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S 5209

Limits the lookback period for insurance overpayment recovery from health care providers to twelve months

2025 Regular Session Introduced by Jessica Scarcella-Spanton and 2 co-sponsors

Limits insurers to a 12-month lookback to recover overpayments from health care providers, stabilizing provider revenue and forcing changes in payer recoupment practices.

PRINT NUMBER 5209A
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WeVote Research Nonpartisan
Bill Summary · S 5209

Summary of Senate Bill S 5209 (2025)

Overview

S 5209, titled “Limits the lookback period for insurance overpayment recovery from health care providers to twelve months,” is a proposed statute that would cap the period during which health insurers can seek to recover overpayments from health care providers to 12 months. The bill is currently listed as PRINT NUMBER 5209A.

  • Introduced: February 19, 2025
  • Primary sponsor: Jessica Scarcella-Spanton
  • Cosponsors: William Weber, James Skoufis
  • Related bills: S 7076 (prior-session), Assembly companion A 3365

Legislative status and actions

  • Referred to the Senate Insurance Committee: February 19, 2025
  • Amendments and recommittals to Insurance: May 20, 2025
  • Print version: 5209A (May 20, 2025)

What the bill would do (key provisions)

  • Cap on lookback period: Establishes a 12-month lookback window during which insurers may recover overpayments from health care providers.
  • Scope: The summary indicates the provision applies to insurance overpayment recoveries from health care providers; specific definitions (e.g., “overpayment,” start of the lookback period, and any carve-outs) are not detailed in the provided material.
  • Effect: By limiting retroactive recovery to a one-year window, the bill would restrict insurers’ ability to seek recoupment beyond 12 months after an overpayment is identified or paid.

Note: The exact statutory definitions, effective date, exemptions, and enforcement mechanisms are not included in the provided text. The 12-month cap is the central change highlighted.

Who is affected

  • Health care providers: Potentially benefit from a more predictable revenue stream and reduced risk of long-tail clawbacks.
  • Health insurers/payers: Would need to adjust audit and recoupment practices to comply with a 12-month lookback limit.
  • Patients: Indirectly affected through potential changes in billing practices and payer-provider dispute dynamics.

Procedural and timeline considerations

  • Introduction: February 19, 2025
  • Committee proceedings: Referred to Insurance; amendments and recommittals occurred on May 20, 2025.
  • Next steps: If advanced, the bill would move through the Insurance Committee and onto floor consideration; further amendments may be possible.

Related context

  • Companion/related measures exist in prior sessions (S 7076; A 3365 in the Assembly), indicating ongoing interest in aligning lookback and recoupment rules across chambers.

This summary provides a concise, nonpartisan outline of S 5209 based on the available bill information. For a complete understanding, the full text and fiscal notes would clarify definitions, exemptions, effective dates, and transitional provisions.

Compiled from official sources — confirm details with the bill’s official record.

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