Bill Text: NY S05015 | 2013-2014 | General Assembly | Amended
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
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.