Senate Bill S9398

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9398
 
                             I N  S E N A T E
 
                               March 9, 2026
                                ___________
 
 Introduced  by Sen. BORRELLO -- 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  establishing  a
   non-emergency   medical  transportation  administrative  modernization
   pilot program to strengthen  program  integrity  and  reduce  improper
   payments,  and requiring program integrity review by the office of the
   Medicaid inspector general
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. The social services law is amended by adding a new section
 365-q to read as follows:
   § 365-Q. NON-EMERGENCY MEDICAL TRANSPORTATION  ADMINISTRATIVE  MODERN-
 IZATION  PILOT  PROGRAM.  1.  ESTABLISHMENT.  THE COMMISSIONER OF HEALTH
 SHALL ESTABLISH A PILOT PROGRAM TO IMPLEMENT  A  UNIFIED  ADMINISTRATIVE
 PLATFORM FOR THE AUTHORIZATION, COORDINATION, MONITORING, AND PAYMENT OF
 NON-EMERGENCY  MEDICAL TRANSPORTATION SERVICES PROVIDED PURSUANT TO THIS
 TITLE.
   2. PURPOSE. THE PURPOSE OF THE PILOT  PROGRAM  SHALL  BE  TO  EVALUATE
 WHETHER IMPROVED ADMINISTRATIVE COORDINATION, DATA INTEGRATION, AND TRIP
 VERIFICATION  PROCESSES  CAN  REDUCE IMPROPER PAYMENTS AND SUPPORT FRAUD
 DETECTION AND RECOVERY EFFORTS, ENHANCE ACCOUNTABILITY IN  THE  ADMINIS-
 TRATION  OF  NON-EMERGENCY MEDICAL TRANSPORTATION SERVICES, AND MAINTAIN
 BENEFICIARY ACCESS TO TRANSPORTATION SERVICES.
   3. SCOPE AND DURATION. (A) THE PILOT  PROGRAM  SHALL  OPERATE  IN  NOT
 FEWER  THAN  TWO AND NOT MORE THAN FIVE COUNTIES SELECTED BY THE COMMIS-
 SIONER.
   (B) THE PILOT PROGRAM SHALL OPERATE FOR A PERIOD OF TWO TO THREE YEARS
 FROM THE DATE OF IMPLEMENTATION OF THE UNIFIED ADMINISTRATIVE PLATFORM.
   (C) PRIOR TO SUCH IMPLEMENTATION, THE  COMMISSIONER  OF  HEALTH  SHALL
 ESTABLISH  BASELINE  IMPROPER  PAYMENT  INDICATORS,  AUDIT FINDINGS, AND
 RELATED PROGRAM INTEGRITY  METRICS  IN  PILOT  COUNTIES  FOR  COMPARISON
 DURING AND AFTER THE PILOT PERIOD.
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD15045-01-6
 S. 9398                             2
              

