New York Assembly Bill A10842

New York 2025-2026 Regular Session

• Introduced: 4/6/26
• Refer: 4/6/26

Caption

Directs the department of health to establish an alternative payment methodology (APM) for federally qualified health centers to preserve and improve patient access to fertility care.

Impact

One of the primary impacts of A10842 is the facilitation of access to fertility treatments by ensuring that federally qualified health centers can procure eligible injectable fertility drugs at more sustainable costs. The proposed APM will guarantee that payments by the Department of Health to these centers will equal the difference between the actual payment for these drugs under Medicaid, calculated using the 340B pricing, and what they would have to pay under the average wholesale acquisition cost. This adjustment is crucial in maintaining affordability and accessibility to essential fertility treatments for patients.

Summary

Assembly Bill A10842 introduces a directive for the New York Department of Health to establish an alternative payment methodology (APM) specifically for federally qualified health centers. The intent of this bill is to improve and maintain patient access to fertility care services by ensuring appropriate payment levels for services provided by these centers. This new payment structure would be an addition to the existing prospective payment system (PPS) and other alternative payment methodologies that these centers currently operate under.

Contention

While the bill is aimed at improving patient access to fertility care, discussions around it may center on the allocation of resources and the potential implications for the state's overall healthcare budget. Proponents are likely to argue for the importance of fertility treatments in comprehensive healthcare, while opponents might raise concerns about the financial impact on state funds and whether the APM might lead to increased demand without corresponding funding increases. The nuanced debate may also highlight the importance of balancing innovative health care methodologies with fiscal responsibility.