BILL NUMBER: S8240

SPONSOR: TEDISCO
 
TITLE OF BILL:

An act to amend the social services law, in relation to appeals and fair
hearings

 
PURPOSE OF THE BILL:

This bill would amend the Social Services Law (SSL) to permit any party
in a Department of Health (DOH) administrative hearing to appeal the
final determination to DOH's chief Administrative Law Judge (AU).

 
SUMMARY OF PROVISIONS:

Section one of the bill would amend subdivision 9 of SSL § 22 to allow
any party to appeal the final determination of the presiding AU to DOH's
chief AU.

Section two of the bill would make it effective 90 days after it shall
              

become law.

 
JUSTIFICATION:

There is a right to fairness in adjudicatory proceedings for all parties
involved. When making a determination in an administrative proceeding,
the presiding AU is required to set forth the grounds for the decision
and the essential facts upon which the agency's inferences are based.
Such a determination is required to be supported by a substantial weight
of the evidence and grounded in law. Currently, if the presiding AU errs
in making a decision, the appellant has the right to apply for a review
of such determination as provided by article seventy-eight of the Civil
Practice Law and Rules. However, if an error is made by the AU against
the agency, there is arguably no recourse to the agency. An erroneous
decision could have a significant effect on the agency's ability to
pursue future claims, implement sanctions, or recover overpayments for
claims rightfully due to the State. This bill would create a mechanism
for either party to appeal to the Chief Administrative Law Judge or such
other person designated by the Commissioner of Health for a review of
the determination made by the presiding AU.

The Medicaid Inspector General's inability to appeal an adverse deci-
sion, is inconsistent with the right to appeal afforded to other State
agencies such as the Industrial Board of Appeals and the Unemployment
Insurance Appeals Board. The creation of this mechanism allows any
aggrieved party, including the Medicaid Inspector General's Office, the
right to fully explain the facts and law on which it relied and the
error made by the presiding AU. Appealing to the Chief AU is a less
costly method of review for all parties involved and may result in
potential errors being corrected prior to the commencement of a timely
and costly article seventy-eight action.

 
PRIOR LEGISLATIVE HISTORY:

None.

 
FISCAL IMPLICATIONS:

This bill is likely to have a positive impact on the State. Creating a
mechanism of review available to either party establishes a more
balanced set of litigation risks, leading to some reduction in the
volume of litigation. Reduced litigation creates the potential for
reduced costs and improved voluntary compliance. Correction of errors
may also lead to increased recoveries.

 
EFFECTIVE DATE:
The bill would take effect 90 days after it becomes law.