N.Y. Social Services Law § 368-c: Audit of state rates of payment to providers of health care services

§ 368-c. Audit of state rates of payment to providers of health care

services. 1. The commissioner may conduct, or have conducted, an audit

of financial and statistical reports used for the purpose of

establishing rates of payment or fees made in accordance with the

medical assistance program.

2. The commissioner shall implement audit procedures and activities to

enable the identification of the appropriate rates of payment made

through the medical assistance program. Furthermore the commissioner

shall conduct an annual review of financial and statistical reports with

respect to residential health care facilities certified pursuant to

article twenty-eight of the public health law. Where such review

indicates substantial noncompliance, as defined in regulation by the

commissioner, with the requirements of the medical assistance program

the commissioner shall conduct or have conducted an on-site audit.

Provided further however, that at least once every four fiscal years an

on-site audit shall be conducted.

3. To allow for the recomputation of affected fees or rates of

payment, the commissioner shall, as appropriate, supply audit findings

to the governmental agency or corporation organized and operating in

accordance with article forty-three of the insurance law responsible for

the promulgation of fees or rates of reimbursement.

4. The commissioner shall enter into interagency agreements, subject

to the approval of the director of the budget, to delineate the

respective responsibilities of the department and other governmental

agencies with respect to this section.

5. The commissioner is authorized to promulgate regulations to

implement the provisions of this section.