Enrollees in New York’s Medicaid managed care plans are ensured full access to healthcare providers in emergency situations by the New York State IDR surprise Bill law. When New Yorkers suffer a stroke, heart attack, brain trauma –timing is critical. Immediate medical efforts and access to the best life- saving care are of the utmost importance.
The New York State surprise Bill law includes an independent dispute resolution (IDR) process, which is overseen by the NYS Department of Financial Services, was enacted by the state legislature. This process ensures this timely access to critical life-saving care for our most vulnerable patient populations.
Without this protection, this at-risk group of patients would lose access to critical services, see delays in urgent care, suffer diminished health outcomes, and drive-up costs to New York’s healthcare systems.
The Governor, in her fiscal year 2025-2026 budget bill (S. 3007/A. 3007, HMH Article VII; Part E) is inexplicably attempting to remove this protection – using the same proposal she attempted to have the legislature enact last year.
The legislature rightfully rejected the Governor’s attempt to repeal this provision last year. We respectfully urge the legislature to reject this proposal once again, in the one-house budgets, as well as the final FY 2025-2026 budget.
Some have suggested that the Federal “no surprises act” prohibits bifurcated state IDR proceedings for Medicaid managed care plans. As we stated last year, and again this year, this is simply incorrect.
We are deeply concerned that the Governor’s proposed removal of the IDR provision within Part E would leave this vulnerable group of New York patients exposed. New York State established these protections with the approval of CMS. As we established during last year’s budget cycle, the Federal no surprises act explicitly directs states to use their own IDR proceedings. That was further confirmed by CMS in its letter to New York State offices, including the Governor’s office, as recently as August 2024.
With the recent moves and in anticipation of the many potential changes New York may see from the Federal level, why would legislators agree to remove protections for New York’s most vulnerable patients? We ask the legislature to join us in our commitment to New York’s Medicaid managed care plan enrollees.
Reject the proposed Medicaid managed care IDR removal in Part E of S. 3007/ A. 3007 – Save the Medicaid managed care IDR. Together, we can continue to serve and support Medicaid managed care patients in New York.
Respectfully,
Quality Care Commission, Inc
