NY S09169

Creates a managed long term care high acuity stabilization pool of up to $50 million for state fiscal year beginning April 1, 2026

Eligible plans must demonstrate high performance on quality measures and serve disproportionately high shares of members with complex long term care needs or high service utilization

Payments limited to plans with medical loss ratios exceeding a commissioner-established threshold (not to exceed 92%) and can only offset costs above that threshold, not increase profit margins

Commissioner of health authorized to establish criteria, methodologies, quality standards, acuity benchmarks, and reporting requirements for fund distribution

Pool payments cannot be incorporated into base premium rates and do not create an entitlement; intended as supplemental and transitional, not replacing actuarially sound rate-setting obligations