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A03470 Summary:

BILL NOA03470A
 
SAME ASSAME AS S02521-A
 
SPONSORGottfried
 
COSPNSREpstein, Jacobson, Thiele, Barron, Simon, Seawright, Dinowitz, Benedetto, Sayegh, Reyes, Glick, Perry, Abinanti, Cruz, Paulin, Solages, Rosenthal L, Gunther, Aubry, Galef, Steck, Niou, Weprin, Taylor, Jean-Pierre, Forrest, Mitaynes, Hevesi, Lunsford, Braunstein, Mamdani, Zinerman, Kelles, De La Rosa, McDonald, Cahill, Gonzalez-Rojas, Bronson, Anderson, Griffin, Burdick, Durso, Clark, Vanel, Englebright, Otis, Pichardo
 
MLTSPNSR
 
Desig Art 28 §§2800 - 2827 to be Title 1, add Title 2 §§2830 - 2833, amd §§2807-e, 206, 2803 & 2807-k, rpld §2807-k sub 14, Pub Health L; amd §5004, CPLR; amd §603, Fin Serv L
 
Relates to medical billing and debt (Part A); relates to defining certain terms (Part B); relates to standardized consolidated itemized general hospital bills (Part C); relates to regulation of the billing of facility fees (Part D); relates to standardized patient financial liability forms (Part E); relates to an all payer database (Part F); relates to the general hospital indigent care pool; and repeals certain provisions of such law relating thereto (Part G); relates to the rate of interest in medical debt actions (Part H); relates to services rendered by a non-participating provider; relates to hospital statements of rights and responsibilities of patients (Part I).
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A03470 Actions:

BILL NOA03470A
 
01/26/2021referred to health
01/28/2021amend and recommit to health
01/28/2021print number 3470a
02/09/2021reported referred to codes
03/09/2021reported referred to ways and means
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A03470 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A3470A
 
SPONSOR: Gottfried
  PURPOSE OR GENERAL IDEA OF BILL: To protect patients from medical debt by simplifying hospital billing; standardizing hospital financial assistance, lessening the interest rate for medical debt, and adding network misinformation and balance billing protections to the Surprise Bill Laws   SUMMARY OF SPECIFIC PROVISIONS: Part A would divide Public Health Law Article 28 into two titles, Title 1 Hospitals, and Title 2, Medical Billing and Debt. Part B creates a new Public Health Law § 2830 to define terms including "affiliated providers", "facility fee", and "hospital-based facility" among others. Part C creates a new Public Health Law § 2831 to require that general hospitals, hospital systems and affiliated health care providers provide plain language bills to patients who have received hospital services, or their legal guardian or survivor. All charges for one hospital visit would be consolidated into one bill that details services, date, and provider, received within seven days of discharge. Charges would be labelled as paid, assigned to an insurer or owed by the patient. Provid- ers not employed by the general hospital would not bill separately. Bills would include contact information to settle disputes. Part D creates a new Public Health Law § 2832 to ban hospitals and professional practices from charging patients for facility fees for either preventive care or if their insurance will not cover the fee. Part E creates a new Public Health Law § 2833 to standardize patient financial liability forms to be used by all hospitals and health care professionals. Part F would amend Public Health Law § 206 to enable all hospitals and health care professionals to participate in the state all-payer data- base. Part G would amend Public Health Law § 2807-k to standardize policies, applications, and appeal procedures related to hospital financial assistance. It would improve public reporting of hospital financial assistance data, and increase the income limit as well as the opportu- nity to apply for assistance. Part H would add a new Civil Practice Law §§ 213-d and 5004 to reduce the percentage rate on medical debt judgements to a rate corresponding to the one-year United States treasury bill rate. Part I sections 1-6 would amend Insurance Law § 603; making conforming amendments to hold consumers harmless from surprise out-of-network bills, or plan and provider misinformation about their network partic- ipation.   JUSTIFICATION: This bill would clarify and simplify medical billing, protect patients from medical debt, and update New York's landmark surprise billing law to provide additional consumer protections for out of network charges. Hospital visits produce bills that can keep coming for years, use admin- istrative codes that are unique to individual facilities, and often do not track what charges have already been paid. It is common for patients to receive multiple bills for the same service long after they or their insurer has already paid for that service. Florida has enacted a number of provisions to protect consumers by ensuring that hospital bills are clear, follow standard formats, and are provided in a timely manner. 2 Patients in New York should receive those same protections. Facility fees are charged separately from payments for medical services to subsidize hospital and clinic operations. This bill would allow insurers to negotiate with provider and pay facility fees through their contracts, but would not allow providers to charge individual patients. It would also ban facility fees altogether for preventive care to make sure that there is no financial disincentive for patients to receive care that is proven to improve their health. It is increasingly common for providers to present patients with liabil- ity forms to sign before providing care that ask patients to take on financial liability for services that they cannot foreseeably budget for. These forms can mislead patients into believing they must pay bills even when they are protected against those bills under New York State Law, for example in the event of a surprise bill. A standard form would ensure patient-friendly language that complies with existing New York laws protecting patients from unfair financial liability for medical care. The state's All-Payer Database (APD) is meant to become an important information tool to support policymaking and a tool that will help consumers plan ahead for expensive medical care. The State cannot adequately know billing practices if it does not have accurate informa- tion, yet some providers are asking health plans to exclude their data from APD submissions. Additionally, the public has yet to see the bene- fits of New York's investment in the All-Payer Database. This section would affirm that the All-Payer Database should be devel- oped to meet the needs of consumers. The lack of standardization in how hospitals implement the Hospital Financial Assistance Law results in patients who should receive assist- ance going without that assistance and even going without care. The state's audits have repeatedly found that hospitals are not comply- ing with the law, as have audits conducted by consumer advocates. 3 A proven income eligibility verification process already exists in The New York State of Health exchange insurance program which can also be used to determine eligibility for hospital financial assistance. The bill would amend New York's surprise bill law to ensure that when a patient relies on incorrect information provided by a provider or health plan that the provider or facility is in-network, when in fact, it is not. Under current law, the patient is still responsible for the cost of care when such postings are incorrect. It is estimated that 35 percent of surprise billing disputes fall into this category.   PRIOR LEGISLATIVE HISTORY: 2019-2020: A8639-A - referred to Health Committee.   FISCAL IMPLICATIONS: None to the state.   EFFECTIVE DATE: Immediately, provided, that the applicable effective date of Parts A through I of this act are specifically set forth in the last section of such Parts. 1 Penelope Wang, "Sick of Confusing Medical Bills?" Consumer Reports, August 1, 2018, https://www.consumerreports.org/medical-billine sick-of- confusing-medical-bills/. 2 Florida Title XXIX Public Health § 395.301 3 Carrie Tracy et al., "Unintended Consequences - How New York State Patients and Safety-Net Hospitals Are Short-Changed," January 20 18, https://www.cssny.org/publications/entry/unintended consequences.
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A03470 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         3470--A
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 26, 2021
                                       ___________
 
