What's happening
This bill limits penalties for managed care organizations for late, incomplete, or inaccurate encounter data, except in cases of fraud or abuse.
Why it matters
Reduces financial risk for managed care organizations (MCOs). By capping penalties for late, incomplete, or inaccurate encounter data, the bill could lower operational costs for MCOs, potentially affecting how they allocate resources to compliance versus patient care.
Potentially impacts data quality oversight. With limited penalties for data issues (except in cases of fraud or abuse), there may be less incentive for MCOs to ensure the highest accuracy and timeliness in their reporting, which could affect state oversight and health policy planning.
Maintains strict consequences for fraud or abuse. The bill clarifies that penalties can still be imposed for intentional wrongdoing, ensuring that serious violations related to fraudulent or abusive practices remain subject to enforcement.
Could influence state-MCO relationships. By restricting additional penalties, the bill may alter the dynamic between the state and managed care organizations, possibly making the state’s managed care program more attractive to insurers or affecting contract negotiations.
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Who cares
Headline styles
Limit Penalties on Insurers
Plain English, a few words. Used as the page title.
Sponsors
2 Co-sponsors
History
- Enacting clause stricken
- 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 Managed Care Penalties
Stricken · Sponsor Gustavo Rivera
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
3068
2019-2020 Regular Sessions
IN ASSEMBLY
January 28, 2019
Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Health
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.
LBD03583-01-9
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.