Desig Art 28 §§2800 - 2827 to be Title 1, add Title 2 §§2830 - 2833, amd §§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).
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A8639A
SPONSOR: Gottfried TITLE OF BILL:
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 defin-
ing 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 database (Part F); to
amend the public health law, in relation to the general hospital indi-
gent 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)
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 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. - 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 developed 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 complying
with the law, as have audits conducted by consumer advocates. - 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:
New bill.
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.consum. erreports.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://wvvw.cssny.org/publications/ entry/unintended consequences.
STATE OF NEW YORK
________________________________________________________________________
8639--A
2019-2020 Regular Sessions
IN ASSEMBLY
October 2, 2019
___________
Introduced by M. of A. GOTTFRIED, D'URSO, EPSTEIN, JACOBSON, THIELE,
BARRON, ORTIZ, SIMON, SEAWRIGHT, LENTOL, DINOWITZ, JAFFEE, BENEDETTO,
SAYEGH, REYES, ARROYO, GLICK, PERRY, MOSLEY, ABINANTI, CRUZ, PAULIN,
ENGLEBRIGHT, SOLAGES, L. ROSENTHAL, GUNTHER, AUBRY, GALEF, STECK,
NIOU, WEPRIN, TAYLOR, SIMOTAS, BUCHWALD, JEAN-PIERRE -- read once and
referred to the Committee on Health -- recommitted to the Committee on
Health in accordance with Assembly Rule 3, sec. 2 -- 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
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD13193-10-0
A. 8639--A 2
1 contained within a Part identified as Parts A through I. The effective
2 date for each particular provision contained within such Part is set
3 forth in the last section of such Part. Any provision in any section
4 contained within a Part, including the effective date of the Part, which
5 makes reference to a section "of this act", when used in connection with
6 that particular component, shall be deemed to mean and refer to the
7 corresponding section of the Part in which it is found. Section four of
8 this act sets forth the general effective date of this act.
9 PART A
10 Section 1. Sections 2800 through 2827 of article 28 of the public
11 health law are designated title 1, and a new title 2 is added to article
12 28, to read as follows:
13 TITLE 2
14 MEDICAL BILLING AND DEBT
15 § 2. This act shall take effect immediately.
16 PART B
17 Section 1. Title 2 of article 28 of the public health law is amended
18 by adding a new section 2830 to read as follows:
19 § 2830. Definitions. As used in this title, the following terms shall
20 have the following meanings, unless the context clearly requires other-
21 wise:
22 1. "Affiliated provider" means a provider that is: (a) employed by a
23 hospital or health system, (b) under a professional services agreement
24 with a hospital or health system, or (c) a clinical faculty member of a
25 medical school or other school that trains individuals to be providers
26 that is affiliated with a hospital or health system.
27 2. "Campus" means: (a) the physical area immediately adjacent to a
28 hospital's main buildings and other areas and structures that are not
29 strictly contiguous to the main buildings but are located within two
30 hundred fifty yards of the main buildings, or (b) any other area that
31 has been determined on an individual case basis by the Centers for Medi-
32 care and Medicaid Services to be part of a hospital's campus.
33 3. "Facility fee" means any fee charged or billed by a hospital or
34 health system for inpatient or outpatient hospital services provided in
35 a hospital-based facility that is: (a) intended to compensate the hospi-
36 tal or health system for the operational expenses of the hospital or
37 health system, and (b) separate and distinct from a fee for patient-spe-
38 cific services, supplies and drugs; "facility fee" shall not include any
39 fee charged or billed by a residential health care facility.
40 4. "Health system" means a group of one or more hospitals and provid-
41 ers affiliated through ownership, governance, membership or other means.
42 5. "Hospital-based facility" means a facility that is owned or oper-
43 ated, in whole or in part, by a hospital or health system where hospital
44 or professional health care services, supplies or drugs are provided.
45 6. "Fee" means any fee charged or billed by a provider for profes-
46 sional health care services provided in a hospital-based facility.
47 7. "Provider" means an individual or entity, whether for profit or
48 nonprofit, whose primary purpose is to provide professional health care
49 services.
50 § 2. This act shall take effect immediately.
51 PART C
A. 8639--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. 8639--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. This act shall take effect one year after it shall have become a
5 law.
