senate Bill S6494

Amended

Relates to automated payment detection, prevention and recovery solutions to reduce correctional healthcare overpayments, billed for eligible services

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Sponsor

Bill Status


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

  • 29 / Jan / 2014
    • REFERRED TO CRIME VICTIMS, CRIME AND CORRECTION
  • 05 / May / 2014
    • AMEND (T) AND RECOMMIT TO CRIME VICTIMS, CRIME AND CORRECTION
  • 05 / May / 2014
    • PRINT NUMBER 6494A
  • 14 / May / 2014
    • REPORTED AND COMMITTED TO FINANCE
  • 11 / Jun / 2014
    • COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • 11 / Jun / 2014
    • ORDERED TO THIRD READING CAL.1341
  • 12 / Jun / 2014
    • PASSED SENATE
  • 12 / Jun / 2014
    • DELIVERED TO ASSEMBLY
  • 12 / Jun / 2014
    • REFERRED TO CORRECTION

Summary

Relates to the development and implementation of automated payment detection, prevention and recovery solutions to reduce correctional healthcare overpayments, and requires that private health insurance and Medicaid are billed for eligible inpatient hospital and professional services.

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Bill Details

See Assembly Version of this Bill:
A8332A
Versions:
S6494
S6494A
Legislative Cycle:
2013-2014
Current Committee:
Law Section:
Correction Law
Laws Affected:
Add ยง140-a, Cor L

Sponsor Memo

BILL NUMBER:S6494

TITLE OF BILL: An act to amend the correction law, in relation to the
development and implementation of automated payment detection,
prevention and recovery solutions to reduce correctional healthcare
overpayments, and to require that private health insurance providers
and Medicaid are billed for eligible inpatient hospital and
professional services

PURPOSE OR GENERAL IDEA OF BILL:

This bill seeks to prevent Medicaid fraud within correctional
facilities, ensuring that patients receive proper services.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 lists that states that have implemented a similar bill have
saved "millions of dollars" and reduced healthcare costs by billing
private health insurance providers and Medicaid for eligible inpatient
healthcare costs. This would apply to all state correctional
facilities.

Section 2 defines the technological services that would be provided to
prevent errors and potential overbilling.

Section 3 details the procedures that would be taken to prevent fraud.

Section 4 states that the savings of this service will be used towards
administration and operation.

JUSTIFICATION:

This will seek to prevent the overcharging of Correctional healthcare
overpayments.

PRIOR LEGISLATIVE HISTORY:

New bill

FISCAL IMPLICATIONS:

To be determined.

EFFECTIVE DATE:

This act shall take effect on the first day of January next succeeding
the date upon which it shall have become a law.

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

                                  6494

                            I N  S E N A T E

                            January 29, 2014
                               ___________

Introduced  by  Sen.  RANZENHOFER -- read twice and ordered printed, and
  when printed to be committed to the Committee on Crime Victims,  Crime
  and Correction

AN  ACT  to amend the correction law, in relation to the development and
  implementation of automated payment detection, prevention and recovery
  solutions to  reduce  correctional  healthcare  overpayments,  and  to
  require  that  private  health  insurance  providers  and Medicaid are
  billed for eligible  inpatient hospital and professional services

