Senate Bill S5329

2023-2024 Legislative Session

Relates to the functions of the Medicaid inspector general with respect to audit and review of medical assistance program funds and requiring notice of certain investigations

download bill text pdf

Sponsored By

Current Bill Status - On Floor Calendar


  • 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

Do you support this bill?

Please enter your contact information

Home address is used to determine the senate district in which you reside. Your support or opposition to this bill is then shared immediately with the senator who represents you.

Optional services from the NY State Senate:

Create an account. An account allows you to officially support or oppose key legislation, sign petitions with a single click, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.

Include a custom message for your Senator? (Optional)

Enter a message to your senator. Many New Yorkers use this to share the reasoning behind their support or opposition to the bill. Others might share a personal anecdote about how the bill would affect them or people they care about.
Actions
Votes

Bill Amendments

co-Sponsors

2023-S5329 - Details

Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-S5329 - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-S5329 - Sponsor Memo

2023-S5329 - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5329
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 2, 2023
                                ___________
 
 Introduced by Sens. HARCKHAM, KENNEDY -- read twice and ordered printed,
   and when printed to be committed to the Committee on Health
 
 AN  ACT  to  amend the public health law and the social services law, in
   relation to the functions  of  the  Medicaid  inspector  general  with
   respect  to  audit  and review of medical assistance program funds and
   requiring notice of certain investigations
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Section 30-a of the public health law is amended by adding
 four new subdivisions 4, 5, 6 and 7 to read as follows:
   4. "PROVIDER" MEANS ANY PERSON OR ENTITY ENROLLED AS A PROVIDER IN THE
 MEDICAL ASSISTANCE PROGRAM.
   5. "RECIPIENT" MEANS AN INDIVIDUAL WHO  IS  ENROLLED  IN  THE  MEDICAL
 ASSISTANCE PROGRAM, INCLUDING AN INDIVIDUAL WHO WAS PREVIOUSLY A RECIPI-
 ENT  AND, IN AN APPROPRIATE CASE, AN INDIVIDUAL WHO IS LEGALLY RESPONSI-
 BLE FOR THE RECIPIENT.
   6. "MEDICAL ASSISTANCE" AND "MEDICAID" MEANS TITLE ELEVEN  OF  ARTICLE
 FIVE OF THE SOCIAL SERVICES LAW AND THE PROGRAM THEREUNDER.
   7.  "DRAFT  AUDIT REPORT", "INITIAL AUDIT REPORT", "PROPOSED NOTICE OF
 AGENCY ACTION" AND "FINAL NOTICE OF AGENCY ACTION" MEANS THOSE DOCUMENTS
 PREPARED AND ISSUED BY THE INSPECTOR UNDER THIS TITLE AND  CORRESPONDING
 REGULATIONS.
   §  2.  Subdivision 20 of section 32 of the public health law, as added
 by chapter 442 of the laws of 2006, is amended to read as follows:
   20. to, consistent with [provisions  of]  this  title  AND  APPLICABLE
 FEDERAL AND STATE LAWS, REGULATIONS, POLICIES, GUIDELINES AND STANDARDS,
 implement  and  amend,  as needed, rules and regulations relating to the
 prevention, detection, investigation and referral  of  fraud  and  abuse
 within  the  medical  assistance  program and the recovery of improperly
 expended medical assistance program funds;

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04963-01-3
 S. 5329                             2
              

co-Sponsors

2023-S5329A - Details

Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-S5329A - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-S5329A - Sponsor Memo

2023-S5329A - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5329--A
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 2, 2023
                                ___________
 
 Introduced  by  Sens.  HARCKHAM, KENNEDY, WEBB -- read twice and ordered
   printed, and when printed to be committed to the Committee  on  Health
   -- reported favorably from said committee and committed to the Commit-
   tee   on  Finance  --  committee  discharged,  bill  amended,  ordered
   reprinted as amended and recommitted to said committee

