Assembly Bill A6813C

2023-2024 Legislative Session

Relates 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

download bill text pdf

Sponsored By

Current Bill Status - In Assembly Committee


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Delivered to Governor
  • Signed By Governor

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Bill Amendments

co-Sponsors

2023-A6813 - Details

See Senate Version of this Bill:
S5329
Current Committee:
Assembly Ways And Means
Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-A6813 - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-A6813 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6813
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                May 8, 2023
                                ___________
 
 Introduced  by  M.  of  A.  PAULIN, L. ROSENTHAL, VANEL -- read once and
   referred to the Committee on Health
 
 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:
 
   Section 1. Section 30-a of the public health law is amended by  adding
 three new subdivisions 4, 5, and 6 to read as follows:
   4.  "MEDICAL  ASSISTANCE,"  "MEDICAID," AND "RECIPIENT" SHALL HAVE THE
 SAME MEANING AS THOSE TERMS IN TITLE  ELEVEN  OF  ARTICLE  FIVE  OF  THE
 SOCIAL  SERVICES  LAW  AND SHALL INCLUDE ANY PAYMENTS TO PROVIDERS UNDER
 ANY MEDICAID MANAGED CARE PROGRAM.
   5. "PROVIDER" MEANS ANY PERSON OR ENTITY ENROLLED AS A PROVIDER IN THE
 MEDICAL ASSISTANCE PROGRAM.
   6. "OVERPAYMENT" SHALL MEAN ANY AMOUNT PAID TO A PROVIDER FOR  MEDICAL
 ASSISTANCE  IN  EXCESS  OF THE AMOUNT ALLOWABLE UNDER THE STATE PLAN FOR
 MEDICAL ASSISTANCE IN EFFECT AT THE TIME OF SUCH SERVICE,  OR  ALLOWABLE
 UNDER  ANY  FEDERALLY  APPROVED  MEDICAID  WAIVER, EXPERIMENT, PILOT, OR
 DEMONSTRATION PROJECT. AN OVERPAYMENT SHALL NOT INCLUDE CIRCUMSTANCES OF
 PROVIDER  NONCOMPLIANCE  WITH  STATE  LAWS,  REGULATIONS  OR  APPLICABLE
 PROMULGATED  STATE  AGENCY POLICIES, GUIDELINES, STANDARDS, PROTOCOLS OR
 INTERPRETATIONS WHICH ARE NOT A CONDITION OF PAYMENT, UNLESS THE PROVID-
 ER OBTAINED PAYMENT BY FRAUD OR DECEIT, OR WHERE THE PROVIDER WAS PREVI-
 OUSLY PROVIDED NOTICE OF ITS FAILURE TO COMPLY AND HAS FAILED TO CORRECT
 SUCH NONCOMPLIANCE.  AN OVERPAYMENT SHALL NOT INCLUDE NONCOMPLIANCE WITH
 ANY APPLICABLE PROMULGATED STATE AGENCY POLICIES, GUIDELINES, STANDARDS,
 PROTOCOLS OR INTERPRETATIONS WHERE  SUCH  POLICY,  GUIDELINE,  STANDARD,
 PROTOCOL  OR  INTERPRETATION  IS  FACIALLY,  OR  AS  APPLIED, REASONABLY
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10461-01-3
 A. 6813                             2
              

co-Sponsors

2023-A6813A - Details

See Senate Version of this Bill:
S5329
Current Committee:
Assembly Ways And Means
Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-A6813A - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-A6813A - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6813--A
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                May 8, 2023
                                ___________
 
 Introduced  by  M.  of  A. PAULIN, L. ROSENTHAL, VANEL, SIMON, McDONALD,
   JACOBSON, GUNTHER, SANTABARBARA, KELLES,  McMAHON  --  read  once  and
   referred  to  the  Committee on Health -- reported and referred to the
   Committee on Ways and Means -- recommitted to the  Committee  on  Ways
   and  Means  in  accordance  with  Assembly Rule 3, sec. 2 -- 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:
 
   Section 1. Section 30-a of the public health law, as added by  chapter
 442 of the laws of 2006, is amended to read as follows:
   §  30-a.  Definitions.  For  the purposes of this title, the following
 definitions shall apply:
   1. "ABUSE" MEANS PROVIDER PRACTICES THAT ARE INCONSISTENT  WITH  SOUND
 FISCAL, BUSINESS OR MEDICAL PRACTICES, AND RESULT IN AN UNNECESSARY COST
 TO  THE  MEDICAID PROGRAM, OR IN REIMBURSEMENT FOR SERVICES THAT ARE NOT
 MEDICALLY NECESSARY OR THAT FAIL TO MEET PROFESSIONALLY RECOGNIZED STAN-
 DARDS FOR HEALTH CARE.  IT  ALSO  INCLUDES  BENEFICIARY  PRACTICES  THAT
 RESULT IN UNNECESSARY COST TO THE MEDICAID PROGRAM.
   2.  "CREDITABLE ALLEGATION OF FRAUD" (A) MEANS AN ALLEGATION WHICH HAS
 BEEN VERIFIED BY THE INSPECTOR,  FROM  ANY  SOURCE,  INCLUDING  BUT  NOT
 LIMITED TO THE FOLLOWING:
   I. FRAUD HOTLINES TIPS VERIFIED BY FURTHER EVIDENCE;
   II. CLAIMS DATA MINING; AND
   III.  PATTERNS  IDENTIFIED THROUGH PROVIDER AUDITS, CIVIL FALSE CLAIMS
 CASES, AND LAW ENFORCEMENT INVESTIGATIONS.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10461-02-4
 A. 6813--A                          2
              

co-Sponsors

2023-A6813B - Details

See Senate Version of this Bill:
S5329
Current Committee:
Assembly Ways And Means
Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-A6813B - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-A6813B - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6813--B
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                May 8, 2023
                                ___________
 