6 PART D
7 Section 1. Title 2 of article 28 of the public health law is amended
8 by adding a new section 2832 to read as follows:
9 § 2832. Regulation of the billing of facility fees. No hospital or
10 health system shall bill or seek payment from a patient for a facility
11 fee: 1. related to the provision of preventive care service as defined
12 by the United States Preventive Services Task Force; or
13 2. where the facility fee is not covered for the patient by a third-
14 party payer.
15 § 2. This act shall take effect on the one hundred eightieth day after
16 it shall have become a law.
17 PART E
18 Section 1. Title 2 of article 28 of the public health law is amended
19 by adding a new section 2833 to read as follows:
20 § 2833. Standardized patient financial liability forms. Every hospi-
21 tal, health system, hospital-based facility, affiliated provider or
22 other provider shall use the uniform patient financial liability form
23 which shall be developed by the commissioner. The form shall disclose
24 to the patient whether services, supplies and drugs provided to the
25 patient are in-network or out-of-network, whether the care is a covered
26 benefit by a third-party payer of the patient, and the nature and amount
27 of the patient's projected financial liability. A patient shall not be
28 financially liable for any service, supplies or drugs subject to this
29 title that is not charged or billed in accordance with this title. The
30 commissioner shall develop and issue the uniform financial liability
31 form within six months of the effective date of this section. The form
32 shall be adopted and used under this section by each hospital, health
33 system, hospital-based facility, affiliated provider and other provider
34 not later than sixty days after the commissioner issues the form.
35 § 2. This act shall take effect immediately.
36 PART F
37 Section 1. Subdivision 18-a of section 206 of the public health law is
38 amended by adding a new paragraph (e) to read as follows:
39 (e)(i) The commissioner shall ensure that the New York state all payer
40 database shall serve the interests of New York's health care consumers.
41 (ii) Every hospital licensed under article twenty-eight of this chap-
42 ter and health care professionals authorized under title eight of the
43 education law shall participate in the all payer database through their
44 insurance carrier contracts, and may participate in the all payer data-
45 base through any other of the hospital's third-party payer contracts.
46 (iii) Data that is required to be submitted to the all payer database
47 shall not be considered proprietary information for the purposes of
48 submission to or inclusion in the all payer database.
49 § 2. This act shall take effect on the one hundred eightieth day after
50 it shall have become a law.
A. 8639--A 5
1 PART G
2 Section 1. Subdivisions 9 and 9-a of section 2807-k of the public
3 health law, subdivision 9 as amended by section 17 of part B of chapter
4 60 of the laws of 2014, subdivision 9-a as added by section 39-a of part
5 A of chapter 57 of the laws of 2006 and paragraph (k) of subdivision 9-a
6 as added by section 43 of part B of chapter 58 of the laws of 2008, are
7 amended to read as follows:
8 9. In order for a general hospital to participate in the distribution
9 of funds from the pool, the general hospital must [implement minimum
10 collection policies and procedures approved] use only the uniform finan-
11 cial assistance form provided by the commissioner. The definitions in
12 section twenty-eight hundred thirty of this article shall apply to this
13 subdivision and subdivision nine-a of this section.
14 9-a. (a) (i) As a condition for participation in pool distributions
15 authorized pursuant to this section and section twenty-eight hundred
16 seven-w of this article for periods on and after January first, two
17 thousand nine, general hospitals shall, effective for periods on and
18 after January first, two thousand [seven, establish] twenty-one, adopt
19 and implement the uniform financial [aid policies and procedures, in
20 accordance with the provisions of this subdivision] assistance form
21 policy, to be developed and issued by the commissioner no later than one
22 hundred eighty days after the effective date of a chapter of the laws of
23 two thousand twenty that amended this subdivision. No later than thirty
24 days after the issuance of the uniform financial assistance form and
25 policy, general hospitals shall implement such form and policy, for
26 reducing hospital charges and charges for affiliated providers otherwise
27 applicable to low-income individuals without third-party health [insur-
28 ance] coverage, or who have [exhausted their] third-party health [insur-
29 ance benefits] coverage that does not cover or limits coverage of the
30 service, and who can demonstrate an inability to pay full charges, and
31 also, at the hospital's discretion, for reducing or discounting the
32 collection of co-pays and deductible payments from those individuals who
33 can demonstrate an inability to pay such amounts. Immigration status
34 shall not be an eligibility criterion.
