•  Summary 
  •  
  •  Actions 
  •  
  •  Committee Votes 
  •  
  •  Floor Votes 
  •  
  •  Memo 
  •  
  •  Text 
  •  
  •  LFIN 
  •  
  •  Chamber Video/Transcript 

A01257 Summary:

BILL NOA01257
 
SAME ASSAME AS S03358
 
SPONSORPaulin
 
COSPNSRSayegh, Jackson, Tapia, Septimo, De Los Santos, Simone, Weprin, Reyes, Brabenec, Simon, Stern, Colton, Raga, Burdick, Steck, Gallahan
 
MLTSPNSR
 
Amd §3614-e, Pub Health L
 
Provides that the submission of claims for services provided by home care agencies shall be done on forms approved by the centers for Medicare and Medicaid services.
Go to top    

A01257 Actions:

BILL NOA01257
 
01/09/2025referred to health
Go to top

A01257 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A1257
 
SPONSOR: Paulin
  TITLE OF BILL: An act to amend the public health law, in relation to the submission of claims for services provided by home care agencies   PURPOSE OR GENERAL IDEA OF BILL: To improve the process for claiming and billing for home and community- based providers.   SUMMARY OF SPECIFIC PROVISIONS: The bill amends Public Health Law Article 36, to provide that home and community providers shall use federally approved forms for the claiming to insurance companies. It also provides that insurers shall not require the utilization by contract or action any specific billing entity nor impede the timely processing and payment of claims. These provisions include Medicaid managed care plans as well managed long-term care plans.   JUSTIFICATION: Many homes and community based providers are having large account balance issues with certain insurers related to the introduction of a new billing and processing software system. This system has caused claims to be pended, denied or to be deemed untimely. Having a good cash flow is vital to the survival of many home care providers. This legis- lation would not limit the insurer's ability to review or audit claims for fraud, waste and abuse. However, a software issue should not be a barrier to payment on clean claims.   PRIOR LEGISLATIVE HISTORY: A5750 of 2023 and 2024, ordered to third reading rules cal. 47 / Same as S6123, committed to rules.   FISCAL IMPLICATIONS: None   EFFECTIVE DATE: Thirty days after enactment
Go to top

A01257 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          1257
 
                               2025-2026 Regular Sessions
 
                   IN ASSEMBLY
 
                                     January 9, 2025
                                       ___________
 
        Introduced  by  M.  of  A.  PAULIN,  SAYEGH,  JACKSON,  TAPIA,  SEPTIMO,
          DE LOS SANTOS, SIMONE, WEPRIN, REYES, BRABENEC, SIMON, STERN,  COLTON,
          RAGA,  BURDICK,  STECK,  GALLAHAN  --  read  once  and referred to the
          Committee on Health
 
        AN ACT to amend the public health law, in relation to the submission  of
          claims for services provided by home care agencies
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Section 3614-e of  the  public  health  law,  as  added  by
     2  section  49  of  part B of chapter 57 of the laws of 2015, is amended to
     3  read as follows:
     4    § 3614-e. Electronic payment of  claims.  1.  The  payment  of  claims
     5  submitted  under contracts or agreements with insurers under the medical
     6  assistance program for home and community-based long-term care  services
     7  provided under this article, by fiscal intermediaries operating pursuant
     8  to section three hundred sixty-five-f of the social services law, and by
     9  residential  health  care facilities operating pursuant to article twen-
    10  ty-eight of this chapter shall be paid via  electronic  funds  transfer.
    11  Claims for services provided by home care agencies licensed or certified
    12  under  this  article  and by fiscal intermediaries operating pursuant to
    13  section three hundred sixty-five-f of the social services law  shall  be
    14  only  submitted  and remitted on forms approved by the centers for Medi-
    15  care and Medicaid services.   Claims  shall  be  submitted  to  insurers
    16  directly  or  by  a  billing  entity  selected  by  the home care agency
    17  licensed or certified under this article or  by  a  fiscal  intermediary
    18  operating  pursuant  to section three hundred sixty-five-f of the social
    19  services law. Insurers shall not require the utilization by contract  or
    20  action  any  specific  billing  entity by a home care agency licensed or
    21  certified under this article  or  by  a  fiscal  intermediary  operating
    22  pursuant  to  section  three hundred sixty-five-f of the social services
    23  law; nor impede the timely processing and payment of claims.
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD03466-01-5

        A. 1257                             2
 
     1    2. Nothing shall limit an insurer's ability to review or audit  claims
     2  for fraud, waste, and abuse.
     3    3.  Such insurers shall include but not be limited to Medicaid managed
     4  care plans and managed long-term care plans.
     5    § 2. This act shall take effect on the thirtieth day  after  it  shall
     6  have become a law.
Go to top