Bill Text: NY S02883 | 2015-2016 | General Assembly | Introduced

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Bill Title: Relates to the development and implementation of automated payment detection, prevention and recovery solutions to reduce correctional healthcare overpayments, and requires that private health insurance and Medicaid are billed for eligible inpatient hospital and professional services.

Spectrum: Partisan Bill (Republican 3-0)

Status: (Engrossed - Dead) 2016-01-06 - REFERRED TO CRIME VICTIMS, CRIME AND CORRECTION [S02883 Detail]

Download: New_York-2015-S02883-Introduced.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         2883
                              2015-2016 Regular Sessions
                                   I N  S E N A T E
                                   January 29, 2015
                                      ___________
       Introduced by Sens. RANZENHOFER, DeFRANCISCO, GALLIVAN -- read twice and
         ordered  printed, and when printed to be committed to the Committee on
         Crime Victims, Crime and Correction
       AN ACT to amend the correction law  and  the  social  services  law,  in
         relation  to  the  development and implementation of automated payment
         detection, prevention and recovery solutions  to  reduce  correctional
         healthcare  overpayments, and to require that private health insurance
         providers and Medicaid are billed for eligible  inpatient hospital and
         professional services
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1.  Legislative  intent.  Other states have saved millions of
    2  dollars by implementing solutions to eliminate and recover  correctional
    3  healthcare  overpayments  and  significantly  have  reduced correctional
    4  healthcare costs by billing private health insurance providers and Medi-
    5  caid for eligible inpatient healthcare costs. New York  can  benefit  by
    6  implementing  similar  measures.  It is the intent of the legislature to
    7  implement automated payment detection, prevention and recovery solutions
    8  to reduce correctional  healthcare  overpayments,  and  to  ensure  that
    9  private  insurance  companies and Medicaid are billed for eligible inpa-
   10  tient hospital and professional services.
   11    S 2. The correction law is amended by adding a new  section  140-a  to
   12  read as follows:
   13    S  140-A.    HEALTHCARE PAYMENTS; BILLING PRIVATE HEALTH INSURANCE AND
   14  MEDICAID. 1. UNLESS OTHERWISE STATED, THE  PROVISIONS  OF  THIS  SECTION
   15  APPLY  TO  ALL  STATE  CORRECTIONAL  HEALTHCARE SYSTEMS AND SERVICES AND
   16  STATE CONTRACTED MANAGED CORRECTIONAL HEALTHCARE SERVICES.
   17    2.  THE  DEPARTMENT  SHALL  IMPLEMENT  AUTOMATED  PAYMENT   DETECTION,
   18  PREVENTION, AND RECOVERY PROCEDURES TO ENSURE THAT PRIVATE HEALTH INSUR-
   19  ANCE  OR  MEDICAID IS BILLED FOR ELIGIBLE INPATIENT HOSPITAL AND PROFES-
   20  SIONAL HEALTHCARE SERVICES.  THESE PROCEDURES MUST INCLUDE, BUT ARE  NOT
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02105-01-5
       S. 2883                             2
    1  LIMITED  TO, CLINICAL CODE EDITING TECHNOLOGY TO FURTHER AUTOMATE CLAIMS
    2  RESOLUTION AND ENHANCE COST CONTAINMENT THROUGH IMPROVED CLAIM  ACCURACY
    3  AND APPROPRIATE CODE CORRECTION. EDITS PERFORMED BY THIS TECHNOLOGY MUST
    4  BE  APPLIED  AUTOMATICALLY  BEFORE  THE ADJUDICATION OF CLAIMS, AND THIS
    5  TECHNOLOGY MUST IDENTIFY AND PREVENT ERRORS  AND  POTENTIAL  OVERBILLING
    6  BASED  ON  WIDELY ACCEPTED PROTOCOLS, SUCH AS THOSE USED BY THE AMERICAN
    7  MEDICAL ASSOCIATION AND THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.
    8    3. THE DEPARTMENT SHALL IMPLEMENT CORRECTIONAL HEALTHCARE CLAIMS AUDIT
    9  AND RECOVERY PROCEDURES  TO  IDENTIFY  IMPROPER  PAYMENTS  MADE  DUE  TO
   10  NON-FRAUDULENT  ISSUES. PROCEDURES THAT MUST BE IMPLEMENTED INCLUDE, BUT
   11  ARE NOT LIMITED TO, OBTAINING PROVIDER SIGN-OFF  ON  AUDIT  RESULTS  AND
   12  CONDUCTING  POST PAYMENT REVIEWS TO ENSURE THAT THE DIAGNOSES AND PROCE-
   13  DURE CODES ARE ACCURATE AND VALID BASED ON SUPPORTING PHYSICIAN DOCUMEN-
   14  TATION WITHIN THE  MEDICAL  RECORDS.  CORE  CATEGORIES  OF  REVIEWS  MAY
   15  INCLUDE,  BUT  ARE  NOT  LIMITED TO, CODING COMPLIANCE DIAGNOSIS RELATED
   16  GROUP (DRG) REVIEWS,  TRANSFERS,  READMISSIONS,  COST  OUTLIER  REVIEWS,
   17  OUTPATIENT SEVENTY-TWO-HOUR RULE REVIEWS, PAYMENT ERRORS, AND BILLING.
   18    4. THE DEPARTMENT MAY CONTRACT TO HAVE SERVICES PERFORMED TO CARRY OUT
   19  THE  REQUIREMENTS  OF  THIS  SECTION,  AND  THE SAVINGS GENERATED BY THE
   20  PERFORMANCE OF THESE SERVICES MUST BE USED FOR THE OPERATION AND  ADMIN-
   21  ISTRATION  OF  THIS  SECTION, INCLUDING SECURING THE TECHNOLOGY SERVICES
   22  REQUIRED BY THIS SECTION. TO FURTHER ACHIEVE THESE  SAVINGS,  CONTRACTOR
   23  REIMBURSEMENT  MAY  BE  BASED  UPON  A PERCENTAGE OF AN ACHIEVED SAVINGS
   24  MODEL, A PER BENEFICIARY PER MONTH MODEL, A  PER  TRANSACTION  MODEL,  A
   25  CASE-RATE   MODEL,  OR  ANY  COMBINATION  OF  THESE  MODELS.  CONTRACTOR
   26  REIMBURSEMENT MODELS ALSO MAY  INCLUDE  PERFORMANCE  GUARANTEES  OF  THE
   27  CONTRACTOR TO ENSURE SAVINGS IDENTIFIED EXCEED PROGRAM COSTS.
   28    S  3. The social services law is amended by adding a new section 368-g
   29  to read as follows:
   30    S 368-G. REIMBURSEMENT OF COSTS FOR CORRECTIONAL  HEALTHCARE.    AFTER
   31  THE AMOUNT OF FEDERAL FUNDS, IF ANY, HAVE BEEN DEDUCTED FROM THE COST OF
   32  CORRECTIONAL  HEALTHCARE,  THE  REMAINING AMOUNT SHALL BE PAID WHOLLY BY
   33  THE STATE.
   34    S 4. This act shall take effect on the first of January next  succeed-
   35  ing the date on which it shall have become a law.