New York State Assembly

 
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A07889 Summary:

A07889 Actions:

A07889 Committee Votes:

Committee:HEALTH   Chair:Gottfried      
DATE:01/11/2022AYE/NAY:26/0  Action: Favorable refer to committee Codes        
Gottfried
Aye
Byrne
Aye
Galef
Aye
McDonough
Aye
Dinowitz
Aye
Byrnes
Aye
Cahill
Aye
Ashby
Aye
Paulin
Aye
Miller
Aye
Cymbrowitz
Aye
Salka
Aye
Gunther
Aye
Jensen
Aye
Rosenthal L 
Aye
Hevesi
Aye
Steck
Aye
Abinanti
Aye
Braunstein
Aye
Solages
Aye
Bichotte Hermel
Aye
Sayegh
Aye
Rosenthal D 
Aye
McDonald
Aye
Reyes
Aye
Gonzalez-Rojas
Aye

Committee:CODES   Chair:Dinowitz      
DATE:01/19/2022AYE/NAY:22/0  Action: Favorable refer to committee Ways and Means        
Dinowitz
Aye
Morinello
Aye
Pretlow
Aye
Giglio
Aye
Cook
Aye
Montesano
Aye
Cymbrowitz
Aye
Reilly
Aye
O'Donnell
Aye
Mikulin
Aye
Lavine
Aye
Tannousis
Aye
Perry
Aye
Abinanti
Aye
Weprin
Aye
Hevesi
Aye
Seawright
Aye
Rosenthal
Aye
Walker
Aye
Vanel
Aye
Cruz
Aye
Carroll
Aye

Committee:WAYS AND MEANS   Chair:Weinstein      
DATE:05/23/2022AYE/NAY:30/0  Action: Favorable refer to committee Rules        
Weinstein
Aye
Ra
Aye
Glick
Aye
Fitzpatrick
Aye
Nolan
Aye
Hawley
Aye
Pretlow
Aye
Montesano
Aye
Colton
Aye
Blankenbush
Excused
Cook
Aye
Norris
Aye
Cahill
Aye
Brabenec
Aye
Aubry
Aye
Palmesano
Aye
Cusick
Excused
Byrne
Aye
Benedetto
Aye
Ashby
Aye
Weprin
Aye
Ramos
Excused
Braunstein
Aye
McDonald
Aye
Rozic
Aye
Dinowitz
Aye
Joyner
Aye
Magnarelli
Aye
Zebrowski
Aye
Bronson
Aye
Dilan
Excused
Seawright
Aye
Hyndman
Excused
Walker
Aye
Bichotte Hermel
Aye

Committee:RULES   Chair:Gottfried      
DATE:05/24/2022AYE/NAY:29/0  Action: Favorable         
Heastie
Excused
Barclay
Excused
Gottfried
Aye
Hawley
Aye
Nolan
Aye
Giglio
Aye
Weinstein
Aye
Blankenbush
Aye
Pretlow
Aye
Norris
Aye
Cook
Aye
Montesano
Aye
Glick
Aye
Ra
Aye
Aubry
Aye
Brabenec
Aye
Englebright
Aye
Dinowitz
Aye
Colton
Aye
Magnarelli
Aye
Paulin
Aye
Peoples-Stokes
Aye
Benedetto
Aye
Lavine
Aye
Lupardo
Aye
Zebrowski
Aye
Thiele
Aye
Braunstein
Aye
Dickens
Aye
Davila
Aye
Hyndman
Aye

A07889 Floor Votes:

A07889 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         7889--A
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                      May 28, 2021
                                       ___________
 
        Introduced  by  M.  of  A.  GOTTFRIED, L. ROSENTHAL, McDONALD, ABINANTI,
          VANEL -- read once and referred to the Committee on Health  --  recom-
          mitted  to the Committee on Health in accordance with Assembly Rule 3,
          sec. 2 -- reported and referred to the Committee on Ways and Means  --
          committee  discharged,  bill amended, ordered reprinted as amended and
          recommitted to said committee
 
