senate Bill S4384D

Establishes the Medicaid identification and anti-fraud biometric technology program

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Bill Status


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor
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actions

  • 04 / Apr / 2011
    • REFERRED TO HEALTH
  • 13 / Apr / 2011
    • AMEND (T) AND RECOMMIT TO HEALTH
  • 13 / Apr / 2011
    • PRINT NUMBER 4384A
  • 03 / Jun / 2011
    • AMEND (T) AND RECOMMIT TO HEALTH
  • 03 / Jun / 2011
    • PRINT NUMBER 4384B
  • 07 / Jun / 2011
    • REPORTED AND COMMITTED TO FINANCE
  • 16 / Jun / 2011
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 16 / Jun / 2011
    • ORDERED TO THIRD READING CAL.1340
  • 17 / Jun / 2011
    • PASSED SENATE
  • 17 / Jun / 2011
    • DELIVERED TO ASSEMBLY
  • 17 / Jun / 2011
    • REFERRED TO HEALTH
  • 04 / Jan / 2012
    • DIED IN ASSEMBLY
  • 04 / Jan / 2012
    • RETURNED TO SENATE
  • 04 / Jan / 2012
    • REFERRED TO HEALTH
  • 01 / Feb / 2012
    • AMEND AND RECOMMIT TO HEALTH
  • 01 / Feb / 2012
    • PRINT NUMBER 4384C
  • 08 / Feb / 2012
    • AMEND AND RECOMMIT TO HEALTH
  • 08 / Feb / 2012
    • PRINT NUMBER 4384D

Summary

Establishes the "Medicaid identification and anti-fraud biometric technology program", requiring the department of health, in consultation with the office of the medicaid inspector general and the office of the attorney general to implement a program requiring the use of biometric technology, as a means of identification and for use as an anti-fraud application in the Medicaid program.

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Bill Details

See Assembly Version of this Bill:
A6555F
Versions:
S4384
S4384A
S4384B
S4384C
S4384D
Legislative Cycle:
2011-2012
Current Committee:
Senate Health
Law Section:
Public Health Law
Laws Affected:
Add Art 2-B §§290 - 293, Pub Health L; amd §367-b, Soc Serv L

Sponsor Memo

BILL NUMBER:S4384D

TITLE OF BILL:
An act
to amend the public health law, in relation to establishing the Medicaid
identification and anti-fraud biometric technology program;
and
to amend the social services law, in relation to conforming medical
assistance identification with the Medicaid identification and
anti-fraud biometric technology program

PURPOSE OR GENERAL IDEA OF THE BILL:
Establishes the Medicaid
Identification and Antifraud Biometric Technology Program.

SUMMARY OF SPECIFIC PROVISIONS:
The Public Health Law is amended by
adding a new article 2-b to provide that the Department of Health
shall develop a request for proposals to implement a program using
biometric technology in hospitals, clinics and pharmacies for the
purpose of patient and provider identification to fight fraud in the
Medicaid program; sets time frames for such request; and requires the
Department of Health to report to the Governor, Senate and Assembly
as to the progress of implementing a biometric identification program.

Section 2: Amends the Social Services Law to require the Social
Services Department to conform its systems with the new Medicaid
Identification and Antifraud Biornetric Identification Program when
available.

Section 3: Provides that this act shall take effect immediately.

JUSTIFICATION:
New York will spend over $54 billion dollars this
fiscal year (2011-2012) on Medicaid and experts estimate that as much
as 10%, or over $5 billion, is spent on fraudulent services and
claims for Medicaid services. New York cannot afford to continue to
pay for such improper and fraudulent claims. Rather than reducing
payments for vital services for our children and most infirm elderly,
we should more aggressively address the billions of dollars lost to
fraud by utilizing modem and effective identification technology.
This legislation will require the Department of Health to develop
result-oriented guidelines and seek requests for proposals to
implement a modem fraud prevention program in hospitals, clinics and
pharmacies all across New York relying on biometric technology. There
are many companies offering various types of biometric identification
systems that are already in common use by private industry and
governmental agencies.

The request for proposals shall focus on results to be obtained,
rather than specific technology, to allow the State to consider the

many technologies that have been developed. These technologies can
use relatively inexpensive software and hardware that has already
been developed and proven to save New York billions of dollars
annually in fraud prevention. The request must also specify that any
proposal must be revenue neutral from inception, whereby program
costs are at least offset by savings from inception, and shall have
as a primary goal reduction in Medicaid expenditures through
elimination of fraud and abuse.

