Establishes the "Medicaid identification and anti-fraud biometric technology program", requiring the department of health, in consultation with the office of the medicaid inspector general and the office of the attorney general to implement a program requiring the use of biometric technology, as a means of identification and for use as an anti-fraud application in the Medicaid program.
TITLE OF BILL: An act to amend the public health law, in relation to establishing the Medicaid identification and anti-fraud biometric technology program; and to amend the social services law, in relation to conforming medical assistance identification with the Medicaid identification and anti-fraud biometric technology program
PURPOSE OR GENERAL IDEA OF THE BILL: Establishes the Medicaid Identification and Antifraud Biometric Technology Program.
SUMMARY OF SPECIFIC PROVISIONS: The Public Health Law is amended by adding a new article 2-b to provide that the Department of Health shall develop a request for proposals to implement a program using biometric technology in hospitals, clinics and pharmacies for the purpose of patient and provider identification to fight fraud in the Medicaid program; sets time frames for such request; and requires the Department of Health to report to the Governor, Senate and Assembly as to the progress of implementing a biometric identification program.
Section 2: Amends the Social Services Law to require the Social Services Department to conform its systems with the new Medicaid Identification and Antifraud Biornetric Identification Program when available.
Section 3: Provides that this act shall take effect immediately.
JUSTIFICATION: New York will spend over $54 billion dollars this fiscal year (2011-2012) on Medicaid and experts estimate that as much as 10%, or over $5 billion, is spent on fraudulent services and claims for Medicaid services. New York cannot afford to continue to pay for such improper and fraudulent claims. Rather than reducing payments for vital services for our children and most infirm elderly, we should more aggressively address the billions of dollars lost to fraud by utilizing modem and effective identification technology. This legislation will require the Department of Health to develop result-oriented guidelines and seek requests for proposals to implement a modem fraud prevention program in hospitals, clinics and pharmacies all across New York relying on biometric technology. There are many companies offering various types of biometric identification systems that are already in common use by private industry and governmental agencies.
The request for proposals shall focus on results to be obtained, rather than specific technology, to allow the State to consider the
many technologies that have been developed. These technologies can use relatively inexpensive software and hardware that has already been developed and proven to save New York billions of dollars annually in fraud prevention. The request must also specify that any proposal must be revenue neutral from inception, whereby program costs are at least offset by savings from inception, and shall have as a primary goal reduction in Medicaid expenditures through elimination of fraud and abuse.
Biometrics is the science and technology of measuring and analyzing biological data. In information technology, biometrics refers to technologies that measure and analyze human body characteristics, such as DNA, fingerprints, eye retinas and irises, voice patterns, facial patterns and hand measurements, for authentication purposes. The identification issued to Medicaid recipients and providers will contain biometric markers for verification that a recipient is eligible for the service requested, and confirm that the provider actually provides the service. Such identification can be made at the beginning and end of a transaction before payment is ever made, instead of relying on the current system of "pay and chase" where law enforcement and court action is required to recoup improper Medicaid payments after they have been made.
PRIOR LEGISLATIVE HISTORY: 2011 - S.4384-B/A.6555-B -- PASSED SENATE/Health
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENT: Will generate substantial savings, perhaps as much as $5 billion annually by preventing health care fraud and improper payments.
