N.Y. Public Health Law Section 2807-FF
New York managed care organization provider tax

1.

The commissioner, subject to the approval of the director of the budget, shall: apply for a waiver or waivers of the broad-based and uniformity requirements related to the establishment of a New York managed care organization provider tax (the “MCO provider tax”) in order to secure federal financial participation for the costs of the medical assistance program; and, subject to approval by the centers for Medicare and Medicaid services, impose the MCO provider tax as an assessment upon insurers, health maintenance organizations, and managed care organizations (collectively referred to as “health plan”) offering the following plans or products:

(a)

Medical assistance program coverage provided by managed care providers pursuant to Social Services Law § 364-J (Managed care programs)section three hundred sixty-four-j of the social services law;

(b)

A health insurance plan serving individuals enrolled pursuant to title one-A of article 25 (Maternal and Child Health)article twenty-five of this chapter;

(c)

Essential plan coverage certified pursuant to title eleven-D of article five of the social services law;

(d)

Coverage purchased on the New York insurance exchange established pursuant to § 268-B (Establishment of NY State of Health, The Official Health Plan Marketplace)section two hundred sixty-eight-b of this chapter; or

(e)

Any other comprehensive coverage subject to articles thirty-two, forty-two and forty-three of the insurance law, or article 44 (Health Maintenance Organizations)article forty-four of this chapter.

2.

The MCO provider tax shall comply with all relevant provisions of federal laws, rules and regulations.

3.

The department shall post on its website the MCO provider tax approval letter by the centers for Medicare and Medicaid services (the “approval letter”).

4.

A health plan, as defined in subdivision one of this section, shall pay the MCO provider tax for each calendar year as follows:

(a)

For Medicaid member months below two hundred fifty thousand member months, a health plan shall pay one hundred twenty-six dollars per member month;

(b)

For Medicaid member months greater than or equal to two hundred fifty thousand member months but less than five hundred thousand member months, a health plan shall pay eighty-eight dollars per member month;

(c)

For Medicaid member months greater than or equal to five hundred thousand member months, a health plan shall pay twenty-five dollars per member month;

(d)

For essential plan member months less than two hundred fifty thousand member months, a health plan shall pay thirteen dollars per member month;

(e)

For essential plan member months greater than or equal to two hundred fifty thousand member months, a health plan shall pay seven dollars per member month;

(f)

For non-essential plan non-Medicaid member months, consisting of the populations covered by the products described in paragraphs (b), (d), and

(e)

of subdivision one of this section, less than two hundred fifty thousand member months, a health plan shall pay two dollars per member month; and

(g)

For non-essential plan non-Medicaid member months greater than or equal to two hundred fifty thousand member months, a health plan shall pay one dollar and fifty cents per member month.

5.

A health plan shall remit the MCO provider tax due pursuant to this section to the commissioner or their designee quarterly or at a frequency defined by the commissioner.

6.

Funds accumulated from the MCO provider tax, including interest and penalties, shall be deposited and credited by the commissioner, or the commissioner’s designee, to the healthcare stability fund established in State Finance Law § 99-SS (Healthcare stability fund)section ninety-nine-ss of the state finance law.

7.

(a) Every health plan subject to the approved MCO provider tax shall submit reports in a form prescribed by the commissioner to accurately disclose information required to implement this section.

(b)

If a health plan fails to file reports required pursuant to this subdivision within sixty days of the date such reports are due and after notification of such reporting delinquency, the commissioner may assess a civil penalty of up to ten thousand dollars for each failure; provided, however, that such civil penalty shall not be imposed if the health plan demonstrates good cause for the failure to timely file such reports.

8.

(a) If a payment made pursuant to this section is not timely, interest shall be payable in the same rate and manner as defined in subdivision eight of § 2807-J (Patient services payments)section twenty-eight hundred seven-j of this article.

(b)

The commissioner may waive a portion or all of either the interest or penalties, or both, assessed under this section if the commissioner determines, in their sole discretion, that the health plan has demonstrated that imposition of the full amount of the MCO provider tax pursuant to the timelines applicable under the approval letter has a high likelihood of creating an undue financial hardship for the health plan or creates a significant financial difficulty in providing needed services to Medicaid beneficiaries. In addition, the commissioner may waive a portion or all of either the interest or penalties, or both, assessed under this section if the commissioner determines, in their sole discretion, that the health plan did not have the information necessary from the department to pay the tax required in this section. Waiver of some or all of the interest or penalties pursuant to this subdivision shall be conditioned on the health plan’s agreement to make MCO provider tax payments on an alternative schedule developed by the department that takes into account the financial situation of the health plan and the potential impact on the delivery of services to Medicaid beneficiaries.