        Introduced  by  M.  of  A. GOTTFRIED, EPSTEIN, JACOBSON, THIELE, BARRON,
          SIMON, SEAWRIGHT, DINOWITZ, BENEDETTO, SAYEGH,  REYES,  GLICK,  PERRY,
          ABINANTI,  CRUZ,  PAULIN, ENGLEBRIGHT, SOLAGES, L. ROSENTHAL, GUNTHER,
          AUBRY, GALEF, STECK, NIOU, WEPRIN,  TAYLOR,  JEAN-PIERRE,  FORREST  --
          read  once  and  referred  to  the  Committee  on  Health -- committee
          discharged, bill amended, ordered reprinted as amended and recommitted
          to said committee
 
        AN ACT to amend the public health law, in relation  to  medical  billing
          and  debt  (Part  A);  to  amend the public health law, in relation to
          defining certain terms (Part B); to amend the public  health  law,  in
          relation  to standardized consolidated itemized general hospital bills
          (Part C); to amend the public health law, in relation to regulation of
          the billing of facility fees (Part D); to amend the public health law,
          in relation to standardized patient financial  liability  forms  (Part
          E);  to amend the public health law, in relation to an all payer data-
          base (Part F); to amend the public health  law,  in  relation  to  the
          general  hospital indigent care pool; and to repeal certain provisions
          of such law relating thereto (Part G); to amend the civil practice law
          and rules, in relation to the rate of interest in medical debt actions
          (Part H); and to amend the financial  services  law,  in  relation  to
          services  rendered  by  a non-participating provider; and to amend the
          public health law, in relation to hospital statements  of  rights  and
          responsibilities of patients (Part I)
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Short title. This act shall be known and may  be  cited  as
     2  the "patient medical debt protection act".
     3    §  2.  This  act enacts into law major components of legislation which
     4  relate to patient medical debt  protection.  Each  component  is  wholly
     5  contained  within  a Part identified as Parts A through I. The effective
     6  date for each particular provision contained within  such  Part  is  set
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00481-03-1

        A. 3470--A                          2
 
     1  forth  in  the  last  section of such Part. Any provision in any section
     2  contained within a Part, including the effective date of the Part, which
     3  makes reference to a section "of this act", when used in connection with
     4  that  particular  component,  shall  be  deemed to mean and refer to the
     5  corresponding section of the Part in which it is found. Section four  of
     6  this act sets forth the general effective date of this act.
 
     7                                   PART A

     8    Section  1.  Sections  2800  through  2827 of article 28 of the public
     9  health law are designated title 1, and a new title 2 is added to article
    10  28, to read as follows:
    11                                   TITLE 2
    12                          MEDICAL BILLING AND DEBT
    13    § 2. This act shall take effect immediately.
 
    14                                   PART B
 
    15    Section 1. Title 2 of article 28 of the public health law  is  amended
    16  by adding a new section 2830 to read as follows:
    17    §  2830. Definitions. As used in this title, the following terms shall
    18  have the following meanings, unless the context clearly requires  other-
    19  wise:
    20    1.  "Affiliated  provider" means a provider that is: (a) employed by a
    21  hospital or health system, (b) under a professional  services  agreement
    22  with  a hospital or health system, or (c) a clinical faculty member of a
    23  medical school or other school that trains individuals to  be  providers
    24  that is affiliated with a hospital or health system.
    25    2.  "Campus"  means:  (a)  the physical area immediately adjacent to a
    26  hospital's main buildings and other areas and structures  that  are  not
    27  strictly  contiguous  to  the  main buildings but are located within two
    28  hundred fifty yards of the main buildings, or (b) any  other  area  that
    29  has been determined on an individual case basis by the Centers for Medi-
    30  care and Medicaid Services to be part of a hospital's campus.
    31    3.  "Facility  fee"  means  any fee charged or billed by a hospital or
    32  health system for inpatient or outpatient hospital services provided  in
    33  a hospital-based facility that is: (a) intended to compensate the hospi-
    34  tal  or  health  system  for the operational expenses of the hospital or
    35  health system, and (b) separate and distinct from a fee for patient-spe-
    36  cific services, supplies and drugs; "facility fee" shall not include any
    37  fee charged or billed by a residential health care facility.
    38    4. "Health system" means a group of one or more hospitals and  provid-
    39  ers affiliated through ownership, governance, membership or other means.
    40    5.  "Hospital-based  facility" means a facility that is owned or oper-
    41  ated, in whole or in part, by a hospital or health system where hospital
    42  or professional health care services, supplies or drugs are provided.
    43    6. "Fee" means any fee charged or billed by  a  provider  for  profes-
    44  sional health care services provided in a hospital-based facility.
    45    7.  "Provider"  means  an  individual or entity, whether for profit or
    46  nonprofit, whose primary purpose is to provide professional health  care
    47  services.
    48    § 2. This act shall take effect immediately.
 
