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--A
                              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, GIBSON, McKEVITT,
         MONTESANO, RIVERA, ROBERTS, GOTTFRIED -- read once and referred to the
         Committee on Insurance -- committee discharged, bill amended,  ordered
         reprinted as amended and recommitted to said committee
       AN ACT to amend the insurance law, in relation to recoveries of overpay-
         ments to health care providers
         THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section 1. Paragraphs 4 and 5 of subsection (b) of section  3224-b  of
    2  the  insurance law are renumbered paragraphs 5 and 6 and a new paragraph
    3  4 is added to read as follows:
    4    (4) A HEALTH PLAN SHALL NOT DETERMINE AN OVERPAYMENT  RECOVERY  AMOUNT
    5  THROUGH  THE  USE  OF  EXTRAPOLATION,  EXCEPT WHERE THERE IS EVIDENCE OF
    6  FRAUD OR INTENTIONAL MISCONDUCT.  A FINDING OF OVERPAYMENT OR  UNDERPAY-
    7  MENT  MUST BE BASED ON THE ACTUAL OVERPAYMENT OR UNDERPAYMENT AND NOT AN
    8  EXTRAPOLATION OR PROJECTION BASED ON THE NUMBER OF PATIENTS SERVED OR ON
    9  THE NUMBER OF PATIENTS ENROLLED IN THAT NETWORK PROVIDER.
   10    S 2. This act shall take effect immediately.
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06450-02-3