BILL NUMBER: S9219
SPONSOR: STEC
 
TITLE OF BILL:
An act to amend the public health law and the social services law, in
relation to Medicaid accountability
 
PURPOSE:
To strengthen Medicaid payment accountability by requiring routine
eligibility verification, mandating audits in high-risk areas, estab-
lishing structured payment safeguards with notice and response periods,
and authorizing limited verification tools to confirm service delivery,
while preserving eligibility standards and due process protections.
 
SUMMARY OF PROVISIONS:
Section 1 Establishes legislative findings
Section 2 Mandates the Department of Health shall establish an enroll-
ment verification system. Section 3 Mandates annual audits of programs
most at risk for fraud.
Section 4 Mandates the department to notify those no longer eligible for
Medicaid following a verification check.
Section 5 Establishes a biometric verification pilot program.
Section 6 Requires the department to report to the Legislature the
results of its audit and eligibility verification programs.
Section 7 Sets effective date.
 
JUSTIFICATION:
Recurring audits have identified preventable Medicaid payment errors
driven by enrollment inaccuracies, claims processing weaknesses, and
insufficient follow-through after audit findings. This legislation
addresses those issues by converting recurring audit findings into
enforceable statutory requirements, while providing clear processes and
response windows for managed care plans and providers to resolve
discrepancies.
The use of eligibility verification data reflects existing federal
requirements and is strictly limited to verification purposes permitted
under federal law. The biometric verification pilot is narrowly scoped,
expressly prohibits facial recognition, includes strong privacy
protections, and ensures access to medically necessary services through
non-biometric alternatives.
 
LEGISLATIVE HISTORY:
New bill
 
FISCAL IMPLICATIONS:
Administrative and systems costs associated with implementation are
expected to be offset, in part, by recoveries and avoided improper
payments.
 
EFFECTIVE DATE:
This act shall take effect immediately.

Statutes affected:
S9219: 35 public health law, 364-j social services law