Biometrics is the science and technology of measuring and analyzing
biological data. In information technology, biometrics refers to
technologies that measure and analyze human body characteristics,
such as DNA, fingerprints, eye retinas and irises, voice patterns,
facial patterns and hand measurements, for authentication purposes.
The identification issued to Medicaid recipients and providers will
contain biometric markers for verification that a recipient is
eligible for the service requested, and confirm that the provider
actually provides the service. Such identification can be made at the
beginning and end of a transaction before payment is ever made,
instead of relying on the current system of "pay and chase" where law
enforcement and court action is required to recoup improper Medicaid
payments after they have been made.

PRIOR LEGISLATIVE HISTORY:
2011 - S.4384-B/A.6555-B -- PASSED SENATE/Health

FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT:
Will generate
substantial savings, perhaps as much as $5 billion annually by
preventing health care fraud and improper payments.

EFFECTIVE DATE:
This act shall take effect immediately.

view bill text
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 4384--D

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                              April 4, 2011
                               ___________

Introduced  by  Sens.  RANZENHOFER, ADDABBO, DeFRANCISCO, LARKIN, YOUNG,
  ZELDIN -- 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  commit-
  tee  --  committee  discharged,  bill  amended,  ordered  reprinted as
  amended and recommitted  to  said  committee  --  recommitted  to  the
  Committee  on  Health  in  accordance  with  Senate  Rule 6, sec. 8 --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted  to  said committee -- committee discharged, bill amended,
  ordered reprinted as amended and recommitted to said committee

AN ACT to amend the public health law, in relation to  establishing  the
  Medicaid  identification  and anti-fraud biometric technology program;
  and to amend the  social  services  law,  in  relation  to  conforming
  medical assistance identification with the Medicaid identification and
  anti-fraud biometric technology program

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. The public health law is amended by adding  a  new  article
2-B to read as follows:
                                ARTICLE 2-B
            MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC
                           TECHNOLOGY PROGRAM
SECTION 290. MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC TECHNOLOGY
               PROGRAM.
        291. DEFINITIONS.
        292. BIOMETRIC TECHNOLOGY USE REQUIREMENT.
        293. RULES AND REGULATIONS.
  S  290.  MEDICAID  IDENTIFICATION  AND ANTI-FRAUD BIOMETRIC TECHNOLOGY
PROGRAM. THERE IS HEREBY ESTABLISHED  IN  THE  DEPARTMENT  THE  MEDICAID
IDENTIFICATION AND ANTI-FRAUD BIOMETRIC TECHNOLOGY PROGRAM.
  S 291. DEFINITIONS. AS USED IN THIS ARTICLE:
  1.  "BIOMETRIC TECHNOLOGY" MEANS TECHNOLOGY THAT MEASURES AND ANALYZES
BIOLOGICAL DATA, INCLUDING BUT  NOT  LIMITED  TO  DNA,  FINGER  IMAGING,

