S03184 Summary:
BILL NO | S03184A |
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SAME AS | SAME AS A05686-A |
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SPONSOR | LITTLE |
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COSPNSR | LANZA, ADDABBO, BONACIC, CARLUCCI, DEFRANCISCO, GOLDEN, KLEIN, MARTINS, MAZIARZ, MCDONALD, SAVINO |
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MLTSPNSR | |
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Amd SS30, 30-a & 32, add S37 & 38, Pub Health L; amd S363-d, Soc Serv L | |
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Relates to procedures, practices and standards for actions by the office of medicaid inspector general and social services districts. |
S03184 Actions:
BILL NO | S03184A | |||||||||||||||||||||||||||||||||||||||||||||||||
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02/10/2011 | REFERRED TO HEALTH | |||||||||||||||||||||||||||||||||||||||||||||||||
06/17/2011 | AMEND (T) AND RECOMMIT TO HEALTH | |||||||||||||||||||||||||||||||||||||||||||||||||
06/17/2011 | PRINT NUMBER 3184A | |||||||||||||||||||||||||||||||||||||||||||||||||
06/20/2011 | COMMITTEE DISCHARGED AND COMMITTED TO RULES | |||||||||||||||||||||||||||||||||||||||||||||||||
06/20/2011 | ORDERED TO THIRD READING CAL.1381 | |||||||||||||||||||||||||||||||||||||||||||||||||
06/20/2011 | PASSED SENATE | |||||||||||||||||||||||||||||||||||||||||||||||||
06/20/2011 | DELIVERED TO ASSEMBLY | |||||||||||||||||||||||||||||||||||||||||||||||||
06/20/2011 | referred to ways and means | |||||||||||||||||||||||||||||||||||||||||||||||||
06/23/2011 | substituted for a5686a | |||||||||||||||||||||||||||||||||||||||||||||||||
06/23/2011 | ordered to third reading rules cal.602 | |||||||||||||||||||||||||||||||||||||||||||||||||
06/23/2011 | passed assembly | |||||||||||||||||||||||||||||||||||||||||||||||||
06/23/2011 | returned to senate | |||||||||||||||||||||||||||||||||||||||||||||||||
09/12/2011 | DELIVERED TO GOVERNOR | |||||||||||||||||||||||||||||||||||||||||||||||||
09/23/2011 | VETOED MEMO.72 |
S03184 Floor Votes:
Yes
Abbate
Yes
Clark
Yes
Gottfried
Yes
Lifton
Yes
Nolan
Yes
Scarborough
Yes
Abinanti
Yes
Colton
Yes
Graf
Yes
Linares
Yes
Oaks
Yes
Schimel
Yes
Amedore
Yes
Conte
Yes
Gunther
Yes
Lopez PD
Yes
O'Donnell
Yes
Schimminger
ER
Arroyo
Yes
Cook
Yes
Hanna
ER
Lopez VJ
Yes
Ortiz
Yes
Schroeder
Yes
Aubry
Yes
Corwin
ER
Hawley
Yes
Losquadro
Yes
Palmesano
Yes
Simotas
Yes
Barclay
ER
Crespo
Yes
Hayes
Yes
Lupardo
Yes
Paulin
Yes
Smardz
Yes
Barron
ER
Crouch
Yes
Heastie
Yes
Magee
Yes
Peoples Stokes
Yes
Spano
Yes
Benedetto
Yes
Curran
Yes
Hevesi
Yes
Magnarelli
Yes
Perry
Yes
Stevenson
Yes
Bing
Yes
Cusick
Yes
Hikind
Yes
Maisel
Yes
Pretlow
Yes
Sweeney
Yes
Blankenbush
Yes
Cymbrowitz
Yes
Hooper
Yes
Malliotakis
Yes
Ra
Yes
Tedisco
ER
Boyland
Yes
DenDekker
Yes
Hoyt
Yes
Markey
Yes
Rabbitt
Yes
Tenney
Yes
Boyle
Yes
Dinowitz
Yes
Jacobs
Yes
McDonough
Yes
Raia
Yes
Thiele
Yes
Braunstein
Yes
Duprey
Yes
Jaffee
Yes
McEneny
Yes
Ramos
Yes
Titone
Yes
Brennan
Yes
Englebright
Yes
Jeffries
Yes
McKevitt
Yes
Reilich
Yes
Titus
Yes
Bronson
Yes
Farrell
Yes
Johns
Yes
McLaughlin
Yes
Reilly
Yes
Tobacco
Yes
Brook Krasny
Yes
Finch
Yes
Jordan
Yes
Meng
Yes
Rivera J
Yes
Weinstein
Yes
Burling
Yes
Fitzpatrick
Yes
Katz
Yes
Miller D
Yes
Rivera N
Yes
Weisenberg
Yes
Butler
Yes
Friend
Yes
Kavanagh
Yes
Miller JM
Yes
Rivera PM
Yes
Weprin
Yes
Cahill
Yes
Gabryszak
Yes
Kellner
Yes
Miller MG
Yes
Roberts
Yes
Wright
Yes
Calhoun
Yes
Galef
ER
Kirwan
Yes
Millman
ER
Robinson
Yes
Zebrowski
Yes
Camara
Yes
Gantt
Yes
Kolb
Yes
Molinaro
Yes
Rodriguez
Yes
Mr. Speaker
Yes
Canestrari
ER
Gibson
Yes
Lancman
Yes
Montesano
Yes
Rosenthal
Yes
Castelli
Yes
Giglio
Yes
Latimer
Yes
Morelle
Yes
Russell
Yes
Castro
Yes
Glick
Yes
Lavine
Yes
Moya
Yes
Saladino
Yes
Ceretto
Yes
Goodell
Yes
Lentol
Yes
Murray
Yes
Sayward
‡ Indicates voting via videoconference
S03184 Text:
Go to top STATE OF NEW YORK ________________________________________________________________________ 3184--A 2011-2012 Regular Sessions IN SENATE February 10, 2011 ___________ Introduced by Sens. LITTLE, LANZA, ADDABBO, BONACIC, CARLUCCI, DeFRAN- CISCO, GOLDEN, KLEIN, MARTINS, MAZIARZ, McDONALD, SAVINO -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- 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 procedures, practices and standards for actions by the office of medicaid inspector general and social services districts The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 30 of the public health law, as added by chapter 2 442 of the laws of 2006, is amended to read as follows: 3 § 30. Legislative intent. This title establishes an independent office 4 of Medicaid inspector general within the department to consolidate staff 5 and other Medicaid fraud detection, prevention and recovery functions 6 from the relevant governmental entities into a single office, and grants 7 such office new powers and responsibilities. As such, this title is 8 intended to create a more efficient and accountable structure, dramat- 9 ically reorganize and streamline the state's process of detecting and 10 combating Medicaid fraud and abuse and maximize the recoupment of 11 improper Medicaid payments. 