35 (ii) A general hospital may use the New York state of health market-
36 place eligibility determination page to establish the patient's house-
37 hold income and residency in lieu of the financial application form,
38 provided it has secured the consent of the patient. A general hospital
39 shall not require a patient to apply for coverage through the New York
40 state of health marketplace in order to receive care or financial
41 assistance.
42 (iii) Upon submission of a completed application form, the patient may
43 disregard any bills until the general hospital has rendered a decision
44 on the application in accordance with this paragraph.
45 (b) Such reductions from charges for [uninsured] patients described in
46 paragraph (a) of this subdivision with incomes below [at least three]
47 four hundred percent of the federal poverty level shall result in a
48 charge to such individuals that does not exceed [the greater of] the
49 amount that would have been paid for the same services [by the "highest
50 volume payor" for such general hospital as defined in subparagraph (v)
51 of this paragraph, or for services provided pursuant to title XVIII of
52 the federal social security act (medicare), or for services] provided
53 pursuant to title XIX of the federal social security act (medicaid), and
54 provided further that such amounts shall be adjusted according to income
55 level as follows:
A. 8639--A 6
1 (i) For patients with incomes at or below [at least one] two hundred
2 percent of the federal poverty level, the hospital shall collect no more
3 than a nominal payment amount, consistent with guidelines established by
4 the commissioner[;].
5 (ii) For patients with incomes between [at least one] two hundred one
6 percent and [one] four hundred [fifty] percent of the federal poverty
7 level, the hospital shall collect no more than the amount identified
8 after application of a proportional sliding fee schedule under which
9 patients with lower incomes shall pay the lowest amount. Such schedule
10 shall provide that the amount the hospital may collect for such patients
11 increases from the nominal amount described in subparagraph (i) of this
12 paragraph in equal increments as the income of the patient increases, up
13 to a maximum of twenty percent of the greater of the amount that would
14 have been paid for the same services [by the "highest volume payor" for
15 such general hospital, as defined in subparagraph (v) of this paragraph,
16 or for services provided pursuant to title XVIII of the federal social
17 security act (medicare) or for services] provided pursuant to title XIX
18 of the federal social security act (medicaid)[;].
19 (iii) [For patients with incomes between at least one hundred fifty-
20 one percent and two hundred fifty percent of the federal poverty level,
21 the hospital shall collect no more than the amount identified after
22 application of a proportional sliding fee schedule under which patients
23 with lower income shall pay the lowest amounts. Such schedule shall
24 provide that the amount the hospital may collect for such patients
25 increases from the twenty percent figure described in subparagraph (ii)
26 of this paragraph in equal increments as the income of the patient
27 increases, up to a maximum of the greater of the amount that would have
28 been paid for the same services by the "highest volume payor" for such
29 general hospital, as defined in subparagraph (v) of this paragraph, or
30 for services provided pursuant to title XVIII of the federal social
31 security act (medicare) or for services provided pursuant to title XIX
32 of the federal social security act (medicaid); and
33 (iv)] For patients with incomes [between at least two hundred fifty-
34 one percent and three hundred] above four hundred one percent of the
35 federal poverty level, the hospital shall collect no more than the
36 greater of the amount that would have been paid for the same services
37 [by the "highest volume payor" for such general hospital as defined in
38 subparagraph (v) of this paragraph, or for services provided pursuant to
39 title XVIII of the federal social security act (medicare), or for
40 services] provided pursuant to title XIX of the federal social security
41 act (medicaid).
42 [(v) For the purposes of this paragraph, "highest volume payor" shall
43 mean the insurer, corporation or organization licensed, organized or
44 certified pursuant to article thirty-two, forty-two or forty-three of
45 the insurance law or article forty-four of this chapter, or other third-
46 party payor, which has a contract or agreement to pay claims for
47 services provided by the general hospital and incurred the highest
48 volume of claims in the previous calendar year.
