What's happening
This bill clarifies penalties for managed care organizations related to encounter data, exempting fraud or abuse cases from new limits.
Why it matters
Limits the cumulative penalties. that managed care organizations (MCOs) can face for late, incomplete, or inaccurate encounter data, which may help MCOs avoid excessive financial consequences for administrative errors or delays.
Specifically excludes cases of fraud or abuse. from these new limits, ensuring that serious wrongdoing can still be penalized to the fullest extent of existing law and not shielded by the new protections.
Clarifies legal expectations for MCOs. , potentially reducing litigation or disputes over how and when penalties can be imposed, and giving clearer guidance for compliance.
May affect how MCOs prioritize data reporting and oversight. , as the law distinguishes between routine data issues and intentional misconduct, possibly leading to improved internal controls for fraud prevention.
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Who cares
Headline styles
Limit Penalties for Insurers
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to health
- Print number 5340a
- Amend and recommit to health
- Referred to health
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.
Limit Penalties for Insurers
In Senate Committee · Health · Sponsor Richard Gottfried
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5340--A
2017-2018 Regular Sessions
IN SENATE
March 22, 2017
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the social services law, in relation to penalties to managed care organizations
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Paragraph (d) of subdivision 32 of section 364-j of the social services law, as added by section 15 of part B of chapter 59 of the laws of 2016, is amended to read as follows:
(d) (i) Penalties under this subdivision may be applied to any and all circumstances described in paragraph (b) of this subdivision until the managed care organization complies with the requirements for submission of encounter data.
(ii) No penalties for late, incomplete or inaccurate encounter data shall be assessed against managed care organizations in addition to those provided for in this subdivision, provided, however, that nothing in this paragraph shall prohibit the imposition of penalties, in cases of fraud or abuse, otherwise authorized by law.
§ 2. This act shall take effect on the ninetieth day after it shall have become a law, provided that the amendments to section 364-j of the social services law, made by section one of this act, shall not affect the repeal of such section, and shall be deemed repealed therewith.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10145-03-7
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the social services law, in relation to penalties to managed care organizations
Purpose
This bill would authorize the Office of the Medicaid Inspector General (OMIG) to impose penalties currently authorized by law against managed care organizations (MCO) for fraudulent or abusive submissions of encounter data to the State.
Summary of provisions
Section 1 would amend Social Services L. § 364-j(32)(d) to create an exception to the prohibition on assessing penalties currently authorized by law for late, incomplete or inaccurate encounter data, for cases of fraud and abuse.
Section 2 would provide the effective date.
Justification
The manipulation of encounter data can result in significant Medicaid overpayments within New York's managed care system. A pattern of inaccurate encounter data submissions will disrupt risk adjusted capitation premium methodologies and cause significant harm to the integrity of the Medicaid program. As more of the Medicaid managed care program moves to a quality and incentive based payment structure, it is essential that there are appropriate disincentives for fraudulent or abusive behavior related to encounter data submission.
Legislative history
New bill
Fiscal implications
None
Effective date
This act shall take effect on the ninetieth day after it shall have become a law.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.