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

  Section  1.  Legislative  intent.  Other states have saved millions of
dollars by implementing solutions to eliminate and recover  correctional
healthcare  overpayments  and  significantly  have  reduced correctional
healthcare costs by billing private health insurance providers and Medi-
caid for eligible inpatient healthcare costs. New York  can  benefit  by
implementing  similar  measures.  It is the intent of the legislature to
implement automated payment detection, prevention and recovery solutions
to reduce correctional  healthcare  overpayments,  and  to  ensure  that
private  insurance  companies and Medicaid are billed for eligible inpa-
tient hospital and professional services.
  S 2. The correction law is amended by adding a new  section  140-a  to
read as follows:
  S  140-A.    HEALTHCARE PAYMENTS; BILLING PRIVATE HEALTH INSURANCE AND
MEDICAID. 1. UNLESS OTHERWISE STATED, THE  PROVISIONS  OF  THIS  SECTION
APPLY  TO  ALL  STATE  CORRECTIONAL  HEALTHCARE SYSTEMS AND SERVICES AND
STATE CONTRACTED MANAGED CORRECTIONAL HEALTHCARE SERVICES.
  2.  THE  DEPARTMENT  SHALL  IMPLEMENT  AUTOMATED  PAYMENT   DETECTION,
PREVENTION, AND RECOVERY PROCEDURES TO ENSURE THAT PRIVATE HEALTH INSUR-
ANCE  OR  MEDICAID IS BILLED FOR ELIGIBLE INPATIENT HOSPITAL AND PROFES-
SIONAL HEALTHCARE SERVICES.  THESE PROCEDURES MUST INCLUDE, BUT ARE  NOT
LIMITED  TO, CLINICAL CODE EDITING TECHNOLOGY TO FURTHER AUTOMATE CLAIMS
RESOLUTION AND ENHANCE COST CONTAINMENT THROUGH IMPROVED CLAIM  ACCURACY
AND APPROPRIATE CODE CORRECTION. EDITS PERFORMED BY THIS TECHNOLOGY MUST
BE  APPLIED  AUTOMATICALLY  BEFORE  THE ADJUDICATION OF CLAIMS, AND THIS

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13172-03-4

S. 6494                             2

TECHNOLOGY MUST IDENTIFY AND PREVENT ERRORS  AND  POTENTIAL  OVERBILLING
BASED  ON  WIDELY ACCEPTED PROTOCOLS, SUCH AS THOSE USED BY THE AMERICAN
MEDICAL ASSOCIATION AND THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.
  3. THE DEPARTMENT SHALL IMPLEMENT CORRECTIONAL HEALTHCARE CLAIMS AUDIT
AND  RECOVERY  PROCEDURES  TO  IDENTIFY  IMPROPER  PAYMENTS  MADE DUE TO
NON-FRAUDULENT ISSUES. PROCEDURES THAT MUST BE IMPLEMENTED INCLUDE,  BUT
ARE  NOT  LIMITED  TO,  OBTAINING PROVIDER SIGN-OFF ON AUDIT RESULTS AND
CONDUCTING POST PAYMENT REVIEWS TO ENSURE THAT THE DIAGNOSES AND  PROCE-
DURE CODES ARE ACCURATE AND VALID BASED ON SUPPORTING PHYSICIAN DOCUMEN-
TATION  WITHIN  THE  MEDICAL  RECORDS.  CORE  CATEGORIES  OF REVIEWS MAY
INCLUDE, BUT ARE NOT LIMITED TO,  CODING  COMPLIANCE  DIAGNOSIS  RELATED
GROUP  (DRG)  REVIEWS,  TRANSFERS,  READMISSIONS,  COST OUTLIER REVIEWS,
OUTPATIENT SEVENTY-TWO-HOUR RULE REVIEWS, PAYMENT ERRORS, AND BILLING.
  4. THE DEPARTMENT MAY CONTRACT TO HAVE SERVICES PERFORMED TO CARRY OUT
THE REQUIREMENTS OF THIS SECTION,  AND  THE  SAVINGS  GENERATED  BY  THE
PERFORMANCE  OF THESE SERVICES MUST BE USED FOR THE OPERATION AND ADMIN-
ISTRATION OF THIS SECTION, INCLUDING SECURING  THE  TECHNOLOGY  SERVICES
REQUIRED  BY  THIS SECTION. TO FURTHER ACHIEVE THESE SAVINGS, CONTRACTOR
REIMBURSEMENT MAY BE BASED UPON A  PERCENTAGE  OF  AN  ACHIEVED  SAVINGS
MODEL,  A  PER  BENEFICIARY  PER MONTH MODEL, A PER TRANSACTION MODEL, A
CASE-RATE  MODEL,  OR  ANY  COMBINATION  OF  THESE  MODELS.   CONTRACTOR
REIMBURSEMENT  MODELS  ALSO  MAY  INCLUDE  PERFORMANCE GUARANTEES OF THE
CONTRACTOR TO ENSURE SAVINGS IDENTIFIED EXCEED PROGRAM COSTS.
  S 3. This act shall take effect on the first of January next  succeed-
ing the date on which it shall become a law.

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