Ensures Medicaid spending results in real access to medical care by increasing transparency in Medicaid managed care network adequacy reviews and safeguarding continuity of care in light of recent major provider network withdrawals.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A9312
SPONSOR: Slater TITLE OF BILL:
An act to amend the public health law, in relation to strengthening
transparency regarding Medicaid network adequacy and protecting benefi-
ciaries from disruptions in care
PURPOSE OR GENERAL IDEA OF BILL:
To ensure Medicaid spending results in real access to medical care by
increasing transparency in Medicaid managed care network adequacy
reviews and safeguarding continuity of care in light of recent major
provider network withdrawals, including Optum's decision to exit Medi-
caid and Medicare Advantage plans in the Hudson Valley.
SUMMARY OF PROVISIONS:
Requires the Department of Health to review and update its managed care
network adequacy guidelines annually;
Provide more public information regarding network adequacy reviews;
Mandates a 90-day notice when large systems withdraw from Medicaid or
Medicare Advantage plans; and
Expands continuity-of-care protections for managed care enrollees when
their provider leaves their plan or the enrollee changes plans.
JUSTIFICATION:
Medicaid is the single largest component of New York's budget. Yet
despite significant spending, beneficiaries - particularly in the Hudson
Valley - face increasing difficulty accessing primary and specialty
care. This problem was underscored by Optum's recent decision to stop
accepting certain Medicaid and Medicare Advantage plans, leaving vulner-
able residents to navigate abrupt disruptions in care.
When patients cannot see a doctor, they turn to emergency rooms, signif-
icantly increasing costs and straining hospitals. This Act ensures tran-
sparency in Medicaid network adequacy reviews, provides consumers with
the information they need to make care decisions, and prevents bureau-
cratic or corporate decisions from undermining the program's intent.
This is not a mandate to spend more taxpayer dollars - it is a truth-in7
Medicaid accountability measure to ensure current spending delivers real
results.
PRIOR LEGISLATIVE HISTORY:
New Bill
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
None. This legislation does not mandate reimbursement increases; it
requires transparency, oversight, and data-driven review.
EFFECTIVE DATE:
Immediately.
STATE OF NEW YORK
________________________________________________________________________
9312
2025-2026 Regular Sessions
IN ASSEMBLY
December 10, 2025
___________
Introduced by M. of A. SLATER -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to strengthening
transparency regarding Medicaid network adequacy and protecting bene-
ficiaries from disruptions in care
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. This act shall be known and may be cited as the "Medicaid
2 network access protection act".
3 § 2. The legislature finds that:
4 1. Medicaid represents the state's largest expenditure, yet many bene-
5 ficiaries face difficulty accessing primary and specialty care, partic-
6 ularly in the Hudson Valley and other suburban and rural regions.
7 2. Recent decisions by large healthcare systems - including Optum - to
8 withdraw from Medicaid and Medicare Advantage networks highlight system-
9 ic vulnerabilities and the need for stronger oversight to ensure conti-
10 nuity of care and prevent taxpayer-funded access erosion.
11 3. Medicaid policy has prioritized coverage expansion without a
12 publicly available, transparent evaluation of whether reimbursement
13 levels and program structures support real-world access to providers.
14 4. Emergency room utilization increases significantly when patients
15 cannot obtain routine care, driving up costs for the system and strain-
16 ing hospital capacity.
17 5. Expanded transparency regarding Medicaid network adequacy is neces-
18 sary to ensure Medicaid dollars are used to provide accessible, contin-
19 uous patient care.
20 It is therefore the intent of this act to ensure New Yorkers have
21 timely access to care and that Medicaid funding is used effectively to
22 provide enrollees with access to care, regardless of where they are
23 located in the state.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD14130-01-5
A. 9312 2
1 § 3. The public health law is amended by adding a new section 4403-h
2 to read as follows:
3 § 4403-h. Network adequacy reviews. 1. The commissioner, in consulta-
4 tion with the superintendent of financial services, the commissioner of
5 addiction services and supports, and the commissioner of mental health,
6 shall:
7 (a) Annually update network adequacy guidelines.
8 (b) Quarterly publicly publish the results of the department's network
9 adequacy surveys of managed care organizations on the department's
10 website and, within thirty days of such publication, the department
11 shall also publish a summary of such survey. Such results shall have any
12 personally identifiable information of patients and providers removed
13 prior to being published.
14 2. Any organization withdrawing from a Medicaid managed care organiza-
15 tion or Medicare advantage network shall provide a minimum of ninety
16 days' notice to the department, the department of financial services,
17 and all patients covered under such plan and who have received services
18 from the organization in the past year.
19 § 4. Subparagraph 1 of paragraph (e) of subdivision 6 of section 4403
20 of the public health law, as amended by section 10 of subpart B of part
21 AA of chapter 57 of the laws of 2022, is amended to read as follows:
22 (1) If an enrollee's health care provider leaves the health mainte-
23 nance organization's network of providers for reasons other than those
24 for which the provider would not be eligible to receive a hearing pursu-
25 ant to paragraph a of subdivision two of section forty-four hundred
26 six-d of this chapter, the health maintenance organization shall provide
27 written notice to the enrollee of the provider's disaffiliation and
28 permit the enrollee to continue an ongoing course of treatment with the
29 enrollee's current health care provider during a transitional period of:
30 (i) [ninety] one hundred eighty days from the later of the date of the
31 notice to the enrollee of the provider's disaffiliation from the organ-
32 ization's network or the effective date of the provider's disaffiliation
33 from the organization's network; or (ii) if the enrollee is pregnant at
34 the time of the provider's disaffiliation, the duration of the pregnancy
35 and post-partum care directly related to the delivery.
36 § 5. Paragraph (f) of subdivision 6 of section 4403 of the public
37 health law, as added by chapter 705 of the laws of 1996, is amended to
38 read as follows:
39 (f) If a new enrollee whose health care provider is not a member of
40 the health maintenance organization's provider network enrolls in the
41 health maintenance organization, the organization shall permit the
42 enrollee to continue an ongoing course of treatment with the enrollee's
43 current health care provider during a transitional period of up to
44 [sixty] one hundred eighty days from the effective date of enrollment,
45 if (i) the enrollee has a life-threatening disease or condition or a
46 degenerative and disabling disease or condition or (ii) the enrollee has
47 entered the second trimester of pregnancy at the effective date of
48 enrollment, in which case the transitional period shall include the
49 provision of post-partum care directly related to the delivery. If an
50 enrollee elects to continue to receive care from such health care
51 provider pursuant to this paragraph, such care shall be authorized by
52 the health maintenance organization for the transitional period only if
53 the health care provider agrees (A) to accept reimbursement from the
54 health maintenance organization at rates established by the health main-
55 tenance organization as payment in full, which rates shall be no more
56 than the level of reimbursement applicable to similar providers within
A. 9312 3
1 the health maintenance organization's network for such services; (B) to
2 adhere to the organization's quality assurance requirements and agrees
3 to provide to the organization necessary medical information related to
4 such care; and (C) to otherwise adhere to the organization's policies
5 and procedures including, but not limited to procedures regarding refer-
6 rals and obtaining pre-authorization and a treatment plan approved by
7 the organization. In no event shall this paragraph be construed to
8 require a health maintenance organization to provide coverage for bene-
9 fits not otherwise covered or to diminish or impair pre-existing condi-
10 tion limitations contained within the subscriber's contract.
11 § 6. This act shall take effect immediately.