(c)

Overpayment by or on behalf of a health plan of a payment shall be applied to any other payment due from the health plan pursuant to this section, or, if no payment is due, at the election of the health plan, shall be applied to future payments or refunded to the health plan. Interest shall be paid on overpayments from the date of overpayment to the date of crediting or refunding at the rate determined in accordance with this subdivision only if the overpayment was made at the direction of the commissioner. Interest under this paragraph shall not be paid if the amount thereof is less than one dollar.

9.

Payments and reports submitted or required to be submitted to the commissioner pursuant to this section by a health plan shall be subject to audit by the commissioner for a period of six years following the close of the calendar year in which such payments and reports are due, after which such payments shall be deemed final and not subject to further adjustment or reconciliation, including through offset adjustments or reconciliations made by a health plan; provided, however, that nothing in this section shall be construed as precluding the commissioner from pursuing collection of any such payments which are identified as delinquent within such six-year period, or which are identified as delinquent as a result of an audit commenced within such six-year period, or from conducting an audit of any adjustment or reconciliation made by a health plan, or from conducting an audit of payments made prior to such six-year period which are found to be commingled with payments which are otherwise subject to timely audit pursuant to this section.

10.

In the event of a merger, acquisition, establishment, or any other similar transaction that results in the transfer of health plan responsibility for all enrollees under this section from a health plan to another health plan or similar entity, and that occurs at any time during which this section is effective, the resultant health plan or similar entity shall be responsible for paying the full tax amount as provided in this section that would have been the responsibility of the health plan to which that full tax amount was assessed upon the effective date of any such transaction. If a merger, acquisition, establishment, or any other similar transaction results in the transfer of health plan responsibility for only some of a health plan’s enrollees under this section but not all enrollees, the full tax amount as provided in this section shall remain the responsibility of that health plan to which that full tax amount was assessed.

Source: Section 2807-FF — New York managed care organization provider tax, https://www.­nysenate.­gov/legislation/laws/PBH/2807-FF (updated May 16, 2025; accessed May 24, 2025).

