S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7920
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 19, 2017
                                ___________
 
 Introduced  by  M.  of  A.  LAVINE,  GOTTFRIED,  COOK, ABINANTI, ARROYO,
   RIVERA, McKEVITT -- Multi-Sponsored by -- M. of A. PERRY -- read  once
   and referred to the Committee on Insurance
 
 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;
   (D) PROVIDE THE HEALTH CARE PROVIDER SIXTY BUSINESS DAYS TO APPEAL THE
 AUDIT FINDINGS; AND
   (E) IN THE EVENT OF AN APPEAL OF THE AUDIT FINDINGS, THE  HEALTH  CARE
 PROVIDER  MAY  SEEK  A  REVIEW OF THE FINDINGS BY A MUTUALLY AGREED UPON
 INDEPENDENT THIRD PARTY AUDITOR. THE COST OF A THIRD PARTY REVIEW  SHALL
 BE SHARED EQUALLY BETWEEN THE PARTIES.
   § 2. This act shall take effect immediately.
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11795-01-7