 Introduced  by  M.  of  A. PAULIN, L. ROSENTHAL, VANEL, SIMON, McDONALD,
   JACOBSON,  GUNTHER,  SANTABARBARA,  KELLES,  McMAHON,  GONZALEZ-ROJAS,
   BURDICK,  ZEBROWSKI,  JENSEN,  BEEPHAN, LUCAS, LUPARDO, STECK, ARDILA,
   SHIMSKY, WEPRIN, HEVESI, SEPTIMO, THIELE, LEVENBERG,  SIMONE,  BLUMEN-
   CRANZ, SEAWRIGHT, RAMOS, LAVINE, SAYEGH, GIBBS, TAPIA -- read once and
   referred  to  the  Committee on Health -- reported and referred to the
   Committee on Ways and Means -- recommitted to the  Committee  on  Ways
   and  Means  in  accordance  with  Assembly Rule 3, sec. 2 -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee -- recommitted to the Committee on Ways and Means in
   accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee
 
 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:
 
   Section 1. Section 30-a of the public health law, as added by  chapter
 442 of the laws of 2006, is amended to read as follows:
   §  30-a.  Definitions.  For  the purposes of this title, the following
 definitions shall apply:
   1. "ABUSE" MEANS PROVIDER PRACTICES THAT ARE INCONSISTENT  WITH  SOUND
 FISCAL, BUSINESS OR MEDICAL PRACTICES, AND RESULT IN AN UNNECESSARY COST
 TO  THE  MEDICAID PROGRAM, OR IN REIMBURSEMENT FOR SERVICES THAT ARE NOT
 MEDICALLY NECESSARY OR THAT FAIL TO MEET PROFESSIONALLY RECOGNIZED STAN-
 DARDS FOR HEALTH CARE.  IT  ALSO  INCLUDES  BENEFICIARY  PRACTICES  THAT
 RESULT IN UNNECESSARY COST TO THE MEDICAID PROGRAM.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10461-04-4
 A. 6813--B                          2
 
              

co-Sponsors

2023-A6813C (ACTIVE) - Details

See Senate Version of this Bill:
S5329
Current Committee:
Assembly Ways And Means
Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-A6813C (ACTIVE) - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-A6813C (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  6813--C
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                May 8, 2023
                                ___________
 
 Introduced  by  M.  of  A. PAULIN, L. ROSENTHAL, VANEL, SIMON, McDONALD,
   JACOBSON,  GUNTHER,  SANTABARBARA,  KELLES,  McMAHON,  GONZALEZ-ROJAS,
   BURDICK,  ZEBROWSKI,  JENSEN,  BEEPHAN, LUCAS, LUPARDO, STECK, ARDILA,
   SHIMSKY, WEPRIN, HEVESI, SEPTIMO, THIELE, LEVENBERG,  SIMONE,  BLUMEN-
   CRANZ,  SEAWRIGHT,  RAMOS,  LAVINE,  SAYEGH,  GIBBS,  TAPIA, BRABENEC,
   DINOWITZ, SILLITTI, RAGA, MEEKS, DAVILA,  BENDETT  --  read  once  and
   referred  to  the  Committee on Health -- reported and referred to the
   Committee on Ways and Means -- recommitted to the  Committee  on  Ways
   and  Means  in  accordance  with  Assembly Rule 3, sec. 2 -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee -- recommitted to the Committee on Ways and Means in
   accordance with Assembly Rule 3, sec. 2 -- committee discharged,  bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee -- recommitted to the Committee on Ways and  Means  in  accordance
   with  Assembly  Rule  3,  sec. 2 -- again reported from said committee
   with amendments, 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:
 
   Section  1. Section 30-a of the public health law, as added by chapter
 442 of the laws of 2006, is amended to read as follows:
   § 30-a. Definitions. For the purposes of  this  title,  the  following
 definitions shall apply:
   1.  "ABUSE"  MEANS PROVIDER PRACTICES THAT ARE INCONSISTENT WITH SOUND
 FISCAL, BUSINESS OR MEDICAL PRACTICES, AND RESULT IN AN UNNECESSARY COST
 TO THE MEDICAID PROGRAM, OR IN REIMBURSEMENT FOR SERVICES THAT  ARE  NOT
 MEDICALLY NECESSARY OR THAT FAIL TO MEET PROFESSIONALLY RECOGNIZED STAN-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10461-07-4
              

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