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A 4860

Relates to capitated payments under the medical assistance program

2025 Regular Session Introduced by Jenifer Rajkumar

A 4860 would regulate capitated Medicaid payments (per‑member‑per‑month), setting rates, risk adjustment, and quality rules to protect beneficiaries and guide providers and plans.

REFERRED TO HEALTH
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Bill Summary · A 4860

Summary of Assembly Bill A 4860

Overview

  • Bill Number: A 4860
  • Title: Relates to capitated payments under the medical assistance program
  • Status: Referred to Health (as of February 6, 2025)
  • Introduced: February 6, 2025
  • Sponsor: Jenifer Rajkumar (primary)
  • Related Bills: A 10629 (prior-session)

Purpose and Intent

  • The bill relates to the use and administration of capitated payments within the medical assistance program (the state Medicaid program). In general terms, a capitated payment is a fixed per-member-per-month payment to managed care entities or providers to cover a broad set of services, rather than paying providers separately for each service (fee-for-service). The bill’s intent appears to be to regulate, authorize, or modify how such capitated payments are structured, delivered, and overseen within Medicaid to influence cost control, care management, and beneficiary outcomes.

Key Provisions (Note: Specific statutory text is not provided in the summary)

  • Based on the bill’s title, prospective or typical provisions in this area may include:
    • Definitions related to capitated payment arrangements in the medical assistance program.
    • Rate-setting methods for capitated payments, including how per-member-per-month rates are determined.
    • Risk adjustment mechanisms to account for beneficiary health status and expected costs.
    • Quality and performance requirements tied to capitated contracts (e.g., quality metrics, performance standards, reporting).
    • Provider network requirements and beneficiary access protections under capitated arrangements.
    • Transition provisions or phased implementation timelines, if changing current payment practices.
    • Financial protections, audits, and compliance measures to ensure proper use of funds and beneficiary protections.
    • Reporting and oversight by the state Medicaid agency or Department of Health.

If enacted, the actual provisions could differ in specificity and scope. The summary above reflects common elements associated with capitated payment reforms in Medicaid programs.

Affected Parties

  • Medicaid beneficiaries / enrollees who receive services through capitated arrangements.
  • Managed care organizations and capitated providers that administer or deliver medical services under fixed per-member payments.
  • State Medicaid program administrators and the relevant health department or agency responsible for implementing capitated payments.
  • Potentially, hospitals, physicians, and other healthcare providers participating in Medicaid managed care networks.

Procedural and Timeline Context

  • Status: Referred to the Health Committee, signaling initial stage in the legislative process.
  • Action timeline: As of the provided information, no further committee actions or floor votes are recorded. Typical next steps would include committee hearings, potential amendments, and floor consideration, followed by passage or rejection in the chamber and consideration by the other house (if applicable) before final passage.
  • Related legislation: A 10629 from a prior session may share themes or objectives, indicating ongoing interest in the governance of capitated payments within Medicaid.

Tracking and Next Steps

  • To monitor progress, check for committee hearing dates, any amended text, and votes in the Health Committee and on the floor.
  • If you want deeper analysis, the bill’s full text will provide exact definitions, rate-setting formulas, risk adjustment details, quality requirements, and transition timelines once released.

Compiled from official sources — confirm details with the bill’s official record.

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