Relates to limiting audit and review of certain medical assistance program funds

S T A T E   O F   N E W   Y O R K
        ________________________________________________________________________

                                          8949

                                    I N  S E N A T E

                                    January 20, 2026
                                       ___________

        Introduced  by Sen. HARCKHAM -- read twice and ordered printed, and when
          printed to be committed to the Committee on Health

        AN ACT to amend the public health law, in  relation  to  the  audit  and
          review  of  medical assistance program funds by the Medicaid inspector
          general

          THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
        BLY, DO ENACT AS FOLLOWS:

     1    Section 1. The public health law is amended by adding a new section 37
     2  to read as follows:
     3    §  37. AUDIT AND REVIEW OF MEDICAL ASSISTANCE PROGRAM FUNDS. WHERE THE
     4  INSPECTOR DETERMINES AN OVERPAYMENT OF  FUNDS  HAS  OCCURRED  DUE  TO  A
     5  PROVIDER'S SUBMISSION OF SUPPORTING RECORDS IN A FORM, FORMAT, OR METHOD
     6  OF  TRANSMISSION  THAT IS NOT IN ACCORDANCE WITH PROGRAM REQUIREMENTS IN
     7  EFFECT AT THE TIME OF THE CLAIM, BUT,  DUE  TO  INTERVENING  CHANGES  TO
     8  PROGRAM  REQUIREMENTS,  INCLUDING  CHANGES  TO  STATE AGENCY GUIDELINES,
     9  REGULATIONS, OR OTHER GUIDANCE, IS IN ACCORDANCE WITH  THE  REQUIREMENTS
    10  IN  EFFECT AT THE TIME OF THE INSPECTOR'S REVIEW OR DETERMINATION OR ANY
    11  ADMINISTRATIVE REVIEWS  AND  OTHER  COURT  PROCEEDINGS  RELATED  TO  THE
    12  INSPECTOR'S  REVIEW  OR  DETERMINATION, THEN, IN THE ABSENCE OF FRAUD OR
    13  EVIDENCE THE PROVIDER RECEIVED REIMBURSEMENT FOR ITEMS OR SERVICES  THAT
    14  WERE  NOT PROVIDED TO THE BENEFICIARY, OR THE BENEFICIARY WAS NOT ELIGI-
    15  BLE FOR THE ITEMS OR SERVICES, RECOUPMENT FOR SUCH  CLAIM  DISALLOWANCES
    16  SHALL  BE  LIMITED  TO  THE  REIMBURSEMENT AMOUNT OF THE CLAIMS ACTUALLY
    17  REVIEWED BY THE INSPECTOR WITHOUT EXTRAPOLATION, AND THE INSPECTOR SHALL
    18  NOT INITIATE NEW OR ADDITIONAL REVIEWS AGAINST THE PROVIDER ON THE  SAME
    19  BASIS.
    20    §  2. This act shall take effect immediately and shall apply to audits
    21  commenced on or after such effective date, audits  pending  as  of  such
    22  date,  and  audits that the Medicaid inspector general has concluded but
    23  which are under administrative review or other properly  filed  judicial
    24  review or appeal.


         EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD14172-01-5