What's happening
This bill limits penalties on managed care organizations for encounter data issues, except in cases of fraud or abuse.
Why it matters
Reduces financial risks for managed care organizations (MCOs). by limiting when they can be penalized for late, incomplete, or inaccurate encounter data submissions, potentially leading to lower administrative costs and increased willingness to participate in Medicaid programs.
Shifts regulatory focus toward intentional wrongdoing. by maintaining penalties only for cases involving fraud or abuse, rather than for unintentional data errors, which could encourage more open reporting of errors and reduce adversarial oversight.
May impact data quality oversight. by reducing the leverage the state has to enforce timely and accurate data submission, which could affect the monitoring and evaluation of Medicaid service delivery and outcomes unless other accountability mechanisms are strengthened.
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Who cares
Headline styles
Limit Managed Care Penalties
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Recommit, enacting clause stricken
- Referred to health
- Referred to health
Full text
1 pageUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1804
2019-2020 Regular Sessions
IN SENATE
January 16, 2019
Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed 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.
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 inaccu- rate 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.