2800
Declaration of policy and statement of purpose 2801
Definitions 2801–A
Establishment or incorporation of hospitals 2801–B
Improper practices in hospital staff appointments and extension of professional privileges prohibited 2801–C
Injunctions 2801–D
Private actions by patients of residential health care facilities 2801–E
Voluntary residential health care facility rightsizing demonstration program 2801–F
Residential health care facility quality incentive payment program 2801–G
Community forum on hospital closure 2801–H
Personal caregiving and compassionate caregiving visitors to nursing home residents during declared local or state health emergencies 2802
Approval of construction 2802–A
Transitional care unit demonstration program 2802–B
Health equity impact assessments 2803
Commissioner and council 2803–A
Authority to contract 2803–AA
Sickle cell disease information distribution 2803–AA*2
Nursing home infection control competency audit 2803–B
Uniform reports and accounting systems for hospital costs 2803–C
Rights of patients in certain medical facilities 2803–C–1
Rights of patients in certain medical facilities 2803–C–2
Lesbian, gay, bisexual and transgender, and people living with HIV long-term care facility residents’ bill of rights 2803–D
Reporting abuses of persons receiving care or services in residential health care facilities 2803–E
Residential health care facilities 2803–E*2
Reporting incidents of possible professional misconduct 2803–F
Respite projects 2803–G
Board of visitors in county owned residential health care facility 2803–H
Health related facility 2803–I
General hospital inpatient discharge review program 2803–J
Information for maternity patients 2803–J*2
Nursing home nurse aide registry 2803–K
In-patient nasogastric feeding procedures 2803–L
Community service plans 2803–M
Discharge of hospital patients to adult homes 2803–N
Hospital care for maternity patients 2803–O
Hospital care for mastectomy, lumpectomy, and lymph node dissection patients 2803–O–1
Required protocols for fetal demise 2803–P
Disclosure of information concerning family violence 2803–Q
Family councils in residential health care facilities 2803–R
Dissemination of information about the abandoned infant protection act 2803–S
Access to product recall information 2803–T
Preadmission information 2803–U
Hospital substance use disorder policies and procedures 2803–V
Lymphedema information distribution 2803–V*2
Standing orders for newborn care in a hospital 2803–W
Independent quality monitors for residential health care facilities 2803–W*2
Disclosure of information concerning pregnancy complications 2803–X
Requirements related to nursing homes and related assets and operations 2803–Y
Provision of residency agreement 2803–Z
Transfer, discharge and voluntary discharge requirements for residential health care facilities 2803–Z*2
Antimicrobial resistance prevention and education 2804
Units for hospital and health-related affairs 2804–A
State task force on clinical practice guidelines and medical technology assessment 2805
Approval of hospitals 2805–A
Disclosure of financial transactions 2805–B
Admission of patients and emergency treatment of nonadmitted patients 2805–C
Every private proprietary nursing home having a capacity of eighty patients or more may have a licensed medical doctor in attendance, upo... 2805–D
Limitation of medical, dental or podiatric malpractice action based on lack of informed consent 2805–E
Reports of residential health care facilities 2805–F
Money deposited or advanced for admittance to nursing homes 2805–G
Maintenance of records 2805–H
Immunizations 2805–I
Treatment of sexual offense victims and maintenance of evidence in a sexual offense 2805–J
Medical, dental and podiatric malpractice prevention program 2805–K
Investigations prior to granting or renewing privileges 2805–L
Adverse event reporting 2805–M
Confidentiality 2805–N
Child abuse prevention 2805–O
Identification of veterans and their spouses by nursing homes, residential health care facilities, and adult care facilities 2805–P
Emergency treatment of rape survivors 2805–Q
Hospital visitation by domestic partner 2805–R
Patients unable to verbally communicate 2805–S
Circulating nurse required 2805–T
Clinical staffing committees and disclosure of nursing quality indicators 2805–U
Credentialing and privileging of health care practitioners providing telemedicine services 2805–V
Observation services 2805–W
Patient notice of observation services 2805–X
Hospital-home care-physician collaboration program 2805–Y
Identification and assessment of human trafficking victims 2805–Z
Hospital domestic violence policies and procedures 2806
Hospital operating certificates 2806–A
Temporary operator 2806–B
Residential health care facilities 2807
Hospital reimbursement provisions 2807–A
General hospital nineteen hundred eighty-six and nineteen hundred eighty-seven inpatient rates and charges 2807–AA
Nurse loan repayment program 2807–B
Outstanding payments and reports due under subdivision eighteen of section twenty-eight hundred seven-c, sections twenty-eight hundred se... 2807–C
General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight 2807–D
Hospital assessments 2807–D–1
Hospital quality contributions 2807–DD
Temporary nursing home stability contributions 2807–E
Uniform bills 2807–F
Health maintenance organization payment factor 2807–FF
New York managed care organization provider tax 2807–I
Service and quality improvement grants 2807–J
Patient services payments 2807–K
General hospital indigent care pool 2807–L
Health care initiatives pool distributions 2807–M
Distribution of the professional education pools 2807–N
Palliative care education and training 2807–O
Early intervention services pool 2807–P
Comprehensive diagnostic and treatment centers indigent care program 2807–R
Funding for expansion of cancer services 2807–S
Professional education pool funding 2807–T
Assessments on covered lives 2807–U
Transfers for tax credits 2807–V
Tobacco control and insurance initiatives pool distributions 2807–W
High need indigent care adjustment pool 2807–X
Grants for long term care demonstration projects 2807–Y
Pool administration 2807–Z
Review of eligible federally qualified health center capital projects 2808
Residential health care facilities 2808–A
Liability of certain persons 2808–B
Certification of financial statements and financial information 2808–C
Reimbursement of general hospital inpatient services 2808–D
Nursing home quality improvement demonstration program 2808–E
Residential health care for children with medical fragility in transition to young adults and young adults with medical fragility demonst... 2808–E*2
Nursing home ratings 2808–F
Advanced residential health care for aging adults medical fragility demonstration program 2809
Residential health care facilities 2810
Residential health care facilities 2811
Discounts and splitting fees with medical referral services 2812
Construction 2813
Separability 2814
Health networks, global budgeting, and health care demonstrations 2815
Health facility restructuring program 2815–A
Community health care revolving capital fund 2816
Statewide planning and research cooperative system 2816–A
Cardiac services information 2817
Community health centers capital program 2818
Health care efficiency and affordability law of New Yorkers (HEAL NY) capital grant program 2819
Hospital acquired infection reporting 2820
Home based primary care for the elderly demonstration project 2821
State electronic health records (EHR) loan program 2822
Residential care off-site facility demonstration project 2823
Supportive housing development program 2824
Central service technicians 2824*2
Surgical technology and surgical technologists 2825
Capital restructuring financing program 2825–A
Health care facility transformation program: Kings county project 2825–B
Oneida county health care facility transformation program: Oneida county project 2825–C
Essential health care provider support program 2825–D
Health care facility transformation program: statewide 2825–E
Health care facility transformation program: statewide II 2825–F
Health care facility transformation program: statewide III 2825–G
Health care facility transformation program: statewide IV 2825–H
Health care facility transformation program: statewide V 2825–I
Healthcare safety net transformation program 2826
Temporary adjustment to reimbursement rates 2827
Plant-based food options 2828
Residential health care facilities 2828*2
Essential support persons allowed for individuals with disabilities during a state of emergency 2829
Nursing homes 2830
Surgical smoke evacuation 2830*2
Regulation of the billing of facility fees 2831
Medically fragile young adults
Green check means up to date. Up to date

Accessed:
May 24, 2025

Last modified:
May 16, 2025

§ 2807-FF’s source at nysenate​.gov

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