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09573-14-2

S. 4384--D                          2

VASCULAR  PATTERNS,  EYE  RETINAS  AND  IRISES,  VOICE  PATTERNS, FACIAL
PATTERNS AND HAND MEASUREMENTS, FOR AUTHENTICATION PURPOSES.
  2.    "BIOMETRIC  VERIFICATION DEVICE" MEANS A DEVICE CAPABLE OF USING
BIOMETRIC VERIFICATION TECHNOLOGY TO VERIFY THE IDENTITY OF  A  MEDICAID
RECIPIENT OR PROVIDER.
  S  292.  BIOMETRIC  TECHNOLOGY  USE REQUIREMENT. 1. THE DEPARTMENT, IN
CONSULTATION WITH THE OFFICE OF THE MEDICAID INSPECTOR GENERAL  AND  THE
OFFICE OF THE ATTORNEY GENERAL, SHALL DEVELOP A REQUEST FOR PROPOSALS TO
IMPLEMENT  A PROGRAM REQUIRING THE USE OF BIOMETRIC TECHNOLOGY BY HOSPI-
TALS, CLINICS AND PHARMACIES, FOR THE PURPOSES OF PATIENT  AND  PROVIDER
IDENTIFICATION  AND FOR USE AS AN ANTI-FRAUD APPLICATION IN THE MEDICAID
PROGRAM.
  2. SUCH REQUEST FOR PROPOSALS SHALL INCLUDE  AT  A  MINIMUM  THAT  (A)
MEDICAID RECIPIENTS AND PROVIDERS SHALL PROVIDE BIOMETRIC PROOF OF THEIR
IDENTITY  ALONG  WITH  OTHER INFORMATION DEEMED NECESSARY BY THE COMMIS-
SIONER.
  (B) SUCH PROGRAM WILL BE CAPABLE OF STORING BIOMETRIC  MARKERS  AND  A
LOG  OF  DOCTOR AND PHARMACY VISITS FOR EACH SERVICE BILLED TO THE MEDI-
CAID PROGRAM.
  (C) MEDICAID IDENTIFICATION SHALL BE ISSUED TO  AND  ACCEPTED  BY  THE
ADMITTING  STAFF  OF  HEALTH  CARE  FACILITIES,  MEDICAL STAFF PROVIDING
SERVICE TO MEDICAID RECIPIENTS AND PHARMACY STAFF.
  (D) MEDICAID RECIPIENTS SHALL BE REQUIRED TO PROVIDE  BIOMETRIC  PROOF
OF  IDENTIFY  AT THE TIME OF EACH VISIT TO A DOCTORS OFFICE OR CLINIC AT
THE POINT OF ACTUALLY BEING SEEN BY THE DOCTOR OR  CLINICAL  STAFF,  AND
SHALL  AGAIN  PROVIDE  PROOF  OF  IDENTITY  UPON  COMPLETION  OF CARE OR
SERVICES.
  (E) BIOMETRIC VERIFICATION DEVICES SHALL  BE  USED  IN  PHARMACIES  TO
VERIFY  THE  IDENTITY  OF THE MEDICAID RECIPIENT AND THE VALIDITY OF THE
MEDICAID  COVERAGE  PRIOR  TO  OR  IN   CONJUNCTION   WITH   FILLING   A
PRESCRIPTION.
  (F)   PROVISIONS   SHALL   BE   INCLUDED  FOR  EMERGENCY  SERVICES  OR
PRESCRIPTIONS AND ALTERNATE IDENTIFICATION METHODS FOR MEDICAID  RECIPI-
ENTS PHYSICALLY OR MENTALLY UNABLE TO PROVIDE BIOMETRIC IDENTIFICATION.
  (G) FRAUD PREVENTION MARKERS INCORPORATED INTO SOFTWARE WHICH SHALL BE
USED TO OPERATE THE HARDWARE COMPONENT OF THE BIOMETRIC TECHNOLOGY SHALL
PREVENT  AND/OR REJECT THE PAYMENT BY THE MEDICAID PROGRAM AND ALERT THE
SERVICE PROVIDER AT POINT OF SERVICE IF  FRAUD  OR  POTENTIAL  FRAUD  IS
IDENTIFIED BY THE BIOMETRIC TECHNOLOGY SYSTEM.
  (H)  PROVISIONS  SHALL  BE INCLUDED TO ENSURE THAT MEDICAID RECIPIENTS
HAVE ACCESS TO EMERGENCY HEALTH SERVICES IN  THE  CASE  OF  A  BIOMETRIC
TECHNOLOGY SYSTEM MALFUNCTION OR FRAUD DETECTION ALARM.
  (I)  EVALUATION AND SELECTION OF AN IDENTIFY CREDENTIALING SYSTEM THAT
ADDRESSES THE REQUIREMENTS OF MEDICAID BENEFICIARIES AND PROVIDERS SHALL
BE BASED  ON  THE  FOLLOWING  CRITERIA:  SECURITY,  PRIVACY,  USABILITY,
PERFORMANCE,  HYGIENE,  BIOMETRIC  CAPTURE AND STORAGE REQUIREMENTS, AND
INTEROPERABILITY.
  3. SUCH REQUEST FOR PROPOSALS SHALL SET FORTH REQUIREMENTS AS  TO  THE
RESULTS AND GOALS TO BE ACHIEVED, RATHER THAN SPECIFIC TECHNICAL METHODS
OR  SYSTEMS,  TO  ALLOW  CONSIDERATION  OF THE WIDEST POSSIBLE CHOICE OF
AVAILABLE TECHNOLOGY.
  4. SUCH REQUEST FOR PROPOSALS SHALL  REQUIRE:  (A)  THAT  THE  PROGRAM
SHALL  BE  REVENUE NEUTRAL FROM INCEPTION, WHEREBY ANY PROGRAM COSTS ARE
AT LEAST OFFSET BY STATE MEDICAID SAVINGS, AND SHALL HAVE AS  A  PRIMARY
GOAL REDUCTION OF MEDICAID EXPENDITURES THROUGH ELIMINATION OF FRAUD AND
ABUSE;  AND (B) THAT THE PROGRAM SHALL BE COST NEUTRAL TO PROVIDERS FROM

