Sayegh, 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.
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
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.