    49                                   PART C

        A. 3470--A                          3
 
     1    Section  1.  Title 2 of article 28 of the public health law is amended
     2  by adding a new section 2831 to read as follows:
     3    §  2831. Standardized consolidated itemized general hospital bills. 1.
     4  After a patient's discharge or  release  from  a  general  hospital,  or
     5  completion of a discrete course of treatment by a hospital-based facili-
     6  ty, the facility shall provide to the patient or to the patient's survi-
     7  vor  or  legal  guardian,  as appropriate, a consolidated itemized bill.
     8  The initial consolidated itemized bill shall be provided  no  more  than
     9  seven  days  after the patient's discharge, or  release or completion of
    10  the episode or course of treatment,   or after a  request    for    such
    11  bill, whichever is earlier.
    12    2. The consolidated itemized bill shall:
    13    (a)  detail in plain language, comprehensible to an ordinary layperson
    14  (consistent with accuracy), the specific nature of charges  or  expenses
    15  incurred  by the patient during the hospitalization or episode or course
    16  of treatment and the date of each service;
    17    (b) detail all services provided to the patient during the  hospitali-
    18  zation  or  episode  or  course of treatment, including all professional
    19  services administered and supplies and drugs,  contain  a  statement  of
    20  specific  services  received  and expenses incurred by date and provider
    21  for such items of service, enumerating in detail the constituent  compo-
    22  nents  of  the  services received within each department of the facility
    23  and including unit price data on rates charged;
    24    (c) identify each item as paid, assigned to a  third-party  payer,  or
    25  expected payment by the patient;
    26    (d)  include  the amount due, if any from the patient, including a due
    27  date;
    28    (e) for any amount paid or to be paid  by  the  patient,  indicate  to
    29  which person or entity an amount is due;
    30    (f)  not  include any generalized category of expenses such as "other"
    31  or "miscellaneous" or similar categories;
    32    (g) list drugs by brand or generic name, even where drug code  numbers
    33  are used;
    34    (h)  specifically  identify physical, rehabilitative, occupational, or
    35  speech therapy treatment by date, type, and  length  of  treatment  when
    36  such treatment is a part of the statement or bill; and
    37    (i) prominently display the telephone number of the facility's patient
    38  liaison responsible for expediting the resolution of any billing dispute
    39  between  the  patient,  or the patient's survivor or legal guardian, and
    40  the billing department or departments.
    41    3.  A provider with any financial or contractual relationship with the
    42  facility may not separately bill the patient or the  patient's  survivor
    43  or legal guardian for such services, supplies or drugs.
    44    4.  Any  subsequent  bill  provided  to  a patient or to the patient's
    45  survivor or legal guardian, as appropriate, relating to the hospitaliza-
    46  tion or episode or course of treatment must include all of the  informa-
    47  tion  required  under  this  section, in or enclosed with the bill or by
    48  reference to a previous consolidated itemized  bill,  with  any  clearly
    49  delineated revisions.
    50    5.    The  consolidated itemized bill, shall be in a form developed by
    51  the commissioner, in consultation with the superintendent  of  financial
    52  services.
    53    6.   Each facility shall establish policies and procedures for review-
    54  ing and responding to questions from patients concerning  the  patient's
    55  consolidated  itemized bill. The response shall be provided no more than
    56  seven business days after the  date  a  question  is  received.  If  the

        A. 3470--A                          4
 
     1  patient  is  not satisfied with the response, the facility shall provide
     2  the patient with the contact information of the hospital  department  or
     3  collection entity to which the issue shall be sent for review.
     4    §  2.  Section  2807-e of the public health law is amended by adding a
     5  new subdivision 6 to read as follows:
     6    6. This section is subject to the provisions of  section  twenty-eight
     7  hundred  thirty-one of this article, and where any provisions of the two
     8  sections conflict, the provisions of section twenty-eight hundred  thir-
     9  ty-one of this article shall control.
    10    §  3. This act shall take effect one year after it shall have become a
    11  law.
 
    12                                   PART D
 
    13    Section 1. Title 2 of article 28 of the public health law  is  amended
    14  by adding a new section 2832 to read as follows:
    15    §  2832.  Regulation  of the billing of facility fees.  No hospital or
    16  health system shall bill or seek payment from a patient for  a  facility
    17  fee:  1.  related to the provision of preventive care service as defined
    18  by the United States Preventive Services Task Force; or
    19    2. where the facility fee is not covered for the patient by  a  third-
    20  party payer.
    21    § 2. This act shall take effect on the one hundred eightieth day after
    22  it shall have become a law.
 
    23                                   PART E
 
    24    Section  1.  Title 2 of article 28 of the public health law is amended
    25  by adding a new section 2833 to read as follows:
    26    § 2833. Standardized patient financial liability forms.  Every  hospi-
    27  tal,  health  system,  hospital-based  facility,  affiliated provider or
    28  other provider shall use the uniform patient  financial  liability  form
    29  which  shall  be developed by the commissioner.  The form shall disclose
    30  to the patient whether services, supplies  and  drugs  provided  to  the
    31  patient  are in-network or out-of-network, whether the care is a covered
    32  benefit by a third-party payer of the patient, and the nature and amount
    33  of the patient's projected financial liability.  A patient shall not  be
    34  financially  liable  for  any service, supplies or drugs subject to this
    35  title that is not charged or billed in accordance with this title.   The
    36  commissioner  shall  develop  and  issue the uniform financial liability
    37  form within six months of the effective date of this section.  The  form
    38  shall  be  adopted  and used under this section by each hospital, health
    39  system, hospital-based facility, affiliated provider and other  provider
    40  not later than sixty days after the commissioner issues the form.
    41    § 2. This act shall take effect immediately.
 
