Source: https://www.nysenate.gov/legislation/bills/2015/S2883
Timestamp: 2019-01-19 08:19:28
Document Index: 723741952

Matched Legal Cases: ['§140', '§368', 'art 1', 'art 2', 'art 3', 'art 4']

NY State Senate Bill S2883
senate Bill S2883
Relates to automated payment detection, prevention and recovery solutions to reduce correctional healthcare overpayments, billed for eligible services
Get Status Alerts for S2883
May 27, 2015 1st report cal.905
Mar 04, 2015 reported and committed to finance
S2883 - Details
Add §140-a, Cor L; add §368-g, Soc Serv L
2013-2014: S6494, A8332
2017-2018: A2428
S2883 - Summary
Relates to the development and implementation of automated payment detection, prevention and recovery solutions to reduce correctional healthcare overpayments, and requires that private health insurance and Medicaid are billed for eligible inpatient hospital and professional services.
S2883 - Sponsor Memo
BILL NUMBER:S2883
An act to amend the correction law and the social services law, in
relation to the development and implementation of automated payment
detection, prevention and recovery solutions to reduce correctional
healthcare overpayments, and to require that private health insurance
providers and Medicaid are billed for eligible  inpatient hospital and
This bill seeks to implement savings for state correctional healthcare
and prevent Medicaid fraud within correctional facilities, while
ensuring that patients receive proper services.
Section 1 - Legislative intent.
Section 2 - Part 1 provides that the new sections apply to all state
correctional healthcare systems and state contracted managed
correctional healthcare systems.
- Part 2 requires implementation of procedures to utilize Medicaid for
reimbursement of correctional healthcare costs and defines the
technological services that would be provided to prevent errors and
potential overbilling.
- Part 3 details the procedures that would be taken to prevent fraud.
- Part 4 states that the state may contract to have services performed
and that savings of this service will be used towards administration
Section 3 - Provides that any Medicaid costs not covered by the
Federal Government will be covered entirely by the state, without
This bill seeks to reduce costs to the state for correctional
healthcare services. Currently, correctional healthcare costs are
borne entirely by the state, even though many, if not all, of these
costs might be covered under either Medicaid or private health
insurance plans. This bill would require to utilize Medicaid and
private insurance coverage when appropriate to reduce costs to the
state. Local governments would not be responsible for any part of the
Medicaid cost for correctional healthcare.
2014 - S.6494-A/A.8332-B - PASSED SENATE/Corrections
The comptroller has estimated that utilizing Medicaid reimbursement
for correctional healthcare might save the state up to $20 million per
S2883 - Bill Text download pdf
Introduced by Sens. RANZENHOFER, DeFRANCISCO, GALLIVAN -- read twice and
AN ACT to amend the correction law  and  the  social  services  law,  in
relation  to  the  development and implementation of automated payment
detection, prevention and recovery solutions  to  reduce  correctional
healthcare  overpayments, and to require that private health insurance
Section  1.  Legislative  intent.  Other states have saved millions of
dollars by implementing solutions to eliminate and recover  correctional
healthcare  overpayments  and  significantly  have  reduced correctional
healthcare costs by billing private health insurance providers and Medi-
caid for eligible inpatient healthcare costs. New York  can  benefit  by
implementing  similar  measures.  It is the intent of the legislature to
implement automated payment detection, prevention and recovery solutions
to reduce correctional  healthcare  overpayments,  and  to  ensure  that
private  insurance  companies and Medicaid are billed for eligible inpa-
tient hospital and professional services.
S 2. The correction law is amended by adding a new  section  140-a  to
S  140-A.    HEALTHCARE PAYMENTS; BILLING PRIVATE HEALTH INSURANCE AND
MEDICAID. 1. UNLESS OTHERWISE STATED, THE  PROVISIONS  OF  THIS  SECTION
APPLY  TO  ALL  STATE  CORRECTIONAL  HEALTHCARE SYSTEMS AND SERVICES AND
STATE CONTRACTED MANAGED CORRECTIONAL HEALTHCARE SERVICES.