12 The legislature recognizes the need to balance the ability of the 13 state to ensure the integrity of the medical assistance program with the 14 need to afford due process to providers and recipients who are investi- 15 gated, audited or subject to other actions, in order to ensure that such 16 actions are conducted in a fair and consistent manner. The legislature 17 also recognizes the need for established statutory standards regarding 18 the conduct of investigations, audits and recovery of payments and other 19 actions. 20 § 2. Section 30-a of the public health law is amended by adding four 21 new subdivisions 4, 5, 6 and 7 to read as follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD07895-09-1S. 3184--A 2 1 4. "Provider" means any person or entity enrolled as a provider in the 2 medical assistance program. 3 5. "Recipient" means an individual who is enrolled in the medical 4 assistance program, including an individual who was previously a recipi- 5 ent and, in an appropriate case, an individual who is legally responsi- 6 ble for the recipient. 7 6. "Medical assistance" and "Medicaid" means title eleven of article 8 five of the social services law and the program thereunder. 9 7. "Draft audit report", "initial audit report", "proposed notice of 10 agency action" and "final notice of agency action" means those documents 11 prepared and issued by the inspector under this title and corresponding 12 regulations. 13 § 3. Subdivision 20 of section 32 of the public health law, as added 14 by chapter 442 of the laws of 2006, is amended to read as follows: 15 20. to, consistent with provisions of this title and other applicable 16 federal and state laws, regulations, policies, guidelines and standards, 17 implement and amend, as needed, rules and regulations relating to the 18 prevention, detection, investigation and referral of fraud and abuse 19 within the medical assistance program and the recovery of improperly 20 expended medical assistance program funds; 21 § 4. The public health law is amended by adding two new sections 37 22 and 38 to read as follows: 23 § 37. Procedures, practices and standards. 1. Subject to federal law 24 or regulation, recovery of an overpayment resulting from the issuance of 25 a final audit report or final notice of agency action relating to a 26 monetary penalty by the inspector shall commence not less than sixty 27 days after the issuance of the final audit report or final notice of 28 agency action. The inspector shall not commence any recovery under this 29 subdivision without providing a minimum of ten days advance written 30 notice to the provider. 31 2. Contracts, cost reports, claims, bills or expenditures of medical 32 assistance program funds that were the subject matter of a previous 33 audit or review by or on behalf of the inspector, within the last three 34 years, shall not be subject to review or audit except on the basis of 35 new information, for good cause to believe that the previous review or 36 audit was erroneous, or where the scope of the inspector's review or 37 audit is significantly different from the scope of the previous review 38 or audit, and shall not be subject to a new audit. 39 3. In conducting audits, the inspector shall apply the laws, regu- 40 lations, policies, guidelines, standards and interpretations of the 41 appropriate agency that were in place at the time the subject claim 42 arose or other conduct took place. Disallowances may be imposed or 43 other action taken only for non-compliance with those laws, regulations, 44 policies, guidelines or standards. For purposes of this subdivision, any 45 change in such laws, regulations, policies, guidelines, standards or 46 interpretations shall only be applied prospectively and upon reasonable 47 notice. 48 4. (a) The inspector shall make no recovery from a provider, based on 49 an administrative or technical defect in procedure or documentation made 50 without intent to falsify or defraud, in connection with claims for 51 payment for medically necessary care, services and supplies or the cost 52 thereof as specified in subdivision two of section three hundred sixty- 53 five-a of the social services law provided in other respects appropri- 54 ately to a beneficiary of the medical assistance program, except as 55 provided in paragraph (b) of this subdivision.S. 3184--A 3 1 (b) Where the basis for recovery is an administrative or technical 2 defect in procedure or documentation without intent to falsify or 3 defraud, the inspector shall afford the provider an opportunity to 4 correct the defect and resubmit the claim within thirty days of notice 5 of the defect. 