    42                                   PART F
 
    43    Section 1. Subdivision 18-a of section 206 of the public health law is
    44  amended by adding a new paragraph (e) to read as follows:
    45    (e)(i) The commissioner shall ensure that the New York state all payer
    46  database shall serve the interests of New York's health care consumers.
    47    (ii)  Every hospital licensed under article twenty-eight of this chap-
    48  ter and health care professionals authorized under title  eight  of  the
    49  education  law shall participate in the all payer database through their

        A. 3470--A                          5
 
     1  insurance carrier contracts, and may participate in the all payer  data-
     2  base through any other of the hospital's third-party payer contracts.
     3    (iii)  Data that is required to be submitted to the all payer database
     4  shall not be considered proprietary  information  for  the  purposes  of
     5  submission to or inclusion in the all payer database.
     6    § 2. This act shall take effect on the one hundred eightieth day after
     7  it shall have become a law.
 
     8                                   PART G
 
     9    Section  1.  Subdivisions  9  and  9-a of section 2807-k of the public
    10  health law, subdivision 9 as amended by section 17 of part B of  chapter
    11  60 of the laws of 2014, subdivision 9-a as added by section 39-a of part
    12  A of chapter 57 of the laws of 2006 and paragraph (k) of subdivision 9-a
    13  as  added by section 43 of part B of chapter 58 of the laws of 2008, are
    14  amended to read as follows:
    15    9. In order for a general hospital to participate in the  distribution
    16  of  funds  from  the  pool, the general hospital must [implement minimum
    17  collection policies and procedures approved] use only the uniform finan-
    18  cial assistance form provided by the commissioner.  The  definitions  in
    19  section  twenty-eight hundred thirty of this article shall apply to this
    20  subdivision and subdivision nine-a of this section.
    21    9-a. (a) (i) As a condition for participation  in  pool  distributions
    22  authorized  pursuant  to  this  section and section twenty-eight hundred
    23  seven-w of this article for periods on  and  after  January  first,  two
    24  thousand  nine,  general  hospitals  shall, effective for periods on and
    25  after January first, two thousand [seven, establish]  twenty-two,  adopt
    26  and  implement  the  uniform  financial [aid policies and procedures, in
    27  accordance with the provisions  of  this  subdivision]  assistance  form
    28  policy, to be developed and issued by the commissioner no later than one
    29  hundred eighty days after the effective date of a chapter of the laws of
    30  two  thousand  twenty-one  that  amended this subdivision. No later than
    31  thirty days after the issuance of the uniform financial assistance  form
    32  and  policy, general hospitals shall implement such form and policy, for
    33  reducing hospital charges and charges for affiliated providers otherwise
    34  applicable to low-income individuals without third-party health  [insur-
    35  ance] coverage, or who have [exhausted their] third-party health [insur-
    36  ance  benefits]  coverage  that does not cover or limits coverage of the
    37  service, and who can demonstrate an inability to pay full  charges,  and
    38  also,  at  the  hospital's  discretion,  for reducing or discounting the
    39  collection of co-pays and deductible payments from those individuals who
    40  can demonstrate an inability to pay  such  amounts.  Immigration  status
    41  shall not be an eligibility criterion.
    42    (ii)  A  general hospital may use the New York state of health market-
    43  place eligibility determination page to establish the  patient's  house-
    44  hold  income  and  residency  in lieu of the financial application form,
    45  provided it has secured the consent of the patient. A  general  hospital
    46  shall  not  require a patient to apply for coverage through the New York
    47  state of health marketplace  in  order  to  receive  care  or  financial
    48  assistance.
    49    (iii) Upon submission of a completed application form, the patient may
    50  disregard  any  bills until the general hospital has rendered a decision
    51  on the application in accordance with this paragraph.
    52    (b) Such reductions from charges for [uninsured] patients described in
    53  paragraph (a) of this subdivision with incomes below  [at  least  three]
    54  four  hundred  percent  of  the  federal poverty level shall result in a

        A. 3470--A                          6
 
     1  charge to such individuals that does not exceed  [the  greater  of]  the
     2  amount  that would have been paid for the same services [by the "highest
     3  volume payor" for such general hospital as defined in  subparagraph  (v)
     4  of  this  paragraph, or for services provided pursuant to title XVIII of
     5  the federal social security act (medicare), or  for  services]  provided
     6  pursuant to title XIX of the federal social security act (medicaid), and
     7  provided further that such amounts shall be adjusted according to income
     8  level as follows:
     9    (i)  For  patients with incomes at or below [at least one] two hundred
    10  percent of the federal poverty level, the hospital shall collect no more
    11  than a nominal payment amount, consistent with guidelines established by
    12  the commissioner[;].
    13    (ii) For patients with incomes between [at least one] two hundred  one
    14  percent  and  [one]  four hundred [fifty] percent of the federal poverty
    15  level, the hospital shall collect no more  than  the  amount  identified
    16  after  application  of  a  proportional sliding fee schedule under which
    17  patients with lower incomes shall pay the lowest amount.  Such  schedule
    18  shall provide that the amount the hospital may collect for such patients
    19  increases  from the nominal amount described in subparagraph (i) of this
    20  paragraph in equal increments as the income of the patient increases, up
    21  to a maximum of twenty percent of the [greater of the] amount that would
    22  have been paid for the same services [by the "highest volume payor"  for
    23  such general hospital, as defined in subparagraph (v) of this paragraph,
    24  or  for  services provided pursuant to title XVIII of the federal social
    25  security act (medicare) or for services] provided pursuant to title  XIX
    26  of the federal social security act (medicaid)[;].
    27    (iii)  [For  patients with incomes between at least one hundred fifty-
    28  one percent and two hundred fifty percent of the federal poverty  level,
    29  the  hospital  shall  collect  no  more than the amount identified after
    30  application of a proportional sliding fee schedule under which  patients
    31  with  lower  income  shall  pay  the lowest amounts. Such schedule shall
    32  provide that the amount the  hospital  may  collect  for  such  patients
    33  increases  from the twenty percent figure described in subparagraph (ii)
    34  of this paragraph in equal increments  as  the  income  of  the  patient
    35  increases,  up to a maximum of the greater of the amount that would have
    36  been paid for the same services by the "highest volume payor"  for  such
    37  general  hospital,  as defined in subparagraph (v) of this paragraph, or
    38  for services provided pursuant to title  XVIII  of  the  federal  social
    39  security  act  (medicare) or for services provided pursuant to title XIX
    40  of the federal social security act (medicaid); and
    41    (iv)] For patients with incomes [between at least two  hundred  fifty-
    42  one  percent  and  three  hundred] above four hundred one percent of the
    43  federal poverty level, the hospital  shall  collect  no  more  than  the
    44  greater  of  the  amount that would have been paid for the same services
    45  [by the "highest volume payor" for such general hospital as  defined  in
    46  subparagraph (v) of this paragraph, or for services provided pursuant to
    47  title  XVIII  of  the  federal  social  security  act (medicare), or for
    48  services] provided pursuant to title XIX of the federal social  security
    49  act (medicaid).
    50    [(v)  For the purposes of this paragraph, "highest volume payor" shall
    51  mean the insurer, corporation or  organization  licensed,  organized  or
    52  certified  pursuant  to  article thirty-two, forty-two or forty-three of
    53  the insurance law or article forty-four of this chapter, or other third-
    54  party payor, which has  a  contract  or  agreement  to  pay  claims  for
    55  services  provided  by  the  general  hospital  and incurred the highest
    56  volume of claims in the previous calendar year.