2.  THE  DEPARTMENT  SHALL  IMPLEMENT  AUTOMATED  PAYMENT   DETECTION,
PREVENTION, AND RECOVERY PROCEDURES TO ENSURE THAT PRIVATE HEALTH INSUR-
ANCE  OR  MEDICAID IS BILLED FOR ELIGIBLE INPATIENT HOSPITAL AND PROFES-
SIONAL HEALTHCARE SERVICES.  THESE PROCEDURES MUST INCLUDE, BUT ARE  NOT
LBD02105-01-5
S. 2883                             2
LIMITED  TO, CLINICAL CODE EDITING TECHNOLOGY TO FURTHER AUTOMATE CLAIMS
RESOLUTION AND ENHANCE COST CONTAINMENT THROUGH IMPROVED CLAIM  ACCURACY
AND APPROPRIATE CODE CORRECTION. EDITS PERFORMED BY THIS TECHNOLOGY MUST
BE  APPLIED  AUTOMATICALLY  BEFORE  THE ADJUDICATION OF CLAIMS, AND THIS
TECHNOLOGY MUST IDENTIFY AND PREVENT ERRORS  AND  POTENTIAL  OVERBILLING
BASED  ON  WIDELY ACCEPTED PROTOCOLS, SUCH AS THOSE USED BY THE AMERICAN
MEDICAL ASSOCIATION AND THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.
3. THE DEPARTMENT SHALL IMPLEMENT CORRECTIONAL HEALTHCARE CLAIMS AUDIT
AND RECOVERY PROCEDURES  TO  IDENTIFY  IMPROPER  PAYMENTS  MADE  DUE  TO
NON-FRAUDULENT  ISSUES. PROCEDURES THAT MUST BE IMPLEMENTED INCLUDE, BUT
ARE NOT LIMITED TO, OBTAINING PROVIDER SIGN-OFF  ON  AUDIT  RESULTS  AND
CONDUCTING  POST PAYMENT REVIEWS TO ENSURE THAT THE DIAGNOSES AND PROCE-
DURE CODES ARE ACCURATE AND VALID BASED ON SUPPORTING PHYSICIAN DOCUMEN-
TATION WITHIN THE  MEDICAL  RECORDS.  CORE  CATEGORIES  OF  REVIEWS  MAY
INCLUDE,  BUT  ARE  NOT  LIMITED TO, CODING COMPLIANCE DIAGNOSIS RELATED
GROUP (DRG) REVIEWS,  TRANSFERS,  READMISSIONS,  COST  OUTLIER  REVIEWS,
OUTPATIENT SEVENTY-TWO-HOUR RULE REVIEWS, PAYMENT ERRORS, AND BILLING.
4. THE DEPARTMENT MAY CONTRACT TO HAVE SERVICES PERFORMED TO CARRY OUT
THE  REQUIREMENTS  OF  THIS  SECTION,  AND  THE SAVINGS GENERATED BY THE
PERFORMANCE OF THESE SERVICES MUST BE USED FOR THE OPERATION AND  ADMIN-
ISTRATION  OF  THIS  SECTION, INCLUDING SECURING THE TECHNOLOGY SERVICES
REQUIRED BY THIS SECTION. TO FURTHER ACHIEVE THESE  SAVINGS,  CONTRACTOR
REIMBURSEMENT  MAY  BE  BASED  UPON  A PERCENTAGE OF AN ACHIEVED SAVINGS
MODEL, A PER BENEFICIARY PER MONTH MODEL, A  PER  TRANSACTION  MODEL,  A
CASE-RATE   MODEL,  OR  ANY  COMBINATION  OF  THESE  MODELS.  CONTRACTOR
REIMBURSEMENT MODELS ALSO MAY  INCLUDE  PERFORMANCE  GUARANTEES  OF  THE
CONTRACTOR TO ENSURE SAVINGS IDENTIFIED EXCEED PROGRAM COSTS.
S  3. The social services law is amended by adding a new section 368-g
S 368-G. REIMBURSEMENT OF COSTS FOR CORRECTIONAL  HEALTHCARE.    AFTER
THE AMOUNT OF FEDERAL FUNDS, IF ANY, HAVE BEEN DEDUCTED FROM THE COST OF
CORRECTIONAL  HEALTHCARE,  THE  REMAINING AMOUNT SHALL BE PAID WHOLLY BY