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Withholding of Payments

NY-ADR

12/23/09 N.Y. St. Reg. MED-51-09-00013-P

NEW YORK STATE REGISTER

VOLUME XXXI, ISSUE 51

December 23, 2009

RULE MAKING ACTIVITIES

MEDICAID INSPECTOR GENERAL, OFFICE OF

PROPOSED RULE MAKING

NO HEARING(S) SCHEDULED

I.D No. MED-51-09-00013-P

Withholding of Payments

PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:

Proposed Action:

This is a consensus rule making to amend section 518.7(c) and add section 518.9 to Title 18 NYCRR.

Statutory authority:

Public Health Law, section 32(20)

Subject:

Withholding of payments.

Purpose:

To conform to federal regulations requiring certain information to be set forth in notices of withholdings.

Text of proposed rule:

Subdivision (c) of section 518.7 is amended to read as follows:

(1) state that the payments are being withheld in accordance with 42 C.F.R. 455.23 and this section;

(2) state that the withholding is for a temporary period only and recite the circumstances under which the withholding will be terminated;

(3) specify whether the withholding applies to all or only some claims and identify which claims if not all claims are involved; and

(4) advise of the right to submit written arguments and documentation in opposition to the withholding and how to submit them.

A new section 518.9 is added to read as follows:

518.9. Incorporation by reference.

The provisions of the Code of Federal Regulations which have been incorporated by reference in this Part have been filed in the Office of the Secretary of State of the State of New York, the publication so filed being the booklet entitled: Code of Federal Regulations, title 42, Parts 455.23, revised as of October 1, 2008, published by the Office of the Federal Register, National Archives and Records Administration, as a special edition of the Federal Register. The regulations incorporated by reference may be examined at the Office of the Department of State, 99 Washington Ave., Albany, NY 12231 at the law libraries of the New York State Supreme Court and the New York State, and at the Office of the Medicaid Inspector General, Office of Counsel, 800 N. Pearl Street, Albany, New York 12204. They may also be purchased from the Superintendent of Documents, Government Printing Office Washington, DC 20402. Copies of the Code of Federal Regulations are also available at many public libraries and bar association libraries.

Text of proposed rule and any required statements and analyses may be obtained from:

Erin C. Morigerato, Esq., Senior Attorney, Office of the Medicaid Inspector General, 400 N. Pearl Street, Albany, New York 12204, (518) 408-0508, email: [email protected]

Data, views or arguments may be submitted to:

Same as above.

Public comment will be received until:

45 days after publication of this notice.

This action was not under consideration at the time this agency's regulatory agenda was submitted.

Consensus Rule Making Determination

The Office of the Medicaid Inspector General (OMIG) was created within the Department of Health under Chapter 442 of the Laws of 2006 as the entity responsible for coordinating and implementing state-wide initiatives related to fraud and abuse within the medical assistance program.

Public Health Law § 32(20) specifically authorizes the OMIG to implement and amend, as needed, rules and regulations related to the prevention, detection, investigation and referral of fraud and abuse within the medical assistance program and the recovery of improperly expended medical assistance program funds.

The OMIG is submitting the proposed rulemaking as a consensus rule pursuant to SAPA 202(1)(b)(i) as no person is likely to object to the adoption of this rule as written. The basis for the OMIG’s determination is that the proposed rulemaking merely conforms to non-discretionary statutory provisions and makes technical changes that are required by those statutory provisions.

Federal regulations require the State Medicaid agency to set forth in their notice of withholding of program payments certain information including a statement that the payments are being withheld in accordance with 42 C.F.R. § 455.23 This consensus rule amends 18 NYCRR § 518.7 to conform to the federal regulation.

Job Impact Statement

Nature of Impact:

This proposed rulemaking will not have any impact on jobs and employment opportunities.

Category and Numbers Affected:

There are no categories of jobs or employment opportunities expected to be affected by the rule.

Regions of Adverse Impact:

Enactment of this proposed regulation would not have an adverse impact on jobs or employment opportunities. As such, there is no area of the state disproportionately affected.

Minimizing Adverse Impact:

There will be no adverse impact on existing jobs.

End of Document