        A. 3470--A                          7

     1    (vi) A hospital may implement policies and procedures to  permit,  but
     2  not  require, consideration on a case-by-case basis of exceptions to the
     3  requirements described in subparagraphs (i) and (ii) of  this  paragraph
     4  based upon the existence of significant assets owned by the patient that
     5  should  be  taken  into  account  in determining the appropriate payment
     6  amount for that patient's care, provided, however,  that  such  proposed
     7  policies  and  procedures  shall  be  subject  to  the  prior review and
     8  approval of the commissioner and, if approved, shall be included in  the
     9  hospital's  financial  assistance  policy  established  pursuant to this
    10  section, and provided further that, if such  approval  is  granted,  the
    11  maximum amount that may be collected shall not exceed the greater of the
    12  amount  that  would have been paid for the same services by the "highest
    13  volume payor" for such general hospital as defined in  subparagraph  (v)
    14  of  this  paragraph, or for services provided pursuant to title XVIII of
    15  the federal social security act (medicare),  or  for  services  provided
    16  pursuant  to title XIX of the federal social security act (medicaid). In
    17  the event that a general hospital reviews a patient's assets  in  deter-
    18  mining  payment  adjustments  such  policies  and  procedures  shall not
    19  consider as assets a patient's primary residence, assets held in a  tax-
    20  deferred  or  comparable  retirement  savings  account,  college savings
    21  accounts, or cars used  regularly  by  a  patient  or  immediate  family
    22  members.
    23    (vii)]  (iv)  Nothing  in this paragraph shall be construed to limit a
    24  hospital's  ability  to  establish  patient  eligibility   for   payment
    25  discounts  at income levels higher than those specified herein and/or to
    26  provide greater payment  discounts  for  eligible  patients  than  those
    27  required by this paragraph.
    28    (c)  [Such  policies and procedures shall be clear, understandable, in
    29  writing and publicly available in summary form and  each]  Each  general
    30  hospital  participating  in  the pool shall ensure that every patient is
    31  made aware of the existence of such [policies  and  procedures]  uniform
    32  financial  assistance  form  and  policy  and  is  provided, in a timely
    33  manner, with a [summary] copy of such [policies and procedures] form and
    34  policy upon request. [Any summary provided to patients shall, at a mini-
    35  mum, include specific information as to income levels used to  determine
    36  eligibility for assistance, a description of the primary service area of
    37  the  hospital  and  the  means  of  applying for assistance. For general
    38  hospitals with twenty-four hour emergency departments, such policies and
    39  procedures]  A  general  hospital  shall  require  the  notification  of
    40  patients  through  written  materials  provided  to  patients during the
    41  intake and registration process,  through  the  conspicuous  posting  of
    42  language-appropriate  information  in the general hospital, and informa-
    43  tion on bills and statements sent  to  patients,  that  financial  [aid]
    44  assistance  may  be  available  to  qualified patients and how to obtain
    45  further information. [For specialty hospitals without  twenty-four  hour
    46  emergency  departments, such notification shall take place through writ-
    47  ten materials provided to patients during the  intake  and  registration
    48  process  prior  to  the  provision of any health care services or proce-
    49  dures, and through information on bills and statements sent to patients,
    50  that financial aid may be available to qualified  patients  and  how  to
    51  obtain further information. Application materials shall include a notice
    52  to  patients  that upon submission of a completed application, including
    53  any information or  documentation  needed  to  determine  the  patient's
    54  eligibility  pursuant to the hospital's financial assistance policy, the
    55  patient may disregard any bills until the hospital has rendered a  deci-
    56  sion  on  the  application  in  accordance  with this paragraph] General

