The bill proposes amendments to the NY State Insurance and Social Services Law, requiring plans and payors to annually report the percentage of overall healthcare spending allocated to primary care. Plans or payors reporting less than 12.5% on primary care services would need to submit plans to increase spending by 1% annually until meeting or exceeding the threshold to address underinvestment in primary care and improve overall health outcomes in New York.

This broad health equity bill includes provisions requiring the Massachusetts Health Policy Commission to establish targets for primary care and behavioral health spending targets and provide analyses of progress toward those targets.

Establishes the Primary Care Investment Task Force which will take a detailed and objective look at where Pennsylvania stands when it comes to primary care investments compared to other states. Building off their findings, the task force will also identify what can be done to bolster investment in primary care.

Establishes the primary care reform commission to review, examine, and make findings on the level of primary care spending by all payers in the context of all health care spending in the state and publish an annual report on the findings, and also make recommendations to increase and strengthen spending on primary care in the state and improve primary care infrastructure, taking care to avoid increasing costs to patients or the total cost of health care.

S. 750 would establish a multistakeholder Primary Care Board with a goal of increasing primary care spend to 12-15% of overall health care expenditures. The bill would also require all insurers in the state to offer a prospective, per member per month Primary Care 4 You payment to all primary care practices.  The payment would be adjusted for clinical and social risk and practice capacity. Monthly prospective payments would be paid from a Primary Care Trust, rather than individual plans.

This bill establishes the Primary Care Transparency Act, which requires all health insurance carriers to report to the Director of the Department of Insurance, Financial Institutions and Professional Registration (DIFP) their total health care medical expenditures and their total primary care medical expenditures for the year by March 1st each year. By March 31st each year, the DIFP must submit a report to the General Assembly. All individual patient data reported under these provisions is confidential and must be reported in the aggregate.

The purpose of this Act is to establish a task force known as the primary care payment reform collaborative to:

(1)  Examine current levels of primary care spending in the State;

(2)  Explore primary care spending mandates in other states;

(3)  Examine alternative methods and models of enhancing primary care spending;

(4)  Explore data collection issues related to understanding the State’s primary care spending, including the capture of non-claims based primary care spending; and

(5)  Generate recommendations to the legislature.

The collaborative shall develop annual recommendations to the legislature to strengthen the primary care system in the State.

This legislation ensures adequate spending in primary care. First, by setting Medicare rates as a baseline for primary care reimbursement. This is a short term fix to stem additional primary care failure and consolidation in Delaware. It also requires that over a period of years that the overall spend of plans into primary care increase gradually to reach the 12% investment mark, but without increasing the total spend so that premiums rise as a result of this reallocation. This legislation extends to individual, group, State employee, and public assistance plans.

The bill establishes a primary care payment reform collaborative in the primary care office in the department of public health and environment. To facilitate the collaborative’s work, the administrator of the all-payer health claims database is to report data on primary care spending by private health insurers, insurers providing state employee health benefit plans, and the department of health care policy and financing under the state medicaid program and the children’s basic health plan.