Bill Text: NY S05015 | 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: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2014-06-16 - PRINT NUMBER 5015B [S05015 Detail]

Download: New_York-2013-S05015-Amended.html

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                           S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                        5015--B
                              2013-2014 Regular Sessions
                                   I N  S E N A T E
                                      May 6, 2013
                                      ___________
       Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
         printed to be committed to the Committee on Insurance  --  recommitted
         to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
         --  committee  discharged,  bill amended, ordered reprinted as amended
         and recommitted  to  said  committee  --  committee  discharged,  bill
         amended,  ordered reprinted as amended and recommitted to said commit-
         tee
       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;
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD06450-07-4
       S. 5015--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.