 AN ACT to amend the public health law and the social  services  law,  in
   relation  to  the  functions  of  the  Medicaid inspector general with
   respect to audit and review of medical assistance  program  funds  and
   requiring notice of certain investigations
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 30-a of the public health law is amended by  adding
 three new subdivisions 4, 5, and 6 to read as follows:
   4.  "MEDICAL  ASSISTANCE,"  "MEDICAID," AND "RECIPIENT" SHALL HAVE THE
 SAME MEANING AS THOSE TERMS IN TITLE  ELEVEN  OF  ARTICLE  FIVE  OF  THE
 SOCIAL  SERVICES  LAW  AND SHALL INCLUDE ANY PAYMENTS TO PROVIDERS UNDER
 ANY MEDICAID MANAGED CARE PROGRAM.
   5. "PROVIDER" MEANS ANY PERSON OR ENTITY ENROLLED AS A PROVIDER IN THE
 MEDICAL ASSISTANCE PROGRAM.
   6. "OVERPAYMENT" SHALL MEAN ANY AMOUNT PAID TO A PROVIDER FOR  MEDICAL
 ASSISTANCE  IN  EXCESS  OF THE AMOUNT ALLOWABLE UNDER THE STATE PLAN FOR
 MEDICAL ASSISTANCE IN EFFECT AT THE TIME OF SUCH SERVICE,  OR  ALLOWABLE
 UNDER  ANY  FEDERALLY  APPROVED  MEDICAID  WAIVER, EXPERIMENT, PILOT, OR
 DEMONSTRATION PROJECT. AN OVERPAYMENT SHALL NOT INCLUDE CIRCUMSTANCES OF
 PROVIDER  NONCOMPLIANCE  WITH  STATE  LAWS,  REGULATIONS  OR  APPLICABLE
 PROMULGATED  STATE  AGENCY POLICIES, GUIDELINES, STANDARDS, PROTOCOLS OR
 INTERPRETATIONS WHICH ARE NOT A CONDITION OF PAYMENT, UNLESS THE PROVID-
 ER OBTAINED PAYMENT BY FRAUD OR DECEIT, OR WHERE THE PROVIDER WAS PREVI-
 OUSLY PROVIDED NOTICE OF ITS FAILURE TO COMPLY AND HAS FAILED TO CORRECT
 SUCH NONCOMPLIANCE.  AN OVERPAYMENT SHALL NOT INCLUDE NONCOMPLIANCE WITH
 ANY APPLICABLE PROMULGATED STATE AGENCY POLICIES, GUIDELINES, STANDARDS,
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04963-02-3
              

co-Sponsors

2023-S5329B - Details

Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-S5329B - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-S5329B - Sponsor Memo

2023-S5329B - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5329--B
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 2, 2023
                                ___________
 
 Introduced  by  Sens.  HARCKHAM,  FERNANDEZ,  KENNEDY, MAY, WEBB -- read
   twice and ordered printed, and when printed to  be  committed  to  the
   Committee  on  Health  --  reported  favorably from said committee and
   committed to the Committee on Finance --  committee  discharged,  bill
   amended,  ordered reprinted as amended and recommitted to said commit-
   tee -- recommitted to the  Committee  on  Health  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 public health law and the social  services  law,  in
   relation  to  the  functions  of  the  Medicaid inspector general with
   respect to audit and review of medical assistance  program  funds  and
   requiring notice of certain investigations
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 30-a of the public health law, as added by  chapter
 442 of the laws of 2006, is amended to read as follows:
   §  30-a.  Definitions.  For  the purposes of this title, the following
 definitions shall apply:
   1. "ABUSE" MEANS PROVIDER PRACTICES THAT ARE INCONSISTENT  WITH  SOUND
 FISCAL, BUSINESS OR MEDICAL PRACTICES, AND RESULT IN AN UNNECESSARY COST
 TO  THE  MEDICAID PROGRAM, OR IN REIMBURSEMENT FOR SERVICES THAT ARE NOT
 MEDICALLY NECESSARY OR THAT FAIL TO MEET PROFESSIONALLY RECOGNIZED STAN-
 DARDS FOR HEALTH CARE.  IT  ALSO  INCLUDES  BENEFICIARY  PRACTICES  THAT
 RESULT IN UNNECESSARY COST TO THE MEDICAID PROGRAM.
   2.  "CREDITABLE ALLEGATION OF FRAUD" (A) MEANS AN ALLEGATION WHICH HAS
 BEEN VERIFIED BY THE INSPECTOR,  FROM  ANY  SOURCE,  INCLUDING  BUT  NOT
 LIMITED TO THE FOLLOWING:
   I. FRAUD HOTLINES TIPS VERIFIED BY FURTHER EVIDENCE;
   II. CLAIMS DATA MINING; AND
   III.  PATTERNS  IDENTIFIED THROUGH PROVIDER AUDITS, CIVIL FALSE CLAIMS
 CASES, AND LAW ENFORCEMENT INVESTIGATIONS.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04963-03-4
              

co-Sponsors

2023-S5329C - Details

Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-S5329C - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-S5329C - Sponsor Memo

2023-S5329C - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5329--C
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 2, 2023
                                ___________
 