        AN ACT to amend the public health law and the social  services  law,  in
          relation  to  the  functions  of  the  Medicaid inspector general with
          respect to audit and review of medical assistance  program  funds  and
          requiring notice of certain investigations
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Section 30-a of the public health law is amended by  adding
     2  four new subdivisions 4, 5, 6 and 7 to read as follows:
     3    4. "Provider" means any person or entity enrolled as a provider in the
     4  medical assistance program.
     5    5.  "Recipient"  means  an  individual  who is enrolled in the medical
     6  assistance program, including an individual who was previously a recipi-
     7  ent and, in an appropriate case, an individual who is legally  responsi-
     8  ble for the recipient.
     9    6.  "Medical  assistance" and "Medicaid" means title eleven of article
    10  five of the social services law and the program thereunder.
    11    7. "Draft audit report", "initial audit report", "proposed  notice  of
    12  agency action" and "final notice of agency action" means those documents
    13  prepared  and issued by the inspector under this title and corresponding
    14  regulations.
    15    § 2. Subdivision 20 of section 32 of the public health law,  as  added
    16  by chapter 442 of the laws of 2006, is amended to read as follows:
    17    20.  to,  consistent  with  [provisions  of] this title and applicable
    18  federal and state laws, regulations, policies, guidelines and standards,
    19  implement and amend, as needed, rules and regulations  relating  to  the
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11500-02-2
        A. 7889--A                          2
 
     1  prevention,  detection,  investigation  and  referral of fraud and abuse
     2  within the medical assistance program and  the  recovery  of  improperly
     3  expended medical assistance program funds;
     4    §  3.  The  public health law is amended by adding two new sections 37
     5  and 38 to read as follows:
     6    § 37. Procedures, practices and standards.  1. Subject to federal  law
     7  or regulation, recovery of an overpayment resulting from the issuance of
     8  a  final  audit report or final notice of agency action by the inspector
     9  shall commence not less than sixty days after the issuance of the  final
    10  audit  report  or final notice of agency action. The inspector shall not
    11  commence any recovery under this subdivision without providing a minimum
    12  of ten days advance written notice to the provider.
    13    2. Contracts, cost reports, claims, bills or expenditures  of  medical
    14  assistance  funds  that  were  the subject matter of a previous audit or
    15  review by or on behalf of the inspector, within the  last  three  years,
    16  shall not be subject again to review or audit except on the basis of new
    17  information, for good cause to believe that the previous review or audit
    18  was  erroneous, or where the scope of the inspector's review or audit is
    19  significantly different from the scope of the previous review or audit.
    20    3. In conducting reviews or audits,  the  inspector  shall  apply  the
    21  laws,  regulations,  policies, guidelines, standards and interpretations
    22  of the appropriate agency, including temporary or emergency regulations,
    23  policies, guidelines, standards and interpretations, that were in  place
    24  at the time the subject claim arose or other conduct took place.  Disal-
    25  lowances  may  be  imposed or other action taken only for non-compliance
    26  with those laws, regulations, policies,  guidelines  or  standards.  For
    27  purposes  of  this  subdivision,  any change in those laws, regulations,
    28  policies, guidelines, standards or interpretations shall only be applied
    29  prospectively and upon reasonable notice.
    30    4. (a) The inspector shall make no recovery from a provider, based  on
    31  an administrative or technical defect in procedure or documentation made
    32  without  intent  to  falsify  or  defraud, in connection with claims for
    33  payment for medically necessary care, services and supplies or the  cost
    34  thereof  as specified in subdivision two of section three hundred sixty-
    35  five-a of the social services law provided in other  respects  appropri-
    36  ately  to  a  beneficiary  of  the medical assistance program, except as
    37  provided in paragraphs (b) and (c) of this subdivision.
    38    (b) Where there is an administrative or technical defect in  procedure
    39  or  documentation  without  intent  to falsify or defraud, the inspector
    40  shall afford the provider an  opportunity  to  correct  the  defect  and
    41  resubmit the claim within thirty days of notice of the defect.
    42    (c) Where a claim relates to a service that was provided more than two
    43  years prior to the commencement of the audit, the provider may submit or
    44  resubmit  the  claim  or  accept  the  disallowance of the amount of the
    45  claim.
    46    5. (a) The inspector shall furnish to the provider at  an  audit  exit
    47  conference  or in any draft audit findings issued or to be issued to the
    48  provider, a detailed written explanation  of  the  extrapolation  method
    49  employed,  including  the  size of the sample, the sampling methodology,
    50  the defined universe of claims, the  specific  claims  included  in  the
    51  sample,  the results of the sample, the assumptions made about the accu-
    52  racy and reliability of the sample and the level of  confidence  in  the
    53  sample  results,  and  the  steps  undertaken and statistics utilized to
    54  calculate the alleged overpayment and any applicable offset based on the
    55  sample results. This written information shall include a description  of
    56  the sampling and extrapolation methodology.
        A. 7889--A                          3
 
