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

Accessed:
May 24, 2025

Last modified:
May 16, 2025

§ 2807-FF’s source at nysenate​.gov

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