EFFECTIVE DATE: This act shall take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 4384--D 2011-2012 Regular Sessions IN SENATE April 4, 2011 ___________Introduced by Sens. RANZENHOFER, ADDABBO, DeFRANCISCO, LARKIN, YOUNG, ZELDIN -- 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 commit- tee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- recommitted to the Committee on Health in accordance with Senate Rule 6, sec. 8 -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to establishing the Medicaid identification and anti-fraud biometric technology program; and to amend the social services law, in relation to conforming medical assistance identification with the Medicaid identification and anti-fraud biometric technology program THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The public health law is amended by adding a new article 2-B to read as follows: ARTICLE 2-B MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC TECHNOLOGY PROGRAM SECTION 290. MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC TECHNOLOGY PROGRAM. 291. DEFINITIONS. 292. BIOMETRIC TECHNOLOGY USE REQUIREMENT. 293. RULES AND REGULATIONS. S 290. MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC TECHNOLOGY PROGRAM. THERE IS HEREBY ESTABLISHED IN THE DEPARTMENT THE MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC TECHNOLOGY PROGRAM. S 291. DEFINITIONS. AS USED IN THIS ARTICLE: 1. "BIOMETRIC TECHNOLOGY" MEANS TECHNOLOGY THAT MEASURES AND ANALYZES BIOLOGICAL DATA, INCLUDING BUT NOT LIMITED TO DNA, FINGER IMAGING,EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD09573-14-2 S. 4384--D 2
VASCULAR PATTERNS, EYE RETINAS AND IRISES, VOICE PATTERNS, FACIAL PATTERNS AND HAND MEASUREMENTS, FOR AUTHENTICATION PURPOSES. 2. "BIOMETRIC VERIFICATION DEVICE" MEANS A DEVICE CAPABLE OF USING BIOMETRIC VERIFICATION TECHNOLOGY TO VERIFY THE IDENTITY OF A MEDICAID RECIPIENT OR PROVIDER. S 292. BIOMETRIC TECHNOLOGY USE REQUIREMENT. 1. THE DEPARTMENT, IN CONSULTATION WITH THE OFFICE OF THE MEDICAID INSPECTOR GENERAL AND THE OFFICE OF THE ATTORNEY GENERAL, SHALL DEVELOP A REQUEST FOR PROPOSALS TO IMPLEMENT A PROGRAM REQUIRING THE USE OF BIOMETRIC TECHNOLOGY BY HOSPI- TALS, CLINICS AND PHARMACIES, FOR THE PURPOSES OF PATIENT AND PROVIDER IDENTIFICATION AND FOR USE AS AN ANTI-FRAUD APPLICATION IN THE MEDICAID PROGRAM. 2. SUCH REQUEST FOR PROPOSALS SHALL INCLUDE AT A MINIMUM THAT (A) MEDICAID RECIPIENTS AND PROVIDERS SHALL PROVIDE BIOMETRIC PROOF OF THEIR IDENTITY ALONG WITH OTHER INFORMATION DEEMED NECESSARY BY THE COMMIS- SIONER. (B) SUCH PROGRAM WILL BE CAPABLE OF STORING BIOMETRIC MARKERS AND A LOG OF DOCTOR AND PHARMACY VISITS FOR EACH SERVICE BILLED TO THE MEDI- CAID PROGRAM. (C) MEDICAID IDENTIFICATION SHALL BE ISSUED TO AND ACCEPTED BY THE ADMITTING STAFF OF HEALTH CARE FACILITIES, MEDICAL STAFF PROVIDING SERVICE TO MEDICAID RECIPIENTS AND PHARMACY STAFF. (D) MEDICAID RECIPIENTS SHALL BE REQUIRED TO PROVIDE BIOMETRIC PROOF OF IDENTIFY AT THE TIME OF EACH VISIT TO A DOCTORS OFFICE OR CLINIC AT THE POINT OF ACTUALLY BEING SEEN BY THE DOCTOR OR CLINICAL STAFF, AND SHALL AGAIN PROVIDE PROOF OF IDENTITY UPON COMPLETION OF CARE OR SERVICES. (E) BIOMETRIC VERIFICATION DEVICES SHALL BE USED IN PHARMACIES TO VERIFY THE IDENTITY OF THE MEDICAID RECIPIENT AND THE VALIDITY OF THE MEDICAID COVERAGE PRIOR TO OR IN CONJUNCTION WITH FILLING A PRESCRIPTION. (F) PROVISIONS SHALL BE INCLUDED FOR EMERGENCY SERVICES OR PRESCRIPTIONS AND ALTERNATE IDENTIFICATION METHODS FOR MEDICAID RECIPI- ENTS PHYSICALLY OR MENTALLY UNABLE TO PROVIDE BIOMETRIC IDENTIFICATION. (G) FRAUD PREVENTION MARKERS INCORPORATED INTO SOFTWARE WHICH SHALL BE USED TO OPERATE THE HARDWARE COMPONENT OF THE BIOMETRIC TECHNOLOGY SHALL PREVENT AND/OR REJECT THE PAYMENT BY THE MEDICAID PROGRAM AND ALERT THE SERVICE PROVIDER AT POINT OF SERVICE IF FRAUD OR POTENTIAL FRAUD IS IDENTIFIED BY THE BIOMETRIC TECHNOLOGY SYSTEM. (H) PROVISIONS SHALL BE INCLUDED TO ENSURE THAT MEDICAID RECIPIENTS HAVE ACCESS TO EMERGENCY HEALTH SERVICES IN THE CASE OF A BIOMETRIC TECHNOLOGY SYSTEM MALFUNCTION OR FRAUD DETECTION ALARM. (I) EVALUATION AND SELECTION OF AN IDENTIFY CREDENTIALING SYSTEM THAT ADDRESSES THE REQUIREMENTS OF MEDICAID BENEFICIARIES AND PROVIDERS SHALL BE BASED ON THE FOLLOWING CRITERIA: SECURITY, PRIVACY, USABILITY, PERFORMANCE, HYGIENE, BIOMETRIC CAPTURE AND STORAGE REQUIREMENTS, AND INTEROPERABILITY. 