NY A04860

Mandates all Medicaid payments transition from fee-for-service to capitated payments (fixed per-patient payments) five years after the bill takes effect

Authorizes the Commissioner of Health to develop patient rating categories based on risk levels to determine reimbursement amounts

Permits capitation contracts to include payment adjustments such as incentive arrangements, pass-through payments, risk corridor mechanisms, and withhold arrangements as defined by federal regulations (42 CFR 438.6)

Requires the Commissioner of Health to submit draft legislation within one year to the Governor, Senate, and Assembly outlining the necessary changes for converting to capitated payments

Directs the Commissioner to immediately begin preparing regulations, applying for federal waivers, and submitting Medicaid state plan amendments to implement the transition