| Date of Action |
Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|---|---|
| Jun 16, 2014 |
print number 5015b |
| Jun 16, 2014 |
amend and recommit to insurance |
| Jun 12, 2014 |
print number 5015a |
| Jun 12, 2014 |
amend (t) and recommit to insurance |
| Jan 08, 2014 |
referred to insurance |
| May 06, 2013 |
referred to insurance |
Senate Bill S5015B
2013-2014 Legislative Session
Sponsored By
(R, C, IP) Senate District
Archive: Last Bill Status - In Senate Committee Insurance Committee
Actions
Bill Amendments
2013-S5015 - Details
2013-S5015 - Sponsor Memo
BILL NUMBER:S5015
TITLE OF BILL: An act to amend the insurance law, in relation to
recoveries of overpayments to health care providers
PURPOSE:
To eliminate the use of certain arbitrary formulas when audits of
physician payments are being conducted.
SUMMARY OF PROVISIONS:
This bill would amend-section 3224-b of the insurance law to prohibit
the use of extrapolation following an audit except where there is
evidence of fraud or intentional misconduct.
JUSTIFICATION:
In some instances health plans, following an audit will use this
arbitrary formula to penalize physicians even when there is no
evidence of fraud or intentional misconduct. Contesting this
unnecessary demand for payments is difficult and burdens practitioners
with burdensome legal experts and costs. Faced with some arbitrary
number a physician will settle for much more moneys than are
justifiable.
2013-S5015 - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
5015
2013-2014 Regular Sessions
I N S E N A T E
May 6, 2013
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance
AN ACT to amend the insurance law, in relation to recoveries of overpay-
ments to health care providers
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraphs 4 and 5 of subsection (b) of section 3224-b of
the insurance law are renumbered paragraphs 5 and 6 and a new paragraph
4 is added to read as follows:
(4) A HEALTH PLAN SHALL NOT DETERMINE AN OVERPAYMENT RECOVERY AMOUNT
THROUGH THE USE OF EXTRAPOLATION, EXCEPT WHERE THERE IS EVIDENCE OF
FRAUD OR INTENTIONAL MISCONDUCT.
S 2. This act shall take effect immediately.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06450-01-3
2013-S5015A - Details
2013-S5015A - Sponsor Memo
BILL NUMBER:S5015A
TITLE OF BILL: An act to amend the insurance law, in relation to
determination of overpayments to health care providers by
extrapolation
PURPOSE: Requires specific measures to be taken if extrapolation is
used to determine if health care providers received overpayments.
SUMMARY OF PROVISIONS: This bill would amend-section 3224-b of the
insurance law to ensure that if extrapolation is used in determining
whether health care providers have received overpayments from a health
care plan, the health care plan must comply with specific
requirements.
JUSTIFICATION: When determining whether a health care provider
received overpayments for services rendered by a health care plan,
extrapolation may be used. This bill will give protections to health
care providers and procedures in order to ensure that providers are
receiving due process.
LEGISLATIVE HISTORY: New Bill.
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: This act shall take effect immediately.
