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A06813 Summary:

COSPNSRRosenthal L, Vanel, Simon, McDonald, Jacobson, Gunther, Santabarbara, Kelles, McMahon, Gonzalez-Rojas, Burdick, Zebrowski, Jensen, Beephan, Lucas, Lupardo, Steck, Ardila, Shimsky, Weprin, Hevesi, Septimo, Thiele, Levenberg, Simone, Blumencranz, Seawright, Ramos, Lavine, Sayegh, Gibbs, Tapia, Brabenec, Dinowitz, Sillitti, Raga, Meeks, Davila, Bendett
Amd §§30-a & 32, add §§37 & 38, Pub Health L; amd §363-d, Soc Serv L
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.
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A06813 Memo:

submitted in accordance with Assembly Rule III, Sec 1(f)
  TITLE OF BILL: 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   PURPOSE OR GENERAL IDEA OF BILL: To provide due process protections to health care providers and recipi- ents in the medical assistance program when under scrutiny by the Office of the Medicaid Inspector General (OMIG).   SUMMARY OF PROVISIONS: Section 1 amends Public Health Law § 30,-a by adding new subdivisions, which defines various terms including "abuse", "creditable allegations of fraud", "fraud"," medical assistance", "overpayment" and " provider". § 2 amends Public Health Law § 32 subdivision 20 to make clear that the Office of the Medicaid Inspector General (OMIG) must act consistently with all applicable state and federal laws, regulations, policies, guidelines, and standards. § 3 adds two new sections to the Public Health Law, § 37 and § 38. § 37 addresses audit and recovery of medical assistance to providers. § 38 addresses procedures, practices and standards for recipients. § 4 amends Social Services Law § 363-d (3) (c) to require OMIG to notify a provider if the provider's compliance program is not satisfactory, and to allow the provider 60 days to submit a proposal for a satisfactory compliance program. It also adds a new subdivision 8 to the section to require OMIG regulations, determinations, or findings relating to a compliance program to be consistent with subdivision 3. § 5 adds a new subsection 6-b to Public Health Law § 32, requiring OMIG to consult with the Commissioner of Health on preparing and filing an annual report by the Commissioner on the impacts that all civil and administrative enforcement actions taken in the previous year have had and will have on the quality and availability of medical care and services, the best interests of the medical assistance program and its recipients, and the fiscal solvency of the providers subject to these actions. § 6 Effective date of January 1, 2026.   JUSTIFICATION: When the OMIG was created in 2007, the emphasis of the legislature and the concern of the public was on fraud and waste in the Medicaid system. Experience with the law has made it clear that the current statute is missing key provisions necessary to assure fairness and procedural clar- ity for all the parties involved, including the personnel of the OMIG. OMIG audits that punish providers for technical errors- not fraud- do not help anyone in the Medicaid system, especially when those errors are the result of contradictory guidance provided by different state agen- cies. OMIG's practice of extrapolating millions of dollars of claims from a small sample of technical errors has been forcing already stretched-thin health care providers (especially in the behavioral health system) to close, which ultimately harms patients. New York's patients cannot afford to lose any more behavioral health providers, especially over unintentional administrative errors. This bill addresses due process for Medicaid beneficiaries who deserve advance notice of any investigations and details about what exactly is being investigated. These beneficiaries deserve to know their rights before OMIG makes any recoveries or enforcement actions against them. These common-sense requirements are necessary to protect vulnerable New Yorkers from OMIG actions that adversely impact the provision of services to vulnerable New Yorkers.   PRIOR LEGISLATIVE HISTORY: 2021-2022: S4486B/A7889A - Vetoed Memo. 89 2024: Amended Sec. 1 Part 8 to reference federal law   FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS: None.   EFFECTIVE DATE: This act shall take effect on the thirtieth day after it shall have become a law.
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