New York A 9553: Relates to limiting audit and review of certain medical assistance program funds

Bill Text

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A09553 Summary:

BILL NOA09553 

&nbsp

SAME ASSAME AS S08949

&nbsp

SPONSORPaulin

&nbsp

COSPNSRMcDonald, Reyes, Rosenthal, Burdick, Jacobson, Magnarelli, Reilly, Schiavoni, Shimsky, Stirpe,
 Jensen, Hevesi

&nbsp

MLTSPNSR

&nbsp

Add §37, Pub Health L

&nbsp

Limits the reimbursement amount of certain overpayment claims and reviews where such overpayment was due to the provider's submission of records which were not in accordance with program requirements at the time but which were in accordance with current requirements as a result of changes to guidelines or regulations.

Go to top A09553 Actions:

BILL NOA09553 

&nbsp

01/14/2026referred to health

02/11/2026reported referred to ways and means

Go to topA09553 Committee&nbspVotes:

Committee:HEALTH Chair:Paulin 
DATE:02/11/2026AYE/NAY:24/0 Action: Favorable refer to committee Ways and Means PaulinAyeJensenAye

DinowitzAyeGandolfoAye

RosenthalAyeBlumencranzAye

HevesiAyeGrayAye

SteckAyeSlaterAye

BraunsteinAyeChludzinskiAye

Bichotte HermelAyeNorberAbsent

SayeghAyeDursoAye

McDonaldAye

ReyesAye

Gonzalez-RojasAye

RajkumarAye

ForrestAye

KellesAye

LucasAbsent

MeeksAye

LunsfordAye

CruzAye

Go to topA09553 Floor&nbspVotes:

There are no Assembly votes for this bill in this legislative session.

Go to topA09553 Text:

 STATE OF NEW YORK
 ________________________________________________________________________

 9553

 IN ASSEMBLY

 January 14, 2026
 ___________

 Introduced by M. of A. PAULIN, REYES, ROSENTHAL, BURDICK, JACOBSON,
 MAGNARELLI, REILLY, SCHIAVONI, SHIMSKY, STIRPE, JENSEN -- read once
 and referred 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

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