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Sponsors
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History
- Referred to social services
- Referred to social services
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Relates to a medical assistance information and payment system
In Senate Committee · Health · Sponsor Kemp Hannon
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
BILL NUMBER:A8909
Title of bill
An act to amend the social services law, in relation to a medical assistance information and payment system
Purpose or general idea of bill
To provide a more cost effective and efficient method to determine the third party eligibility of Medicaid claims for prescription drugs, while at the same time generating hundreds of millions of dollars for New York State taxpayers.
Summary of specific provisions
Section one of the bill directs the department of health to implement an initiative establishing an automated real time prospective pre claims payment review process.
Section two of the bill directs the Department to issue an RFP within ninety days of the effective date.
Section three of the bill provides for an immediate effective date.
Justification
Under the existing system, Medicaid provides initial coverage for prescription drugs and later determines a patient's eligibility for third party insurer coverage. Medicaid must then process and recover claims from the third party insurers. Under the system established by this bill, third party eligibility determinations would be made electronically at the time of purchase, thereby avoiding the need for payment and recovery.
This technology has been developed and would transition New York State's Medicaid pharmacy program from a "pay and chase" model to a "cost avoidance" model.
The eligibility and correct payer information could be determined at the point of sale using secure industry standard transactions and communicating the information to the pharmacy in real-time, eliminating pharmacy "pay and chase". The system would be supported by an experienced call center application and staff. The plan can be implemented in 120 to 150 days.
Prior legislative history
New bill.
Fiscal implications
Annual savings for New York State Medicaid are expected to range from $180 million to $360 million.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.