NY A07801

Requires Medicaid managed care reimbursement rates for essential safety net hospitals to be set at no less than regional average commercial rates for health care services in the same geographic region

Defines essential safety net hospitals as those with at least 36% Medicaid/uninsured patients for both inpatient and outpatient volumes, no more than 20% commercially insured inpatients, and not part of health systems with $10 billion or more in annual patient revenue

Establishes two geographic regions for rate calculations: New York City (Bronx, Kings, New York, Queens, Richmond counties) and all remaining counties in the state

Requires managed care organizations to provide quarterly written certification of compliance with payment requirements and report claim denial information for essential safety net hospital claims

Mandates the commissioner report to the governor and legislature by September 1, 2025 on feasibility of obtaining federal approval to modify Medicaid fee-for-service rates under this framework