     1    (b) The sampling and extrapolation methodologies used by the inspector
     2  shall  be  statistically reasonably valid for the intended use and shall
     3  be established in regulations of the inspector.
     4    §  38.  Procedures,  practices  and  standards for recipients. 1. This
     5  section applies to any adjustment or recovery of  a  medical  assistance
     6  payment  from  a  recipient,  and  any investigation or other proceeding
     7  relating thereto.
     8    2. At least five business days prior to commencement of any  interview
     9  with  a  recipient  as  part of an investigation, the inspector or other
    10  investigating entity shall provide the recipient with written notice  of
    11  the  investigation.  The notice of the investigation shall set forth the
    12  basis for the investigation; the potential  for  referral  for  criminal
    13  investigation;  the  individual's right to be accompanied by a relative,
    14  friend, advocate or attorney during questioning; contact information for
    15  local legal services offices; the individual's right to  decline  to  be
    16  interviewed or participate in an interview but terminate the questioning
    17  at any time without loss of benefits; and the right to a fair hearing in
    18  the event that the investigation results in a determination of incorrect
    19  payment.
    20    3.  Following completion of the investigation and at least thirty days
    21  prior to commencing a recovery or adjustment action or requesting volun-
    22  tary repayment,  the  inspector  or  other  investigating  entity  shall
    23  provide the recipient with written notice of the determination of incor-
    24  rect  payment  to  be recovered or adjusted. The notice of determination
    25  shall identify the evidence relied upon, set forth the  factual  conclu-
    26  sions of the investigation, and explain the recipient's right to request
    27  a fair hearing in order to contest the outcome of the investigation. The
    28  explanation of the right to a fair hearing shall conform to the require-
    29  ments of subdivision twelve of section twenty-two of the social services
    30  law and regulations thereunder.
    31    4.  A fair hearing under section twenty-two of the social services law
    32  shall be available to any recipient who receives a  notice  of  determi-
    33  nation  under  subdivision  three of this section, regardless of whether
    34  the recipient is still enrolled in the medical assistance program.
    35    § 4. Paragraph (c) of subdivision 3 of section  363-d  of  the  social
    36  services  law,  as  amended  by section 4 of part V of chapter 57 of the
    37  laws of 2019, is amended and a new subdivision 8 is  added  to  read  as
    38  follows:
    39    (c)  In  the  event  that  the  commissioner of health or the Medicaid
    40  inspector general finds that the provider does not have  a  satisfactory
    41  program  [within ninety days after the effective date of the regulations
    42  issued pursuant to subdivision four of this section],  the  commissioner
    43  or  Medicaid  inspector  general shall so notify the provider, including
    44  specification of the basis of  the  finding  sufficient  to  enable  the
    45  provider  to adopt a satisfactory compliance program. The provider shall
    46  submit to the commissioner or  Medicaid  inspector  general  a  proposed
    47  satisfactory  compliance  program  within  sixty  days of the notice and
    48  shall adopt the program as expeditiously as possible.  If  the  provider
    49  does  not  propose and adopt a satisfactory program in such time period,
    50  the provider may be subject to any sanctions or penalties  permitted  by
    51  federal  or  state  laws  and  regulations,  including revocation of the
    52  provider's agreement to participate in the medical assistance program.
    53    8. Any regulation, determination or finding of the commissioner or the
    54  Medicaid inspector general relating to a compliance program  under  this
    55  section  shall  be  subject  to and consistent with subdivision three of
    56  this section.
        A. 7889--A                          4
 
     1    § 5. Section 32 of the public health law is amended by  adding  a  new
     2  subdivision 6-b to read as follows:
     3    6-b.  to consult with the commissioner on the preparation of an annual
     4  report, to be made and filed by the commissioner on or before the  first
     5  day  of July to the governor, the temporary president of the senate, the
     6  speaker of the assembly, the minority leader of the senate, the minority
     7  leader of the assembly, the commissioner, the commissioner of the office
     8  of addiction services and supports, and the commissioner of  the  office
     9  of  mental  health  on  the  impacts  that  all civil and administrative
    10  enforcement actions taken under subdivision six of this section  in  the
    11  previous  calendar year will have and have had on the quality and avail-
    12  ability of medical care and services, the best  interests  of  both  the
    13  medical  assistance  program  and its recipients, and fiscal solvency of
    14  the providers who were subject to the civil or  administrative  enforce-
    15  ment action;
    16    § 6. This act shall take effect immediately.