This bill (S 4955) sets new standards for how New York's Medicaid Inspector General audits and reviews payments to healthcare providers. It requires the Inspector General to follow specific protocols when checking claims, cost reports, or payments, including providing providers access to applicable standards before audits begin. Key provisions include mandating detailed explanations in audit reports, considering factors like whether errors were minor clerical mistakes (e.g., transposed codes), and limiting recoupment for isolated errors. The bill directly affects Medicaid providers who receive state medical assistance payments, ensuring audits are transparent, fair, and based on clear, documented procedures.
This bill eliminates the "look-back period" for non-institutionalized Medicaid applicants seeking home care services. It repeals a provision requiring Medicaid applicants to have no asset transfers below fair market value for 60 months prior to application, instead establishing a 30-month look-back period (pending federal approval) for home care eligibility. This change directly affects individuals applying for community-based long-term care services who previously faced eligibility delays due to past asset transfers. The policy simplifies eligibility by removing penalties for asset transfers made within the shorter look-back window.
Provides that Medicaid and policies issued in this state that provide coverage for hospital, surgical or medical care shall provide coverage for standard fertility preservation services when a necessary cancer treatment may directly or indirectly cause iatrogenic infertility to a covered person.
This bill requires New York State to establish episodic payments (a payment system based on specific care episodes rather than per visit) as the standard method for reimbursing certified home health agencies starting October 1, 2025. It directly affects Medicaid managed care plans, child health insurance plans, and Essential Health Plans operating in New York by mandating they use this payment system and ensure access to home health services for enrolled members. The law requires the state commissioner to notify these plans annually about their responsibilities, emphasizing that home health services reduce avoidable hospital costs. Plans may still negotiate alternative payment rates with agencies, including value-based options tied to health outcomes.
Requires Medicaid to cover a wearable medical device that uses low-intensity, alternating electric fields delivered to the tumor site to treat glioblastoma and other cancers as recommended by medical and scientific evidence.
Repeals managed long term care provisions for Medicaid recipients; establishes provisions for fully integrated plans for long term care including PACE and MAP plans.
This bill amends New York's mental hygiene law to automatically include Down syndrome as a qualifying condition under the definition of developmental disability for Medicaid eligibility. It adds Down syndrome to a list of specific conditions (alongside cerebral palsy, autism, and others) that now qualify individuals for Medicaid without needing separate assessments. People with Down syndrome who meet income and other standard Medicaid criteria will automatically qualify under this change. The law takes effect immediately upon enactment.
Requires social services districts to distribute educational materials pertaining to sexual health, including information on HIV prevention and pre-exposure prophylaxis to individuals enrolled in Medicaid.
Relates to reimbursement for Medicaid for services required by state law; provides department of health must pay 100% of the non-federal share for services required by state law, not federal.
Provides Medicaid reimbursement for interpretation services provided by hospital inpatient, outpatient and emergency department settings and in diagnostic treatment centers; provides further that time frames for notice, approval or certification of rates of payment and to the requirement of prior notice of rates of payment are suspended, deemed without any force and effect from and after February 1, 2027 for such rates effective for the period April 1, 2027 through March 31, 2028.