2013-S5015A - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
5015--A
2013-2014 Regular Sessions
I N S E N A T E
May 6, 2013
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance -- recommitted
to the Committee on Insurance in accordance with Senate Rule 6, sec. 8
-- committee discharged, bill amended, ordered reprinted as amended
and recommitted to said committee
AN ACT to amend the insurance law, in relation to determination of over-
payments to health care providers by extrapolation
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 2 of subsection (b) of section 3224-b of the
insurance law, as amended by chapter 237 of the laws of 2009, is amended
to read as follows:
(2) [A health plan shall provide a health care provider with the
opportunity to challenge an overpayment recovery, including the sharing
of claims information, and shall establish written policies and proce-
dures for health care providers to follow to challenge an overpayment
recovery. Such challenge shall set forth the specific grounds on which
the provider is challenging the overpayment recovery] IN THE EVENT THAT
THE PROCESS KNOWN AS EXTRAPOLATION WILL BE USED IN DETERMINING WHETHER
HEALTH CARE PROVIDERS HAVE RECEIVED OVERPAYMENTS FROM A HEALTH CARE
PLAN, THE HEALTH CARE PLAN SHALL COMPLY WITH THE FOLLOWING REQUIREMENTS:
(A) ADVISE THE HEALTH CARE PROVIDER WITH WRITTEN NOTICE THAT EXTRAPO-
LATION WILL BE UTILIZED;
(B) APPLY A VALID STATISTICAL METHODOLOGY THAT USES STRATIFIED RANDOM
SAMPLING METHODS TO ASSURE A FAIR EVALUATION OF THE CLAIMS SUBJECT TO
AUDIT;
(C) ADVISE THE HEALTH CARE PROVIDER AS TO THE TYPE OF METHODOLOGY
USED;
(D) PROVIDE THE HEALTH CARE PROVIDER SIXTY BUSINESS DAYS TO APPEAL THE
AUDIT FINDINGS; AND
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06450-04-4
2013-S5015B (ACTIVE) - Details
2013-S5015B (ACTIVE) - Sponsor Memo
BILL NUMBER:S5015B REVISED MEMO 06/17/2014
TITLE OF BILL: An act to amend the insurance law, in relation to deter-
mination of overpayments to health care providers by extrapolation
PURPOSE:
Requires specific measures to be taken if extrapolation is used to
determine if health care providers received overpayments.
SUMMARY OF PROVISIONS:
This bill would amend-section 3224-b of the insurance law to ensure that
if extrapolation is used in determining whether health care providers
have received overpayments from a health care plan, the health care plan
must comply with specific requirements.
JUSTIFICATION:
Insurance companies have the ability after performing an audit for a
specified period of time, to use a process known as extrapolation in
order to seek additional payments from the healthcare provider based on
a projection of what they believe the healthcare provider has over-
charged, for which no audit was conducted. This legislation allows
healthcare companies to continue extrapolation, but gives the healthcare
provider "doctors" the ability to determine how the extrapolated numbers
2013-S5015B (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K
________________________________________________________________________
5015--B
2013-2014 Regular Sessions
I N S E N A T E
May 6, 2013
___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when
printed to be committed to the Committee on Insurance -- recommitted
to the Committee on Insurance 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 commit-
tee
AN ACT to amend the insurance law, in relation to determination of over-
payments to health care providers by extrapolation
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 2 of subsection (b) of section 3224-b of the
insurance law, as amended by chapter 237 of the laws of 2009, is amended
to read as follows:
(2) A health plan shall provide a health care provider with the oppor-
tunity to challenge an overpayment recovery, including the sharing of
claims information, and shall establish written policies and procedures
for health care providers to follow to challenge an overpayment recov-
ery. Such challenge shall set forth the specific grounds on which the
provider is challenging the overpayment recovery. IN THE EVENT THAT THE
PROCESS KNOWN AS EXTRAPOLATION WILL BE USED IN DETERMINING WHETHER
HEALTH CARE PROVIDERS HAVE RECEIVED OVERPAYMENTS FROM A HEALTH CARE
PLAN, THE HEALTH CARE PLAN SHALL COMPLY WITH THE FOLLOWING REQUIREMENTS:
(A) ADVISE THE HEALTH CARE PROVIDER WITH WRITTEN NOTICE THAT EXTRAPO-
LATION WILL BE UTILIZED;
(B) APPLY A VALID STATISTICAL METHODOLOGY THAT USES STRATIFIED RANDOM
SAMPLING METHODS TO ASSURE A FAIR EVALUATION OF THE CLAIMS SUBJECT TO
AUDIT;
(C) ADVISE THE HEALTH CARE PROVIDER AS TO THE TYPE OF METHODOLOGY
USED;
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD06450-07-4
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