Bill Text: NY A07920 | 2017-2018 | General Assembly | Introduced

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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: Partisan Bill (Democrat 7-0)

Status: (Introduced - Dead) 2018-01-03 - referred to insurance [A07920 Detail]

Download: New_York-2017-A07920-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________
                                          7920
                               2017-2018 Regular Sessions
                   IN ASSEMBLY
                                      May 19, 2017
                                       ___________
        Introduced  by  M.  of  A.  LAVINE,  GOTTFRIED,  COOK, ABINANTI, ARROYO,
          RIVERA, McKEVITT -- 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    § 2. This act shall take effect immediately.
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11795-01-7