Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
May 12, 2016 |
referred to health |
Senate Bill S7765
2015-2016 Legislative Session
Sponsored By
(R, C, IP) Senate District
Archive: Last Bill Status - In Senate Committee Health Committee
- Introduced
-
- In Committee Assembly
- In Committee Senate
-
- On Floor Calendar Assembly
- On Floor Calendar Senate
-
- Passed Assembly
- Passed Senate
- Delivered to Governor
- Signed By Governor
Actions
2015-S7765 (ACTIVE) - Details
- Current Committee:
- Senate Health
- Law Section:
- Social Services Law
- Laws Affected:
- Amd §367-b, Soc Serv L
2015-S7765 (ACTIVE) - Sponsor Memo
BILL NUMBER: S7765 TITLE OF BILL : An act to amend the social services law, in relation to claims for payment furnished by providers under the medical assistance program PURPOSE OR GENERAL IDEA OF BILL : This bill would allow providers who are unable to submit timely claims for Medicaid payment due to unforeseeable technical issues or computer systems malfunctions to be able to receive payment for their services, instead of having to forfeit the reimbursement regardless of the amount, which occurs today. SUMMARY OF SPECIFIC PROVISIONS : Section 1 codifies in statute Department of Health regulations governing timely billing requirements under the Medicaid program. This section also adds that for purposes of determining when Medicaid claim submission delays may be excused based on the fact that they were due to "circumstances outside of the control of a provider", this excuse would include unforeseeable electronic, technical, or other computer or systems malfunction. Section 2 provides for an immediate effective date with retroactive
2015-S7765 (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 7765 I N S E N A T E May 12, 2016 ___________ Introduced by Sen. ROBACH -- read twice and ordered printed, and when printed to be committed to the Committee 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 NOTIFICATION TO THE PROVIDER ADVISING THE PROVIDER OF SUCH INSUFFICIENCY OR INVALIDITY. ANY RETURNED CLAIM NOT CORRECTLY RESUBMITTED WITHIN SIXTY EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD11584-03-6
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