3. SUCH REQUEST FOR PROPOSALS SHALL SET FORTH REQUIREMENTS AS TO THE RESULTS AND GOALS TO BE ACHIEVED, RATHER THAN SPECIFIC TECHNICAL METHODS OR SYSTEMS, TO ALLOW CONSIDERATION OF THE WIDEST POSSIBLE CHOICE OF AVAILABLE TECHNOLOGY. 4. SUCH REQUEST FOR PROPOSALS SHALL REQUIRE: (A) THAT THE PROGRAM SHALL BE REVENUE NEUTRAL FROM INCEPTION, WHEREBY ANY PROGRAM COSTS ARE AT LEAST OFFSET BY STATE MEDICAID SAVINGS, AND SHALL HAVE AS A PRIMARY GOAL REDUCTION OF MEDICAID EXPENDITURES THROUGH ELIMINATION OF FRAUD AND ABUSE; AND (B) THAT THE PROGRAM SHALL BE COST NEUTRAL TO PROVIDERS FROMS. 4384--D 3
INCEPTION, WHEREBY ANY PROVIDER COSTS ARE AT LEAST OFFSET BY PROVIDER SAVINGS, AND SHALL HAVE AS A PRIMARY GOAL PROVIDER SAVINGS THROUGH INCREASED EFFICIENCIES. 5. (A) SUCH REQUEST FOR PROPOSALS FOR THE IMPLEMENTATION OF A PROGRAM FOR BIOMETRIC TECHNOLOGY USE SHALL BE PUBLISHED ON OR BEFORE JANUARY FIFTEENTH, TWO THOUSAND THIRTEEN, AND SHALL PROVIDE THAT PROPOSALS SHALL BE OPENED ON OR BEFORE MARCH FIRST, TWO THOUSAND THIRTEEN. (B) THE COMMISSIONER SHALL REPORT TO THE GOVERNOR, THE TEMPORARY PRES- IDENT OF THE SENATE AND THE SPEAKER OF THE ASSEMBLY ON OR BEFORE MARCH THIRTIETH, TWO THOUSAND THIRTEEN WITH REGARD TO THE PROGRESS MADE IN THE DEVELOPMENT OF CRITERIA FOR A PROGRAM OF BIOMETRIC IDENTIFICATION AND OF THE IMPLEMENTATION OF SUCH PROGRAM. S 293. RULES AND REGULATIONS. THE COMMISSIONER IS AUTHORIZED AND DIRECTED TO PROMULGATE SUCH RULES AND REGULATIONS AS HE OR SHE MAY DEEM NECESSARY OR APPROPRIATE TO EFFECTUATE THE PURPOSES OF THIS ARTICLE. S 2. Subdivision 1 of section 367-b of the social services law, as added by chapter 639 of the laws of 1976, is amended to read as follows: 1. The department, IN CONSULTATION WITH THE COMMISSIONER OF HEALTH, shall design and implement a statewide medical assistance information and payments system for the purpose of providing individual and aggre- gate data to social services districts to assist them in making basic management decisions, to the department and other state agencies to assist in the administration of the medical assistance program, and to the governor and the legislature as may be necessary to assist in making major administrative and policy decisions affecting such program. Such system shall be designed so as to be capable of the following: a. receiving and processing information relating to the eligibility of each person applying for medical assistance and of issuing a medical assistance identification card, AND WHEN AVAILABLE UTILIZING THE BIOME- TRIC IDENTIFICATION ISSUED BY THE DEPARTMENT OF HEALTH, CONFORMING TO THE REQUIREMENTS SET FORTH IN THE MEDICAID IDENTIFICATION AND ANTI-FRAUD BIOMETRIC TECHNOLOGY PROGRAM ESTABLISHED PURSUANT TO ARTICLE TWO-B OF THE PUBLIC HEALTH LAW to persons determined by a social services offi- cial to be eligible for such assistance; b. ACTIVATING MEDICAL ASSISTANCE IDENTIFICATION BY REQUIRING AN APPLICANT RECEIVING SUCH IDENTIFICATION FROM THE DEPARTMENT TO HAVE IT VERIFIED AT A SOCIAL SERVICES DISTRICT OFFICE IN THE SOCIAL SERVICES DISTRICT IN WHICH THE APPLICANT RESIDES; C. receiving and processing information relating to each qualified provider of medical assistance furnishing care, services or supplies for which claims for payment are made pursuant to this title;
[c.]D. receiving and processing, in a form and manner prescribed by the department, all claims for medical care, services and supplies, and making payments for valid claims to providers of medical care, services and supplies on behalf of social services districts; AND [d.]E. maintaining information necessary to allow the department, consistent with the powers and duties of the department of health, to review the appropriateness, scope and duration of medical care, services and supplies provided to any eligible person pursuant to this chapter [; and e. initiating implementation of such a system for the district comprising the city of New York, in a manner compatible with expansion of such system to districts other than the district comprising the city of New York]. S 3. This act shall take effect immediately.