2026

FLOOR Vote

Yes: 42 • No: 20

Actions Timeline

SIGNED CHAP.57
5/28/2026House
DELIVERED TO GOVERNOR
5/28/2026House
RETURNED TO ASSEMBLY
5/27/2026Senate
PASSED SENATE
5/27/2026Senate
MESSAGE OF NECESSITY - 3 DAY MESSAGE
5/27/2026Senate
3RD READING CAL.1333
5/27/2026Senate
SUBSTITUTED FOR S9007C
5/27/2026Senate
REFERRED TO FINANCE
5/27/2026Senate
DELIVERED TO SENATE
5/27/2026House
PASSED ASSEMBLY
5/27/2026House
MESSAGE OF NECESSITY - 3 DAY MESSAGE
5/27/2026House
ORDERED TO THIRD READING RULES CAL.216
5/27/2026House
RULES REPORT CAL.216
5/27/2026House
REPORTED
5/27/2026House
REPORTED REFERRED TO RULES
5/27/2026House
PRINT NUMBER 10007C
5/26/2026House
AMEND (T) AND RECOMMIT TO WAYS AND MEANS
5/26/2026House
PRINT NUMBER 10007B
3/9/2026House
AMEND AND RECOMMIT TO WAYS AND MEANS
3/9/2026House
PRINT NUMBER 10007A
2/20/2026House
AMEND AND RECOMMIT TO WAYS AND MEANS
2/20/2026House
REFERRED TO WAYS AND MEANS
1/21/2026House

Bill Text

Amendment C
5/26/2026
PDF
Amendment B
3/9/2026
PDF
Amendment A
2/20/2026
PDF
Original
1/21/2026
PDF

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