 Introduced  by  Sens.  HARCKHAM, BORRELLO, FERNANDEZ, GALLIVAN, KENNEDY,
   MAY, MAYER, SEPULVEDA, WEBB -- read twice  and  ordered  printed,  and
   when  printed  to  be committed to the Committee on Health -- reported
   favorably from said  committee  and  committed  to  the  Committee  on
   Finance  --  committee  discharged, bill amended, ordered reprinted as
   amended and recommitted  to  said  committee  --  recommitted  to  the
   Committee  on  Health  in  accordance  with  Senate  Rule 6, sec. 8 --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted  to said committee -- reported favorably from said commit-
   tee and committed to the Committee on Finance -- committee discharged,
   bill amended, ordered reprinted as amended  and  recommitted  to  said
   committee
 
 AN  ACT  to  amend the public health law and the social services law, in
   relation to the functions  of  the  Medicaid  inspector  general  with
   respect  to  audit  and review of medical assistance program funds and
   requiring notice of certain investigations
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1. Section 30-a of the public health law, as added by chapter
 442 of the laws of 2006, is amended to read as follows:
   § 30-a. Definitions. For the purposes of  this  title,  the  following
 definitions shall apply:
   1.  "ABUSE"  MEANS PROVIDER PRACTICES THAT ARE INCONSISTENT WITH SOUND
 FISCAL, BUSINESS OR MEDICAL PRACTICES, AND RESULT IN AN UNNECESSARY COST
 TO THE MEDICAID PROGRAM, OR IN REIMBURSEMENT FOR SERVICES THAT  ARE  NOT
 MEDICALLY NECESSARY OR THAT FAIL TO MEET PROFESSIONALLY RECOGNIZED STAN-
 DARDS  FOR  HEALTH  CARE.  IT  ALSO  INCLUDES BENEFICIARY PRACTICES THAT
 RESULT IN UNNECESSARY COST TO THE MEDICAID PROGRAM.
   2. "CREDITABLE ALLEGATION OF FRAUD" (A) MEANS AN ALLEGATION WHICH  HAS
 BEEN  VERIFIED  BY  THE  INSPECTOR,  FROM  ANY SOURCE, INCLUDING BUT NOT
 LIMITED TO THE FOLLOWING:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04963-04-4
              

co-Sponsors

2023-S5329D (ACTIVE) - Details

Law Section:
Public Health Law
Laws Affected:
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
Versions Introduced in 2021-2022 Legislative Session:
S4486

2023-S5329D (ACTIVE) - Summary

Requires the Medicaid inspector general to comply with standards relating to the audit and review of medical assistance program funds; establishes procedures, practices and standards for the adjustment or recovery of a medical assistance payment from recipients; requires notice of certain investigations.

2023-S5329D (ACTIVE) - Sponsor Memo

2023-S5329D (ACTIVE) - Bill Text download pdf

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  5329--D
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                               March 2, 2023
                                ___________
 
 Introduced  by  Sens.  HARCKHAM, BORRELLO, FERNANDEZ, GALLIVAN, KENNEDY,
   MAY, MAYER, SEPULVEDA, WEBB -- read twice  and  ordered  printed,  and
   when  printed  to  be committed to the Committee on Health -- reported
   favorably from said  committee  and  committed  to  the  Committee  on
   Finance  --  committee  discharged, bill amended, ordered reprinted as
   amended and recommitted  to  said  committee  --  recommitted  to  the
   Committee  on  Health  in  accordance  with  Senate  Rule 6, sec. 8 --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted  to said committee -- reported favorably from said commit-
   tee and committed to the Committee on Finance -- 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 committee
 
 AN ACT to amend the public health law and the social  services  law,  in
   relation  to  the  functions  of  the  Medicaid inspector general with
   respect to audit and review of medical assistance  program  funds  and
   requiring notice of certain investigations

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Section 30-a of the public health law, as added by  chapter
 442 of the laws of 2006, is amended to read as follows:
   §  30-a.  Definitions.  For  the purposes of this title, the following
 definitions shall apply:
   1. "ABUSE" MEANS PROVIDER PRACTICES THAT ARE INCONSISTENT  WITH  SOUND
 FISCAL, BUSINESS OR MEDICAL PRACTICES, AND RESULT IN AN UNNECESSARY COST
 TO  THE  MEDICAID PROGRAM, OR IN REIMBURSEMENT FOR SERVICES THAT ARE NOT
 MEDICALLY NECESSARY OR THAT FAIL TO MEET PROFESSIONALLY RECOGNIZED STAN-
 DARDS FOR HEALTH CARE.  IT  ALSO  INCLUDES  BENEFICIARY  PRACTICES  THAT
 RESULT IN UNNECESSARY COST TO THE MEDICAID PROGRAM.

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD04963-05-4
 S. 5329--D                          2
 
              

Comments

Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.

Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.

Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.