Assembly Bill A1084

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

                                  1084

                       2011-2012 Regular Sessions

                          I N  A S S E M B L Y

                               (PREFILED)

                             January 5, 2011
                               ___________

Introduced  by M. of A. DESTITO -- read once and referred to the Commit-
  tee on Health

AN ACT to amend the social services law, in relation  to  providing  for
  medicaid management

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

  Section 1. Paragraphs (d) and (e) of subdivision 1 of section 363-c of
the social services law, as amended by section 19 of part C  of  chapter
109 of the laws of 2006, are amended to read as follows:
  (d) opportunities for education and prevention; [and]
  (e)  ANNUALLY  THE  NUMBER  OF  PERSONS  ON  WAITING  LISTS TO RECEIVE
SERVICES AND THE TYPE OF SERVICES FOR EACH LIST; AND
  (F) the collective priority of critical needs for the  medicaid  popu-
lation.
  S  2.  Section  363-c  of the social services law is amended by adding
nine new subdivisions 4, 5, 6, 7, 8,  9,  10,  11  and  12  to  read  as
follows:
  4.  THE  DEPARTMENT SHALL DEVELOP OUTCOME RESULTS-BASED OBJECTIVES FOR
MEDICAID SERVICE AND ADMINISTRATIVE CONTRACTS WITH OTHER STATE AGENCIES.
REIMBURSEMENT SHALL BE BASED ON THE COMPLETION OF OUTCOMES, AS APPROPRI-
ATE.
  5. THE DEPARTMENT SHALL IDENTIFY PAYMENT RATES FOR  MEDICAID  SERVICES
PROVIDED BY OTHER STATE AGENCIES THAT EXCEED AVAILABLE COMPARABLE MARKET
RATES  AND  DEVELOP METHODS TO ENSURE THAT, WHERE APPROPRIATE, RATES ARE
THE LOWER OF COST OR MARKET. TO  ENSURE  THAT  THE  PROVISIONS  OF  THIS
SECTION  ARE MET AND THAT DUPLICATIVE SERVICES ARE NOT PROVIDED TO MEDI-
CAID RECIPIENTS, THE DEPARTMENT MAY LIMIT MEDICAID SERVICES PROVIDED  BY
OTHER STATE AGENCIES.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01493-01-1

              

A. 1084                             2

  6.  THE  DEPARTMENT  SHALL  DEVELOP AN ANNUAL PLAN TO CONDUCT PERIODIC
AUDITS, REVIEWS, AND INSPECTIONS OF STATE  AGENCIES  RECEIVING  MEDICAID
FUNDS FOR THE PURPOSE OF:
  (A) ENSURING COMPLIANCE WITH STATE AND FEDERAL REGULATIONS;
  (B)  PROMOTING ACCOUNTABILITY, ECONOMY, EFFECTIVENESS, AND EFFICIENCY;
AND
  (C) PREVENTING AND DETECTING WASTE, FRAUD, AND ABUSE.
  7. AUDITS AND REVIEWS SHALL BE PERFORMED IN ACCORDANCE WITH  GENERALLY
ACCEPTED GOVERNMENT AUDITING STANDARDS.
  8.  REPORTS  SHALL BE ISSUED IN ACCORDANCE WITH PROFESSIONAL STANDARDS
AND SHALL INCLUDE A DESCRIPTION OF ANY SIGNIFICANT PROBLEMS, ABUSES, AND
DEFICIENCIES ENCOUNTERED IN THE ADMINISTRATION AND OPERATION OF MEDICAID
SERVICES ALONG WITH RECOMMENDATIONS FOR CORRECTIVE ACTION. REPORTS SHALL
INCLUDE THE FINANCIAL VALUE OF ANY ITEMS REPORTED.
  9. THE DEPARTMENT  IS  AUTHORIZED  TO  DIRECTLY  ACCESS  ALL  SYSTEMS,
RECORDS,  REPORTS, REVIEWS, FILES, DOCUMENTS, PAPERS, AND SIMILAR INFOR-
MATION RELATED TO MEDICAID PAYMENTS WITHIN STATE AGENCIES  AND  ENTITIES
DOING BUSINESS WITH THESE AGENCIES.
  10.  THE  DEPARTMENT MAY ENTER INTO EXTERNAL CONTRACTS AS NECESSARY IN
FULFILLING THE REQUIREMENTS OF THIS SECTION.
  11. THE DEPARTMENT SHALL WITHHOLD ANY AMOUNTS RELATED TO FRAUD, ABUSE,
AND NON-COMPLIANCE.
  12. THE DEPARTMENT SHALL MAKE ALL REPORTS AVAILABLE TO  THE  GOVERNOR,
THE SENATE FINANCE COMMITTEE, THE ASSEMBLY WAYS AND MEANS COMMITTEE, THE
SENATE  HEALTH  COMMITTEE,  THE  ASSEMBLY  HEALTH  COMMITTEE, THE SENATE
SOCIAL SERVICES, CHILDREN  AND  FAMILIES  COMMITTEE,  AND  THE  ASSEMBLY
SOCIAL SERVICES COMMITTEE.
  S 3. This act shall take effect immediately.