 
   (D)  THE  COMMISSIONER  OF  HEALTH MAY MODIFY OR DISCONTINUE THE PILOT
 PROGRAM BASED UPON  DEMONSTRATED  OUTCOMES  AND  SHALL  PROVIDE  WRITTEN
 NOTICE OF ANY SUCH ACTION TO THE GOVERNOR AND THE LEGISLATURE.
   4.  PLATFORM  REQUIREMENTS.  THE  ADMINISTRATIVE  PLATFORM SHALL, AT A
 MINIMUM:
   (A)  PROVIDE  VERIFICATION  OF  MEDICAID  ELIGIBILITY  AND  ENROLLMENT
 STATUS;
   (B)  INCORPORATE  ELECTRONICALLY  DOCUMENTED LEVEL-OF-SERVICE DETERMI-
 NATIONS CONSISTENT  WITH  CRITERIA  ESTABLISHED  BY  THE  DEPARTMENT  OF
 HEALTH;
   (C) PERMIT COMMUNICATION AMONG THE DEPARTMENT OF HEALTH, ITS TRANSPOR-
 TATION  MANAGER  OR  CONTRACTOR,  TRANSPORTATION  PROVIDERS, HEALTH CARE
 PROVIDERS, AND ELIGIBLE RECIPIENTS;
   (D) ALLOW RECIPIENTS OR THEIR AUTHORIZED REPRESENTATIVES  TO  SCHEDULE
 RIDES AND OBTAIN TRIP STATUS INFORMATION;
   (E)  INCLUDE  OBJECTIVE  VALIDATION OF TRIP INITIATION AND COMPLETION,
 INCLUDING LOCATION-BASED OR COMPARABLE VERIFICATION METHODS WHERE  PRAC-
 TICABLE;
   (F) SUPPORT CLAIMS PROCESSING AND IMPROVE PAYMENT TIMELINESS FOR CLEAN
 CLAIMS; AND
   (G)  GENERATE  REPORTING REGARDING UTILIZATION, EXPENDITURES, DENIALS,
 COMPLAINT TRENDS, AND PROVIDER PERFORMANCE SUFFICIENT TO SUPPORT PROGRAM
 INTEGRITY REVIEW.
   5. INTEGRATION WITH PROGRAM INTEGRITY FUNCTIONS. (A) THE  COMMISSIONER
 SHALL  ENSURE  THAT  DATA  GENERATED  THROUGH THE PILOT PLATFORM IS MADE
 AVAILABLE TO THE OFFICE OF THE MEDICAID INSPECTOR GENERAL  IN  A  FORMAT
 SUFFICIENT TO SUPPORT AUDIT, INVESTIGATION, AND RECOVERY EFFORTS.
   (B)  THE PLATFORM SHALL SUPPORT IDENTIFICATION OF UTILIZATION PATTERNS
 AND BILLING TRENDS FOR REVIEW BY THE OFFICE OF  THE  MEDICAID  INSPECTOR
 GENERAL.
   (C) NOTHING IN THIS SECTION SHALL LIMIT THE STATUTORY AUTHORITY OF THE
 OFFICE  OF  THE  MEDICAID  INSPECTOR GENERAL UNDER SECTION THIRTY-TWO OF
 THIS CHAPTER.
   6. REPORTING. (A) NO LATER THAN FEBRUARY FIRST OF EACH YEAR  IN  WHICH
 THE  PILOT IS IN OPERATION, AND WITHIN NINETY DAYS FOLLOWING ITS CONCLU-
 SION, THE COMMISSIONER  SHALL  SUBMIT  A  REPORT  DETAILING  OPERATIONAL
 OUTCOMES OF THE PILOT.
   (B)  SUCH  REPORT  SHALL  BE  SUBMITTED TO THE GOVERNOR, THE TEMPORARY
 PRESIDENT OF THE SENATE, THE SPEAKER OF THE ASSEMBLY, THE MINORITY LEAD-
 ER OF THE SENATE, AND THE MINORITY LEADER OF THE ASSEMBLY.
   (C) THE REPORT SHALL INCLUDE: (I) A COMPARISON OF PILOT AND  NON-PILOT
 COUNTIES  ON  ACCESS  AND  PROGRAM INTEGRITY MEASURES, INCLUDING BUT NOT
 LIMITED TO IMPROPER PAYMENT TRENDS; (II)  CHANGES  IN  IMPROPER  PAYMENT
 INDICATORS  AND  AUDIT  FINDINGS  DURING  THE PILOT PERIOD; AND (III) AN
 ANALYSIS PREPARED IN  COORDINATION  WITH  THE  OFFICE  OF  THE  MEDICAID
 INSPECTOR  GENERAL  REGARDING  THE  PILOT'S  IMPACT  ON FRAUD DETECTION,
 REFERRALS, AND RECOVERIES.
   (D) THE REPORT SHALL INCLUDE RECOMMENDATIONS  REGARDING  CONTINUATION,
 MODIFICATION, OR STATEWIDE EXPANSION OF THE PILOT PROGRAM.
   7.  FEDERAL  COMPLIANCE.  THE  COMMISSIONER  SHALL  SEEK  ANY  FEDERAL
 APPROVALS NECESSARY TO IMPLEMENT THE  PILOT  PROGRAM.  NOTHING  IN  THIS
 SECTION  SHALL  BE  CONSTRUED TO ALTER MEDICAID ELIGIBILITY STANDARDS OR
 BENEFICIARY RIGHTS UNDER FEDERAL LAW.
   § 2. This act shall take effect immediately.