S379-2011 - NY Senate Open Legislation - Relates to a medical assistance information and payment system

Relates to a medical assistance information and payment system; directs the department of health to issue a request for proposal for the purpose of providing the system within 90 days.

Sponsor: HANNON Committee: HEALTH
Law Section: Social Services Law
Law: Amd S367-b, Soc Serv L

S379-2011 Actions

Jan 4, 2012: REFERRED TO HEALTH
Jan 4, 2012: returned to senate
Jan 4, 2012: died in assembly
Jun 15, 2011: referred to health
Jun 15, 2011: DELIVERED TO ASSEMBLY
Jun 15, 2011: PASSED SENATE
Feb 7, 2011: ADVANCED TO THIRD READING
Feb 1, 2011: 2ND REPORT CAL.
Jan 31, 2011: 1ST REPORT CAL.41
Jan 5, 2011: REFERRED TO HEALTH

S379-2011 Meetings

Health: Jan 31, 2011

S379-2011 Calendars

S379-2011 Votes

VOTE: COMMITTEE VOTE: - Health - Jan 31, 2011

Ayes (9): Hannon, Ball, Farley, Fuschillo, Golden, Larkin, McDonald, Seward, Young
Ayes W/R (8): Duane, Adams, Gianaris, Kruger, Montgomery, Rivera, Smith, Stewart-Cousins

VOTE: FLOOR VOTE: - Jun 15, 2011

Ayes (59): Adams, Alesi, Ball, Bonacic, Breslin, Carlucci, DeFrancisco, Diaz, Dilan, Duane, Espaillat, Farley, Flanagan, Fuschillo, Gallivan, Gianaris, Golden, Griffo, Grisanti, Hannon, Hassell-Thomps, Huntley, Johnson, Kennedy, Klein, Krueger, Kruger, Lanza, Larkin, LaValle, Libous, Little, Marcellino, Martins, Maziarz, McDonald, Montgomery, Nozzolio, O'Mara, Oppenheimer, Parker, Peralta, Perkins, Ranzenhofer, Ritchie, Robach, Saland, Sampson, Savino, Serrano, Seward, Skelos, Smith, Squadron, Stavisky, Stewart-Cousin, Valesky, Young, Zeldin
Nays (3): Addabbo, Avella, Rivera

S379-2011 Memo

BILL NUMBER:S379

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:
2010:  S.7520 Hannon/A.8909 Destito

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.

S379-2011 Text


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

                                     379

                         2011-2012 Regular Sessions

                              I N  SENATE

                                 (PREFILED)

                               January 5, 2011
                                 ___________

  Introduced  by  Sen.  HANNON -- 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  a  medical
    assistance information and payment system

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


    Section 1. Subparagraph 2 of paragraph (b) of subdivision 8 of section
  367-b of the social services law, as amended by chapter 109 of the  laws
  of 2007, is amended to read as follows:

    (2) Coordination of benefits. Develop, test and implement an automated
  process  to  improve  the  coordination  of benefits between the medical
  assistance program and other sources of coverage for medical  assistance
  recipients.  Such  initiative shall initially examine the savings poten-
  tial to the medical assistance program through retrospective  review  of
  claims  paid  which  shall  be  completed not later than January thirty-
  first, two thousand seven. If, based upon such initial  experience,  the
  Medicaid  inspector general deems the automated process to be capable of
  including or moving to a prospective review, with negligible  effect  on
  the  turnaround of claims for provider payment or on recipient access to
  services, then the Medicaid inspector general in subsequent tests  shall
  examine  the  savings  potential through prospective, pre-claims payment
  review.  PROVIDED, HOWEVER, THAT THE DEPARTMENT OF HEALTH  SHALL  IMPLE-
  MENT  AN INITIATIVE ESTABLISHING AN AUTOMATED REAL TIME PROSPECTIVE PRE-
  CLAIMS PAYMENT REVIEW PROCESS, INCLUDING, BUT NOT LIMITED  TO,  A  PRIOR
  PHARMACY  AUTHORIZATION  AND  PRE-PHARMACY  CLAIMS REVIEW OF ALTERNATIVE
  INSURANCE COVERAGE PROGRAM, PROVIDED HOWEVER THAT  ANY  SUCH  INITIATIVE
  HAS  MINIMAL  INITIAL  COSTS TO THE DEPARTMENT OF HEALTH. ANY INITIATIVE
  IMPLEMENTED BY THE DEPARTMENT OF HEALTH SHALL HAVE A  NEGLIGIBLE  EFFECT
  ON  THE TURNAROUND OF CLAIMS FOR PROVIDER PAYMENT OR ON RECIPIENT ACCESS
  TO SERVICES AND DEMONSTRATE SAVINGS POTENTIAL.

   EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                        [ ] is old law to be omitted.
                                                             LBD01738-01-1

 S. 379                              2

    S 2. The department of health shall issue a request for proposals  for
  the  purpose  of  providing  the system described in subparagraph (2) of
  paragraph (b) of subdivision 8 of section 367-b of the  social  services
  law, as amended by section one of this act, within 90 days of the effec-
  tive  date of this act. Bids from qualified vendors shall be received by
  the department of health no later than 60 days following the issuance of
  the request for proposals. Any contract issued pursuant to this  section
  shall  be  issued within 90 days following receipt of bids and installa-
  tion of such system completed by the successful bidder within  180  days
  of the issuance of such contract.
    S 3. This act shall take effect immediately.

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S379-2011: Relates to a medical assistance information and payment system