Building on the recent efforts of the Centers for Medicare & Medicaid Services (CMS), as evidenced by issuance of its own Request for Information (RFI) on October 19, 2019, the New York State Department of Health (DOH) is similarly examining whether advanced and emerging technologies, such as artificial intelligence (AI) applications, machine learning, data analytics and systems, or other technology-enabled data solutions, are available to help improve efficiencies and integrity in New York State’s expansive Medicaid program. Accordingly, the purpose of this RFI is for DOH to obtain input on how New York State, through DOH working in collaboration with the Office of the Medicaid Inspector General (OMIG), may be better able to use advanced or next generation technology applications that enhance Medicaid program integrity and efficiency by allowing DOH to assess, anticipate, and act in real-time to inform policy-making, strategic decision-making, and recovery efforts.

Improved integrity and efficiency in the Medicaid program may come in various forms and include:

• ensuring accurate claims review, adjudication, and payment;
• aligning payment incentives with service delivery;
• implementing rapid and appropriate utilization controls for services;
• identifying and understanding variations in clinical practice and the clinical and financial results from those variations;
• reducing unnecessary administrative burdens for plans and providers;
• rapidly assessing broader and interconnected data sets to streamline service delivery; and
• encouraging accurate coding and clinical documentation practices, among others.

Through application of identified advanced technologies and staffing resources to analyze and respond to applicable technological outputs, which may be the subject of a future DOH or OMIG procurement, the State seeks to reduce unnecessary or improper program expenditures, improve policy decision-making, improve audit efficiency, reduce administrative burdens and costs, and enhance overall program quality.