Assembly Bill A8172

Vetoed By Governor
2015-2016 Legislative Session

Relates to claims for payment furnished by providers under the medical assistance program

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Archive: Last Bill Status - Vetoed by Governor


  • Introduced
    • In Committee Assembly
    • In Committee Senate
    • On Floor Calendar Assembly
    • On Floor Calendar Senate
    • Passed Assembly
    • Passed Senate
  • Vetoed By Governor
  • Signed By Governor

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2015-A8172 (ACTIVE) - Details

See Senate Version of this Bill:
S5883
Law Section:
Social Services Law
Laws Affected:
Amd ยง367-b, Soc Serv L

2015-A8172 (ACTIVE) - Summary

Relates to claims for payment furnished by providers under the medical assistance program.

2015-A8172 (ACTIVE) - Bill Text download pdf

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

                                  8172

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                              June 10, 2015
                               ___________

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

AN ACT to amend the social services  law,  in  relation  to  claims  for
  payment furnished by providers under the medical assistance program

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

  Section 1. Section 367-b of the social  services  law  is  amended  by
adding a new subdivision 15 to read as follows:
  15. (A) NOTWITHSTANDING ANY OTHER PROVISION OF LAW, CLAIMS FOR PAYMENT
FOR  MEDICAL  CARE, SERVICES OR SUPPLIES FURNISHED BY ANY PROVIDER UNDER
THE MEDICAL ASSISTANCE PROGRAM MUST BE INITIALLY SUBMITTED WITHIN NINETY
DAYS OF THE DATE THE MEDICAL CARE, SERVICES OR SUPPLIES  WERE  FURNISHED
TO AN ELIGIBLE PERSON TO BE VALID AND ENFORCEABLE AGAINST THE DEPARTMENT
OR  A  SOCIAL SERVICES DISTRICT, UNLESS THE PROVIDER'S SUBMISSION OF THE
CLAIMS IS DELAYED BEYOND NINETY DAYS DUE TO CIRCUMSTANCES OUTSIDE OF THE
CONTROL OF THE PROVIDER. SUCH CIRCUMSTANCES INCLUDE, BUT ARE NOT LIMITED
TO, ATTEMPTS TO RECOVER FROM A THIRD-PARTY  INSURER,  LEGAL  PROCEEDINGS
AGAINST  A RESPONSIBLE THIRD-PARTY OR THE RECIPIENT OF THE MEDICAL CARE,
SERVICES OR SUPPLIES, AN UNFORESEEABLE COMPUTER OR  SYSTEMS  MALFUNCTION
WHICH,  IN  THE JUDGMENT OF THE DEPARTMENT, IMPACTED THE SUBMISSION OF A
SIGNIFICANT NUMBER OF CLAIMS AND WAS UNKNOWN TO THE  PROVIDER  PRIOR  TO
THE  EXPIRATION OF THE NINETY DAY TIME PERIOD, OR DELAYS IN THE DETERMI-
NATION OF CLIENT ELIGIBILITY BY THE SOCIAL SERVICES DISTRICT. ALL CLAIMS
SUBMITTED AFTER NINETY DAYS MUST BE ACCOMPANIED BY A  STATEMENT  OF  THE
REASON  FOR SUCH DELAY AND MUST BE SUBMITTED WITHIN THIRTY DAYS FROM THE
TIME SUBMISSION CAME WITHIN THE CONTROL OF THE PROVIDER, SUBJECT TO  THE
LIMITATIONS OF PARAGRAPH (C) OF THIS SUBDIVISION.
  (B)  ANY  CLAIM  RETURNED  TO  A PROVIDER DUE TO DATA INSUFFICIENCY OR
CLAIMING  ERRORS  MAY  BE  RESUBMITTED  BY  THE  PROVIDER  UPON   PROPER
COMPLETION  OF  THE  CLAIM  IN  ACCORDANCE  WITH  THE  CLAIMS PROCESSING
REQUIREMENTS OF THE DEPARTMENT WITHIN SIXTY DAYS  OF  THE  DATE  OF  THE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD11584-01-5
              

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