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
feedback