Relates to the calculation of rates for certain treatment pursuant to the medical assistance program

Minimum insurer payments for outpatient treatment

Insurers must pay qualifying in-network facilities negotiated rates at least equal to New York’s Medicaid rates for covered outpatient treatment. Addiction facilities must be authorized by the state addiction office to provide outpatient, intensive outpatient, outpatient rehabilitation, or opioid treatment. Mental health facilities must hold an Article 31 operating certificate or be operated by the state mental health office or its authorities. Licensed crisis stabilization centers also qualify. The minimum uses the Medicaid rate effective April 1 of the prior year, established before October 1 of that year. This replaces the prior requirement for a service-specific fee schedule published by November 1. The state addiction and mental health offices must publish enough information to calculate rates, in formats their commissioners choose. Before premium filings, the state financial services superintendent must provide guidance on payment changes for the next policy year. Insurers may account for differences between estimated and actual Medicaid rates in later premium filings submitted for approval. The act takes effect immediately, but its main rate provisions follow the effective date and terms of a separate 2025 law. The law does not specify changes to household premiums or out-of-pocket costs.