S. 4384--D                          3

INCEPTION, WHEREBY ANY PROVIDER COSTS ARE AT LEAST  OFFSET  BY  PROVIDER
SAVINGS,  AND  SHALL  HAVE  AS  A  PRIMARY GOAL PROVIDER SAVINGS THROUGH
INCREASED EFFICIENCIES.
  5.  (A) SUCH REQUEST FOR PROPOSALS FOR THE IMPLEMENTATION OF A PROGRAM
FOR BIOMETRIC TECHNOLOGY USE SHALL BE PUBLISHED  ON  OR  BEFORE  JANUARY
FIFTEENTH, TWO THOUSAND THIRTEEN, AND SHALL PROVIDE THAT PROPOSALS SHALL
BE OPENED ON OR BEFORE MARCH FIRST, TWO THOUSAND THIRTEEN.
  (B) THE COMMISSIONER SHALL REPORT TO THE GOVERNOR, THE TEMPORARY PRES-
IDENT  OF  THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE MARCH
THIRTIETH, TWO THOUSAND THIRTEEN WITH REGARD TO THE PROGRESS MADE IN THE
DEVELOPMENT OF CRITERIA FOR A PROGRAM OF BIOMETRIC IDENTIFICATION AND OF
THE IMPLEMENTATION OF SUCH PROGRAM.
  S 293. RULES AND  REGULATIONS.  THE  COMMISSIONER  IS  AUTHORIZED  AND
DIRECTED  TO PROMULGATE SUCH RULES AND REGULATIONS AS HE OR SHE MAY DEEM
NECESSARY OR APPROPRIATE TO EFFECTUATE THE PURPOSES OF THIS ARTICLE.
  S 2.  Subdivision 1 of section 367-b of the social  services  law,  as
added by chapter 639 of the laws of 1976, is amended to read as follows:
  1.  The  department,  IN CONSULTATION WITH THE COMMISSIONER OF HEALTH,
shall design and implement a statewide  medical  assistance  information
and  payments  system for the purpose of providing individual and aggre-
gate data to social services districts to assist them  in  making  basic
management  decisions,  to  the  department  and other state agencies to
assist in the administration of the medical assistance program,  and  to
the governor and the legislature as may be necessary to assist in making
major  administrative and policy decisions affecting such program.  Such
system shall be designed so as to be capable of the following:
  a. receiving and processing information relating to the eligibility of
each person applying for medical assistance and  of  issuing  a  medical
assistance  identification card, AND WHEN AVAILABLE UTILIZING THE BIOME-
TRIC IDENTIFICATION ISSUED BY THE DEPARTMENT OF  HEALTH,  CONFORMING  TO
THE REQUIREMENTS SET FORTH IN THE MEDICAID IDENTIFICATION AND ANTI-FRAUD
BIOMETRIC  TECHNOLOGY  PROGRAM  ESTABLISHED PURSUANT TO ARTICLE TWO-B OF
THE PUBLIC HEALTH LAW to persons determined by a social  services  offi-
cial to be eligible for such assistance;
  b.    ACTIVATING  MEDICAL  ASSISTANCE  IDENTIFICATION  BY REQUIRING AN
APPLICANT RECEIVING SUCH IDENTIFICATION FROM THE DEPARTMENT TO  HAVE  IT
VERIFIED  AT  A  SOCIAL  SERVICES DISTRICT OFFICE IN THE SOCIAL SERVICES
DISTRICT IN WHICH THE APPLICANT RESIDES;
  C. receiving and processing information  relating  to  each  qualified
provider of medical assistance furnishing care, services or supplies for
which claims for payment are made pursuant to this title;
  [c.]  D.  receiving and processing, in a form and manner prescribed by
the department, all claims for medical care, services and supplies,  and
making  payments for valid claims to providers of medical care, services
and supplies on behalf of social services districts; AND
  [d.] E. maintaining information necessary  to  allow  the  department,
consistent  with  the  powers and duties of the department of health, to
review the appropriateness, scope and duration of medical care, services
and supplies provided to any eligible person pursuant to this  chapter[;
and
  e.  initiating  implementation  of  such  a  system  for  the district
comprising the city of New York, in a manner compatible  with  expansion
of  such system to districts other than the district comprising the city
of New York].
  S 3.  This act shall take effect immediately.

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