        A. 3470--A                          8
 
     1  hospitals shall post the uniform financial assistance  application  form
     2  and  policy in a conspicuous location on the general hospital's website.
     3  The commissioner shall likewise post the  uniform  financial  assistance
     4  form and policy on the department's hospital profile page related to the
     5  general hospital's or any successor website.
     6    (d)  The  commissioner  shall provide application materials to general
     7  hospitals, including the uniform financial assistance  application  form
     8  and  policy.  These  application  materials  shall  include  a notice to
     9  patients that upon submission  of  a  completed  application  form,  the
    10  patient  may disregard any bills until the general hospital has rendered
    11  a decision on the application in accordance  with  this  paragraph.  The
    12  application  materials  shall include specific information as the income
    13  levels  used  to  determine  eligibility  for  financial  assistance,  a
    14  description of the primary service area of the hospital and the means to
    15  apply  for assistance. Such policies and procedures shall include clear,
    16  objective criteria for determining a patient's ability to  pay  and  for
    17  providing  such adjustments to payment requirements as are necessary. In
    18  addition to adjustment mechanisms such  as  sliding  fee  schedules  and
    19  discounts  to  fixed  standards, such policies and procedures shall also
    20  provide for the use of installment plans for the payment of  outstanding
    21  balances by patients pursuant to the provisions of the hospital's finan-
    22  cial  assistance policy. The monthly payment under such a plan shall not
    23  exceed [ten] five percent of the gross monthly income of  the  patient[,
    24  provided,  however,  that  if patient assets are considered under such a
    25  policy, then patient assets which are not excluded  assets  pursuant  to
    26  subparagraph (vi) of paragraph (b) of this subdivision may be considered
    27  in  addition  to  the  limit  on monthly payments.] The rate of interest
    28  charged to the patient on the unpaid balance, if any, shall  not  exceed
    29  the  [rate  for  a ninety-day security] federal funds rate issued by the
    30  United States Department of Treasury[, plus  .5  percent]  and  no  plan
    31  shall include an accelerator or similar clause under which a higher rate
    32  of  interest  is  triggered upon a missed payment. [If such policies and
    33  procedures] The policy shall not include  a  requirement  of  a  deposit
    34  prior to [non-emergent,] medically-necessary care[, such deposit must be
    35  included  as part of any financial aid consideration]. Such policies and
    36  procedures shall be applied consistently to all eligible patients.
    37    (e) Such [policies and procedures] policy shall [permit  patients  to]
    38  require  the hospital's chief financial officer to provide a sworn affi-
    39  davit, that must be filed with a complaint for medical  debt  collection
    40  action  in  a  court of jurisdiction, that the patient does not meet the
    41  income or residency criteria  for  financial  assistance.  Patients  may
    42  apply  for  assistance  [within  at  least  ninety  days  of the date of
    43  discharge or date of service  and  provide  at  least  twenty  days  for
    44  patients  to  submit  a  completed  application]  at any time during the
    45  collection process, including after the commencement of a  medical  debt
    46  court action or upon securing a default judgment in a court of jurisdic-
    47  tion.    Such  policies and procedures may require that patients seeking
    48  payment adjustments provide [appropriate] the following financial infor-
    49  mation and documentation in support  of  their  application[,  provided,
    50  however, that such application process shall not be unduly burdensome or
    51  complex]  that are used by the New York state of health marketplace: pay
    52  checks or pay stubs; rent receipts; a letter from the patient's employer
    53  attesting to the patient's gross income; or, if none  of  the  aforemen-
    54  tioned  information  and  documentation  are  available, a written self-
    55  attestation of the  patient's  income.  General  hospitals  shall,  upon
    56  request,  assist  patients  in understanding the hospital's policies and

        A. 3470--A                          9
 
     1  procedures and in applying for payment adjustments.  [Application  forms
     2  shall be printed] The commissioner shall translate the financial assist-
     3  ance  application  form  and policy into the "primary languages" of each
     4  general hospital. Each general hospital shall print and post these mate-
     5  rials  to  its  website in the "primary languages" of patients served by
     6  the general hospital. For  the  purposes  of  this  paragraph,  "primary
     7  languages"  shall include any language that is either (i) used to commu-
     8  nicate, during at least five percent of patient visits  in  a  year,  by
     9  patients  who  cannot  speak,  read,  write  or  understand  the English
    10  language at the level of proficiency necessary  for  effective  communi-
    11  cation  with health care providers, or (ii) spoken by non-English speak-
    12  ing individuals comprising more than one percent of the primary hospital
    13  service area population, as  calculated  using  demographic  information
    14  available  from  the United States Bureau of the Census, supplemented by
    15  data from school systems. Decisions regarding such applications shall be
    16  made within thirty days of receipt  of  a  completed  application.  Such
    17  policies  and  procedures  shall  require  that  the  hospital issue any
    18  denial/approval of such application in writing with information  on  how
    19  to  appeal  the  denial  and  shall require the hospital to establish an
    20  appeals process under which it will evaluate the denial of  an  applica-
    21  tion. [Nothing in this subdivision shall be interpreted as prohibiting a
    22  hospital from making the availability of financial assistance contingent
    23  upon  the  patient  first  applying  for coverage under title XIX of the
    24  social security act (medicaid) or another insurance program if,  in  the
    25  judgment  of  the  hospital, the patient may be eligible for medicaid or
    26  another insurance program, and upon the patient's cooperation in follow-
    27  ing  the  hospital's  financial  assistance  application   requirements,
    28  including the provision of information needed to make a determination on
    29  the  patient's  application  in accordance with the hospital's financial
    30  assistance policy.]
    31    (f) Such policies and procedures  shall  provide  that  patients  with
    32  incomes  below [three] four hundred percent of the federal poverty level
    33  are deemed presumptively eligible  for  payment  adjustments  and  shall
    34  conform  to the requirements set forth in paragraph (b) of this subdivi-
    35  sion, provided, however, that  nothing  in  this  subdivision  shall  be
    36  interpreted  as precluding hospitals from extending such payment adjust-
    37  ments to other patients, either generally or on  a  case-by-case  basis.
    38  Such  [policies  and  procedures]  policy  shall provide financial [aid]
    39  assistance for emergency hospital services, including  emergency  trans-
    40  fers  pursuant  to  the  federal  emergency medical treatment and active
    41  labor act (42 USC 1395dd), to patients who reside in New York state  and
    42  for medically necessary hospital services for patients who reside in the
    43  hospital's  primary  service  area  as  determined according to criteria
    44  established by  the  commissioner.  In  developing  such  criteria,  the
    45  commissioner  shall  consult with representatives of the hospital indus-
    46  try, health care consumer advocates and local public  health  officials.
    47  Such  criteria shall be made available to the public no less than thirty
    48  days prior to the date of implementation and shall, at a minimum:
    49    (i) prohibit a  hospital  from  developing  or  altering  its  primary
    50  service  area in a manner designed to avoid medically underserved commu-
    51  nities or communities with high percentages of uninsured residents;
    52    (ii) ensure that every geographic area of the state is included in  at
    53  least  one  general  hospital's  primary  service  area so that eligible
    54  patients may access care and financial assistance; and
    55    (iii) require the hospital to notify the commissioner upon making  any
    56  change  to its primary service area, and to include a description of its

