Bill Text: NY A03088 | 2013-2014 | General Assembly | Amended

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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: Slight Partisan Bill (Democrat 9-3)

Status: (Engrossed - Dead) 2014-06-19 - REFERRED TO RULES [A03088 Detail]

Download: New_York-2013-A03088-Amended.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        3088--C
                              2013-2014 Regular Sessions
                                 I N  A S S E M B L Y
                                   January 23, 2013
                                      ___________
       Introduced  by M. of A. LAVINE, COOK, ARROYO, DUPREY, McKEVITT, MONTESA-
         NO, RIVERA, ROBERTS, GOTTFRIED, SCHIMEL -- Multi-Sponsored by -- M. of
         A. PERRY -- read once and referred to the Committee  on  Insurance  --
         committee  discharged,  bill amended, ordered reprinted as amended and
         recommitted to said committee  --  recommitted  to  the  Committee  on
         Insurance  in  accordance  with  Assembly  Rule 3, sec. 2 -- committee
         discharged, bill amended, ordered reprinted as amended and recommitted
         to said committee -- again reported from said  committee  with  amend-
         ments, ordered reprinted as amended and recommitted to said committee
       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;
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06450-06-4
       A. 3088--C                          2
    1    (C)  ADVISE  THE  HEALTH  CARE  PROVIDER AS TO THE TYPE OF METHODOLOGY
    2  USED;
    3    (D) PROVIDE THE HEALTH CARE PROVIDER SIXTY BUSINESS DAYS TO APPEAL THE
    4  AUDIT FINDINGS; AND
    5    (E)  IN  THE EVENT OF AN APPEAL OF THE AUDIT FINDINGS, THE HEALTH CARE
    6  PROVIDER MAY SEEK A REVIEW OF THE FINDINGS BY  A  MUTUALLY  AGREED  UPON
    7  INDEPENDENT  THIRD PARTY AUDITOR. THE COST OF A THIRD PARTY REVIEW SHALL
    8  BE SHARED EQUALLY BETWEEN THE PARTIES.
    9    S 2. This act shall take effect immediately.