Bill Text: NY A01193 | 2015-2016 | General Assembly | Introduced
Bill Title: Relates to the determination of overpayment recovery amounts for health care providers; provides certain requirements be met when the process known as extrapolation will be used.
Spectrum: Moderate Partisan Bill (Democrat 9-2)
Status: (Engrossed - Dead) 2016-04-05 - REFERRED TO INSURANCE [A01193 Detail]
Download: New_York-2015-A01193-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 1193 2015-2016 Regular Sessions I N A S S E M B L Y January 8, 2015 ___________ Introduced by M. of A. LAVINE, COOK, SCHIMEL, ABINANTI, ARROYO, McKEV- ITT, DUPREY, ROBERTS, GOTTFRIED, RIVERA -- Multi-Sponsored by -- M. of A. PERRY -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, in relation to determination of over- payments to health care providers by extrapolation THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Paragraph 2 of subsection (b) of section 3224-b of the 2 insurance law, as amended by chapter 237 of the laws of 2009, is amended 3 to read as follows: 4 (2) A health plan shall provide a health care provider with the oppor- 5 tunity to challenge an overpayment recovery, including the sharing of 6 claims information, and shall establish written policies and procedures 7 for health care providers to follow to challenge an overpayment recov- 8 ery. Such challenge shall set forth the specific grounds on which the 9 provider is challenging the overpayment recovery. IN THE EVENT THAT THE 10 PROCESS KNOWN AS EXTRAPOLATION WILL BE USED IN DETERMINING WHETHER 11 HEALTH CARE PROVIDERS HAVE RECEIVED OVERPAYMENTS FROM A HEALTH CARE 12 PLAN, THE HEALTH CARE PLAN SHALL COMPLY WITH THE FOLLOWING REQUIREMENTS: 13 (A) ADVISE THE HEALTH CARE PROVIDER WITH WRITTEN NOTICE THAT EXTRAPO- 14 LATION WILL BE UTILIZED; 15 (B) APPLY A VALID STATISTICAL METHODOLOGY THAT USES STRATIFIED RANDOM 16 SAMPLING METHODS TO ASSURE A FAIR EVALUATION OF THE CLAIMS SUBJECT TO 17 AUDIT; 18 (C) ADVISE THE HEALTH CARE PROVIDER AS TO THE TYPE OF METHODOLOGY 19 USED; 20 (D) PROVIDE THE HEALTH CARE PROVIDER SIXTY BUSINESS DAYS TO APPEAL THE 21 AUDIT FINDINGS; AND 22 (E) IN THE EVENT OF AN APPEAL OF THE AUDIT FINDINGS, THE HEALTH CARE 23 PROVIDER MAY SEEK A REVIEW OF THE FINDINGS BY A MUTUALLY AGREED UPON 24 INDEPENDENT THIRD PARTY AUDITOR. THE COST OF A THIRD PARTY REVIEW SHALL 25 BE SHARED EQUALLY BETWEEN THE PARTIES. 26 S 2. This act shall take effect immediately. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD03090-01-5