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

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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--B
                              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
       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
    5  opportunity  to challenge an overpayment recovery, including the sharing
    6  of claims information, and shall establish written policies  and  proce-
    7  dures  for  health  care providers to follow to challenge an overpayment
    8  recovery. Such challenge shall set forth the specific grounds  on  which
    9  the  provider is challenging the overpayment recovery] IN THE EVENT THAT
   10  THE 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;
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06450-05-4
       A. 3088--B                          2
    1    (D) PROVIDE THE HEALTH CARE PROVIDER SIXTY BUSINESS DAYS TO APPEAL THE
    2  AUDIT FINDINGS; AND
    3    (E)  IN  THE EVENT OF AN APPEAL OF THE AUDIT FINDINGS, THE HEALTH CARE
    4  PROVIDER MAY SEEK A REVIEW OF THE FINDINGS BY  A  MUTUALLY  AGREED  UPON
    5  INDEPENDENT  THIRD PARTY AUDITOR. THE COST OF A THIRD PARTY REVIEW SHALL
    6  BE SHARED EQUALLY BETWEEN THE PARTIES.
    7    S 2. This act shall take effect immediately.