        A. 3470--A                         10
 
     1  primary service area in  the  hospital's  annual  implementation  report
     2  filed  pursuant  to  subdivision  three  of section twenty-eight hundred
     3  three-l of this [article] title.
     4    (g)  Nothing  in  this  subdivision shall be interpreted as precluding
     5  hospitals from extending payment  adjustments  for  medically  necessary
     6  non-emergency  hospital  services  to patients outside of the hospital's
     7  primary service area. For patients determined to be eligible for  finan-
     8  cial  [aid]  assistance  under  the  terms of [a hospital's] the uniform
     9  financial [aid] assistance policy, such [policies and procedures] policy
    10  shall  prohibit  any  limitations  on  financial  [aid]  assistance  for
    11  services  based  on  the  medical condition of the applicant, other than
    12  typical limitations or exclusions based  on  medical  necessity  or  the
    13  clinical or therapeutic benefit of a procedure or treatment.
    14    (h)  Such  policies and procedures shall not permit the securance of a
    15  lien or forced sale or foreclosure of a patient's primary  residence  in
    16  order  to  collect  an  outstanding  medical  bill and shall require the
    17  hospital to refrain from sending an account to collection if the patient
    18  has submitted a completed application for financial [aid, including  any
    19  required supporting documentation] assistance, while the hospital deter-
    20  mines  the patient's eligibility for such [aid] assistance.  Such [poli-
    21  cies and procedures] policy  shall  provide  for  written  notification,
    22  which  shall  include  notification  on a patient bill, to a patient not
    23  less than thirty days prior to the referral of debts for collection  and
    24  shall  require  that the collection agency obtain the hospital's written
    25  consent prior to commencing a legal action. Such  [policies  and  proce-
    26  dures] policy shall require all general hospital staff who interact with
    27  patients  or  have  responsibility  for  billing  and  collections to be
    28  trained in such [policies and procedures] policy, and require the imple-
    29  mentation of a mechanism for the general hospital to measure its compli-
    30  ance with [such policies and procedures] the policy. Such [policies  and
    31  procedures]  policy  shall  require  that  any  collection  agency under
    32  contract with a general hospital for the collection of debts follow  the
    33  [hospital's]  uniform  financial  assistance policy, including providing
    34  information to patients on how to apply for financial  assistance  where
    35  appropriate.  Such  [policies  and  procedures]  policy  shall  prohibit
    36  collections from a patient who is determined to be eligible for  medical
    37  assistance  pursuant  to title XIX of the federal social security act at
    38  the time services were rendered and for which services medicaid  payment
    39  is available.
    40    (i) Reports required to be submitted to the department by each general
    41  hospital  as  a  condition  for  participation  in  the pools, and which
    42  contain, in accordance with applicable regulations, a certification from
    43  an independent  certified  public  accountant  or  independent  licensed
    44  public accountant or an attestation from a senior official of the hospi-
    45  tal  that the hospital is in compliance with conditions of participation
    46  in the pools, shall also contain, for reporting  periods  on  and  after
    47  January first, two thousand seven:
    48    (i)  a  report  on  hospital costs incurred and uncollected amounts in
    49  providing services to  [eligible]  patients  [without  insurance]  found
    50  eligible for financial assistance, including the amount of care provided
    51  for a nominal payment amount, during the period covered by the report;
    52    (ii)  hospital  costs incurred and uncollected amounts for deductibles
    53  and coinsurance for eligible patients with insurance or other third-par-
    54  ty payor coverage;
    55    (iii) the number of patients, organized  according  to  United  States
    56  postal  service  zip code, who applied for financial assistance pursuant

        A. 3470--A                         11

     1  to the [hospital's] uniform financial assistance policy, and the number,
     2  organized according to United States  postal  service  zip  code,  whose
     3  applications were approved and whose applications were denied;
     4    (iv) the reimbursement received for indigent care from the pool estab-
     5  lished pursuant to this section;
     6    (v)  the  amount  of  funds  that have been expended on [charity care]
     7  financial assistance from charitable bequests made or trusts established
     8  for the purpose of providing financial assistance to  patients  who  are
     9  eligible in accordance with the terms of such bequests or trusts;
    10    (vi)  for  hospitals located in social services districts in which the
    11  district allows hospitals to assist patients with such applications, the
    12  number of applications for eligibility under title  XIX  of  the  social
    13  security  act (medicaid) that the hospital assisted patients in complet-
    14  ing and the number denied and approved;
    15    (vii) the hospital's financial losses resulting from services provided
    16  under medicaid; and
    17    (viii) the number of referrals to collection agents or outside  vendor
    18  court cases and liens placed on [the primary] any residences of patients
    19  through the collection process used by a hospital.
    20    (j) [Within ninety days of the effective date of this subdivision each
    21  hospital  shall submit to the commissioner a written report on its poli-
    22  cies and procedures for financial assistance to patients which are  used
    23  by  the  hospital on the effective date of this subdivision. Such report
    24  shall include copies of its policies and procedures, including  material
    25  which  is  distributed  to patients, and a description of the hospital's
    26  financial aid policies and procedures. Such  description  shall  include
    27  the  income levels of patients on which eligibility is based, the finan-
    28  cial aid eligible patients receive and the  means  of  calculating  such
    29  aid,  and  the  service  area, if any, used by the hospital to determine
    30  eligibility] The commissioner shall include  the  data  collected  under
    31  paragraph (i) of this subdivision in regular audits of the annual gener-
    32  al hospital institutional cost report.
    33    (k)  In  the event it is determined by the commissioner that the state
    34  will be unable to secure all necessary federal approvals to include,  as
    35  part  of  the  state's  approved  state plan under title nineteen of the
    36  federal social security act, a requirement[, as set forth  in  paragraph
    37  one  of  this  subdivision,]  that compliance with this subdivision is a
    38  condition of participation in pool distributions authorized pursuant  to
    39  this  section and section twenty-eight hundred seven-w of this [article]
    40  title, then such condition of participation shall  be  deemed  null  and
    41  void  and,  notwithstanding  section  twelve of this chapter, failure to
    42  comply with the provisions of this subdivision  by  a  hospital  on  and
    43  after the date of such determination shall make such hospital liable for
    44  a  civil  penalty  not  to  exceed  ten  thousand  dollars for each such
    45  violation. The imposition of such civil penalties shall  be  subject  to
    46  the provisions of section twelve-a of this chapter.
    47    §  2.  Subdivision  14  of  section 2807-k of the public health law is
    48  REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions  14,
    49  15 and 16.
    50    § 3. This act shall take effect immediately.
 
