S T A T E O F N E W Y O R K
________________________________________________________________________
2934
2013-2014 Regular Sessions
I N S E N A T E
January 25, 2013
___________
Introduced by Sens. HANNON, RANZENHOFER -- read twice and ordered print-
ed, and when printed to be committed to the Committee on Health
AN ACT to amend the social services law, in relation to a medical
assistance information and payment system
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Subparagraph 2 of paragraph (b) of subdivision 8 of section
367-b of the social services law, as amended by chapter 109 of the laws
of 2007, is amended to read as follows:
(2) Coordination of benefits. Develop, test and implement an automated
process to improve the coordination of benefits between the medical
assistance program and other sources of coverage for medical assistance
recipients. Such initiative shall initially examine the savings poten-
tial to the medical assistance program through retrospective review of
claims paid which shall be completed not later than January thirty-
first, two thousand seven. If, based upon such initial experience, the
Medicaid inspector general deems the automated process to be capable of
including or moving to a prospective review, with negligible effect on
the turnaround of claims for provider payment or on recipient access to
services, then the Medicaid inspector general in subsequent tests shall
examine the savings potential through prospective, pre-claims payment
review. PROVIDED, HOWEVER, THAT THE DEPARTMENT OF HEALTH SHALL IMPLE-
MENT AN INITIATIVE ESTABLISHING AN AUTOMATED REAL TIME PROSPECTIVE PRE-
CLAIMS PAYMENT REVIEW PROCESS, INCLUDING, BUT NOT LIMITED TO, A PRIOR
PHARMACY AUTHORIZATION AND PRE-PHARMACY CLAIMS REVIEW OF ALTERNATIVE
INSURANCE COVERAGE PROGRAM, PROVIDED HOWEVER THAT ANY SUCH INITIATIVE
HAS MINIMAL INITIAL COSTS TO THE DEPARTMENT OF HEALTH. ANY INITIATIVE
IMPLEMENTED BY THE DEPARTMENT OF HEALTH SHALL HAVE A NEGLIGIBLE EFFECT
ON THE TURNAROUND OF CLAIMS FOR PROVIDER PAYMENT OR ON RECIPIENT ACCESS
TO SERVICES AND DEMONSTRATE SAVINGS POTENTIAL.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD05787-01-3
S. 2934 2
S 2. The department of health shall issue a request for proposals for
the purpose of providing the system described in subparagraph (2) of
paragraph (b) of subdivision 8 of section 367-b of the social services
law, as amended by section one of this act, within 90 days of the effec-
tive date of this act. Bids from qualified vendors shall be received by
the department of health no later than 60 days following the issuance of
the request for proposals. Any contract issued pursuant to this section
shall be issued within 90 days following receipt of bids and installa-
tion of such system completed by the successful bidder within 180 days
of the issuance of such contract.
S 3. This act shall take effect immediately.