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A08172 Summary:

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A08172 Committee Votes:

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A08172 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          8172
 
                               2015-2016 Regular Sessions
 
                   IN ASSEMBLY
 
                                      June 10, 2015
                                       ___________
 
        Introduced  by M. of A. MORELLE -- read once and referred to the Commit-
          tee on Health
 
        AN ACT to amend the social services  law,  in  relation  to  claims  for
          payment furnished by providers under the medical assistance program
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Section 367-b of the social  services  law  is  amended  by
     2  adding a new subdivision 15 to read as follows:
     3    15. (a) Notwithstanding any other provision of law, claims for payment
     4  for  medical  care, services or supplies furnished by any provider under
     5  the medical assistance program must be initially submitted within ninety
     6  days of the date the medical care, services or supplies  were  furnished
     7  to an eligible person to be valid and enforceable against the department
     8  or  a  social services district, unless the provider's submission of the
     9  claims is delayed beyond ninety days due to circumstances outside of the
    10  control of the provider. Such circumstances include, but are not limited
    11  to, attempts to recover from a third-party  insurer,  legal  proceedings
    12  against  a responsible third-party or the recipient of the medical care,
    13  services or supplies, an unforeseeable computer or  systems  malfunction
    14  which,  in  the judgment of the department, impacted the submission of a
    15  significant number of claims and was unknown to the  provider  prior  to
    16  the  expiration of the ninety day time period, or delays in the determi-
    17  nation of client eligibility by the social services district. All claims
    18  submitted after ninety days must be accompanied by a  statement  of  the
    19  reason  for such delay and must be submitted within thirty days from the
    20  time submission came within the control of the provider, subject to  the
    21  limitations of paragraph (c) of this subdivision.
    22    (b)  Any  claim  returned  to  a provider due to data insufficiency or
    23  claiming  errors  may  be  resubmitted  by  the  provider  upon   proper
    24  completion  of  the  claim  in  accordance  with  the  claims processing
    25  requirements of the department within sixty days  of  the  date  of  the
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD11584-01-5
        A. 8172                             2
 
     1  notification to the provider advising the provider of such insufficiency
     2  or invalidity. Any returned claim not correctly resubmitted within sixty
     3  days  or  on  the  second  resubmission is neither valid nor enforceable
     4  against the department or a social services district.
     5    (c)  Notwithstanding paragraphs (a) and (b) of this subdivision to the
     6  contrary:
     7    (i) all claims for payment for  medical  care,  services  or  supplies
     8  furnished  by  non-public providers under the medical assistance program
     9  must be finally submitted to the department or its fiscal agent  and  be
    10  payable  within  two  years from the date the care, services or supplies
    11  were furnished in order to be  valid  and  enforceable  as  against  the
    12  department or a social services district; and
    13    (ii)  all  claims  for  payment for medical care, services or supplies
    14  furnished by public providers must be finally submitted to  the  depart-
    15  ment  or  its fiscal agent and be payable within two years from the date
    16  the care, services or supplies were  furnished  (or  within  such  other
    17  period  as agreed by the department and the public provider for payments
    18  initially made by the public provider under a  program  other  than  the
    19  medical  assistance  program)  in  order  to be valid and enforceable as
    20  against the department or a social services district.
    21    (d) For purposes of this subdivision, a claim is considered  submitted
    22  upon its receipt by the department or its fiscal agent.
    23    §  2.  This  act  shall take effect immediately and shall apply to all
    24  provider claims that were the subject of  an  appeal  or  department  of
    25  health review on or after January 1, 2015.