    51                                   PART H
 
    52    Section  1.    Section  5004  of  the civil practice law and rules, as
    53  amended by chapter 258 of the laws  of  1981,  is  amended  to  read  as
    54  follows:

        A. 3470--A                         12
 
     1    §  5004.  Rate  of interest. Interest shall be at the rate of nine per
     2  centum per annum, except where otherwise provided by  statute,  provided
     3  that  in medical debt actions by a hospital licensed under article twen-
     4  ty-eight of the public health law or a health care professional  author-
     5  ized   under title eight of the education law the interest rate shall be
     6  calculated at the one-year United States treasury  bill  rate.  For  the
     7  purpose of this section, the "one-year United States treasury bill rate"
     8  means  the  weekly average one-year constant maturity treasury yield, as
     9  published by the board of governors of the federal reserve  system,  for
    10  the calendar week preceding the date of the entry of the judgment award-
    11  ing  damages. Provided however, that this section shall not apply to any
    12  provision of the tax law which provides for the annual rate of  interest
    13  to be paid on a judgment or accrued claim.
    14    § 2. This act shall take effect immediately.
 
    15                                   PART I

    16    Section  1.  Subsection  (h)  of section 603 of the financial services
    17  law, as added by section 26 of part H of chapter 60 of the laws of 2014,
    18  is amended to read as follows:
    19    (h) "Surprise bill" means a bill for health care services, other  than
    20  emergency services, received by:
    21    (1)  an insured for services rendered by a non-participating physician
    22  at a participating hospital  or  ambulatory  surgical  center,  where  a
    23  participating  physician is unavailable or a non-participating physician
    24  renders services without the insured's knowledge, or unforeseen  medical
    25  services  arise  at  the  time  the  health  care services are rendered;
    26  provided, however, that a surprise bill shall not mean a  bill  received
    27  for health care services when a participating physician is available and
    28  the  insured  has  elected  to  obtain services from a non-participating
    29  physician;
    30    (2) an insured for services rendered by a non-participating  provider,
    31  where  the services were referred by a participating physician to a non-
    32  participating provider without explicit written consent of  the  insured
    33  acknowledging  that the participating physician is referring the insured
    34  to a non-participating provider and that  the  referral  may  result  in
    35  costs not covered by the health care plan; [or]
    36    (3)  an  insured for services rendered by a non-participating provider
    37  when the insured reasonably relied upon an  oral  or  written  statement
    38  that the non-participating provider was a participating provider made by
    39  a health care plan, or agent or representative of a health care plan, or
    40  as  specified  in the health care plan provider listing or directory, or
    41  provider information on the health plan's website;
    42    (4) an insured for services rendered by a  non-participating  provider
    43  when  the insured reasonably relied upon a statement that the non-parti-
    44  cipating provider was a participating provider made by the  non-partici-
    45  pating  provider,  or  agent  or representative of the non-participating
    46  provider, or as specified on the non-participating  provider's  website;
    47  or
    48    (5)  a patient who is not an insured for services rendered by a physi-
    49  cian at a hospital or ambulatory surgical center, where the patient  has
    50  not  timely received all of the disclosures required pursuant to section
    51  twenty-four of the public health law.
    52    § 2. Paragraph (k) of subdivision 1 of  section  2803  of  the  public
    53  health  law,  as added by chapter 241 of the laws of 2016, is amended to
    54  read as follows:

        A. 3470--A                         13
 
     1    (k) The  statement  regarding  patient  rights  and  responsibilities,
     2  required  pursuant  to  paragraph (g) of this subdivision, shall include
     3  provisions informing the patient of his or her right to [choose] be held
     4  harmless from certain bills for emergency services and  surprise  bills,
     5  and  to  submit  surprise  bills  or bills for emergency services to the
     6  independent dispute process established in article six of the  financial
     7  services  law,  and  informing the patient of his or her right to view a
     8  list of the hospital's standard charges and the health plans the  hospi-
     9  tal  participates with consistent with section twenty-four of this chap-
    10  ter.
    11    § 3. This act shall take effect immediately.
    12    § 3. Severability clause.  If any provision of this act, or any appli-
    13  cation of any provision of this act,  is  held  to  be  invalid,  or  to
    14  violate  or  be  inconsistent  with  any federal law or regulation, that
    15  shall not affect the validity or effectiveness of any other provision of
    16  this act, or of any other application of  any  provision  of  this  act,
    17  which  can be given effect without that provision or application; and to
    18  that end, the provisions and applications of this act are severable.
    19    § 4. This act shall take effect immediately  provided,  however,  that
    20  the  applicable effective date of Parts A through I of this act shall be
    21  as specifically set forth in the last section of such Parts.   Effective
    22  immediately, the commissioner of health and the superintendent of finan-
    23  cial  services  shall make regulations and take other actions reasonably
    24  necessary to implement every part of this act when it takes effect.
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