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A01193 Summary:

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A01193 Committee Votes:

A01193 Floor Votes:

A01193 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          1193
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                     January 8, 2015
                                       ___________
 
        Introduced  by  M. of A. LAVINE, COOK, SCHIMEL, ABINANTI, ARROYO, McKEV-
          ITT, DUPREY, ROBERTS, GOTTFRIED, RIVERA -- 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.
                                                                   LBD03090-01-5