NY SOC SERV § 367-b

Medical assistance information and payment system

The department must create “a statewide medical assistance information and payments system” that is capable of, among other functions, “maintaining information to allow the department…to review the appropriateness, scope and duration of medical care, services and supplies provided to” medical assistance beneficiaries. 

Information regarding a person’s application or receipt of medical assistance benefits is confidential and may only be disclosed pursuant to the administration of public assistance programs. 

The department may contract out their medical assistance payment responsibilities (e.g. payment design, auditing) to “fiscal intermediaries or fiscal agents.”  Such contracts must reserve the state’s ability to create program standards (e.g. provider qualifications, payment rates) and the state’s ability to oversee the contractor’s performance. 

The department must consult with the office of the Medicaid inspector general to “develop, test, and implement” methods to improve the medical assistance information and payment system’s ability to detect and control fraud.  These methods must include prepayment claims review, benefit coordination, paid claims review, and targeted claims and utilization review.