6 5. (a) The inspector shall furnish to the provider at an audit exit 7 conference or in any draft audit findings issued or to be issued to the 8 provider, a detailed written explanation of the extrapolation method 9 employed, including the size of the sample, the sampling methodology, 10 the defined universe of claims, the specific claims included in the 11 sample, the results of the sample, the assumptions made about the accu- 12 racy and reliability of the sample and the level of confidence in the 13 sample results, and the steps undertaken and statistics utilized to 14 calculate the alleged overpayment and any applicable offset based on the 15 sample results. This written information shall include a description of 16 the sampling and extrapolation methodology. 17 (b) The sampling and extrapolation methodologies used by the inspector 18 shall be statistically reasonably valid for the intended use and shall 19 be established in regulations of the inspector. 20 § 38. Procedures, practices and standards for recipients. 1. This 21 section applies to any adjustment or recovery of a medical assistance 22 payment from a recipient, and any investigation or other proceeding 23 relating thereto. 24 2. At least five business days prior to commencement of any interview 25 with a recipient as part of an investigation, the inspector or other 26 investigating entity shall provide the recipient with written notice of 27 the investigation. The notice of the investigation shall set forth the 28 basis for the investigation; the potential for referral for criminal 29 investigation; the individual's right to be accompanied by a relative, 30 friend, advocate or attorney during questioning; contact information for 31 local legal services offices; the individual's right to decline to be 32 interviewed or participate in an interview but terminate the questioning 33 at any time without loss of benefits; and the right to a fair hearing in 34 the event that the investigation results in a determination of incorrect 35 payment. 36 3. Following completion of the investigation and at least thirty days 37 prior to commencing a recovery or adjustment action or requesting volun- 38 tary repayment, the inspector or other investigating entity shall 39 provide the recipient with written notice of the determination of incor- 40 rect payment to be recovered or adjusted. The notice of determination 41 shall identify the evidence relied upon, set forth the factual conclu- 42 sions of the investigation, and explain the recipient's right to request 43 a fair hearing in order to contest the outcome of the investigation. The 44 explanation of the right to a fair hearing shall conform to the require- 45 ments of subdivision twelve of section twenty-two of the social services 46 law and regulations thereunder. 47 4. A fair hearing under section twenty-two of the social services law 48 shall be available to any recipient who receives a notice of determi- 49 nation under subdivision three of this section, regardless of whether 50 the recipient is still enrolled in the medical assistance program. 51 § 5. Paragraph (b) of subdivision 3 of section 363-d of the social 52 services law, as amended by section 44 of part C of chapter 58 of the 53 laws of 2007, is amended and a new subdivision 5 is added to read as 54 follows: 55 (b) In the event that the commissioner of health or the Medicaid 56 inspector general finds that the provider does not have a satisfactoryS. 3184--A 4 1 program [within ninety days after the effective date of the regulations2issued pursuant to subdivision four of this section, the] under this 3 section, the commissioner or Medicaid inspector general shall so notify 4 the provider, including specification of basis of the finding sufficient 5 to enable the provider to adopt a satisfactory compliance program. The 6 provider shall submit to the commissioner or Medicaid inspector general 7 a proposed satisfactory compliance program within sixty days of the 8 notice and shall adopt the program as expeditiously as possible. If the 9 provider does not propose and adopt a satisfactory program in such time 10 period, the provider may be subject to any sanctions or penalties 11 permitted by federal or state laws and regulations, including revocation 12 of the provider's agreement to participate in the medical assistance 13 program. 14 5. Any regulation, determination or finding of the commissioner or the 15 Medicaid inspector general relating to a compliance program under this 16 section shall be subject to and consistent with subdivision three of 17 this section. 18 § 6. This act shall take effect October 1, 2011 and shall apply to any 19 matter commenced or pending on or after such date. However with respect 20 to any matter pending on or after such date, this act shall not invali- 21 date any actions or steps taken or commenced prior to such date and 22 shall only apply to actions or steps commenced on or after such date.