49 (vi) A hospital may implement policies and procedures to permit, but
50 not require, consideration on a case-by-case basis of exceptions to the
51 requirements described in subparagraphs (i) and (ii) of this paragraph
52 based upon the existence of significant assets owned by the patient that
53 should be taken into account in determining the appropriate payment
54 amount for that patient's care, provided, however, that such proposed
55 policies and procedures shall be subject to the prior review and
56 approval of the commissioner and, if approved, shall be included in the
A. 8639--A 7
1 hospital's financial assistance policy established pursuant to this
2 section, and provided further that, if such approval is granted, the
3 maximum amount that may be collected shall not exceed the greater of the
4 amount that would have been paid for the same services by the "highest
5 volume payor" for such general hospital as defined in subparagraph (v)
6 of this paragraph, or for services provided pursuant to title XVIII of
7 the federal social security act (medicare), or for services provided
8 pursuant to title XIX of the federal social security act (medicaid). In
9 the event that a general hospital reviews a patient's assets in deter-
10 mining payment adjustments such policies and procedures shall not
11 consider as assets a patient's primary residence, assets held in a tax-
12 deferred or comparable retirement savings account, college savings
13 accounts, or cars used regularly by a patient or immediate family
14 members.
15 (vii)] (iv) Nothing in this paragraph shall be construed to limit a
16 hospital's ability to establish patient eligibility for payment
17 discounts at income levels higher than those specified herein and/or to
18 provide greater payment discounts for eligible patients than those
19 required by this paragraph.
20 (c) [Such policies and procedures shall be clear, understandable, in
21 writing and publicly available in summary form and each] Each general
22 hospital participating in the pool shall ensure that every patient is
23 made aware of the existence of such [policies and procedures] uniform
24 financial assistance form and policy and is provided, in a timely
25 manner, with a [summary] copy of such [policies and procedures] form and
26 policy upon request. [Any summary provided to patients shall, at a mini-
27 mum, include specific information as to income levels used to determine
28 eligibility for assistance, a description of the primary service area of
29 the hospital and the means of applying for assistance. For general
30 hospitals with twenty-four hour emergency departments, such policies and
31 procedures] A general hospital shall require the notification of
32 patients through written materials provided to patients during the
33 intake and registration process, through the conspicuous posting of
34 language-appropriate information in the general hospital, and informa-
35 tion on bills and statements sent to patients, that financial [aid]
36 assistance may be available to qualified patients and how to obtain
37 further information. [For specialty hospitals without twenty-four hour
38 emergency departments, such notification shall take place through writ-
39 ten materials provided to patients during the intake and registration
40 process prior to the provision of any health care services or proce-
41 dures, and through information on bills and statements sent to patients,
42 that financial aid may be available to qualified patients and how to
43 obtain further information. Application materials shall include a notice
44 to patients that upon submission of a completed application, including
45 any information or documentation needed to determine the patient's
46 eligibility pursuant to the hospital's financial assistance policy, the
47 patient may disregard any bills until the hospital has rendered a deci-
48 sion on the application in accordance with this paragraph] General
49 hospitals shall post the uniform financial assistance application form
50 and policy in a conspicuous location on the general hospital's website.
51 The commissioner shall likewise post the uniform financial assistance
52 form and policy on the department's hospital profile page related to the
53 general hospital's or any successor website.
54 (d) The commissioner shall provide application materials to general
55 hospitals, including the uniform financial assistance application form
56 and policy. These application materials shall include a notice to
A. 8639--A 8
1 patients that upon submission of a completed application form, the
2 patient may disregard any bills until the general hospital has rendered
3 a decision on the application in accordance with this paragraph. The
4 application materials shall include specific information as the income
5 levels used to determine eligibility for financial assistance, a
6 description of the primary service area of the hospital and the means to
7 apply for assistance. Such policies and procedures shall include clear,
8 objective criteria for determining a patient's ability to pay and for
9 providing such adjustments to payment requirements as are necessary. In
10 addition to adjustment mechanisms such as sliding fee schedules and
11 discounts to fixed standards, such policies and procedures shall also
12 provide for the use of installment plans for the payment of outstanding
13 balances by patients pursuant to the provisions of the hospital's finan-
14 cial assistance policy. The monthly payment under such a plan shall not
15 exceed [ten] five percent of the gross monthly income of the patient[,
16 provided, however, that if patient assets are considered under such a
17 policy, then patient assets which are not excluded assets pursuant to
18 subparagraph (vi) of paragraph (b) of this subdivision may be considered
19 in addition to the limit on monthly payments.] The rate of interest
20 charged to the patient on the unpaid balance, if any, shall not exceed
21 the [rate for a ninety-day security] federal funds rate issued by the
22 United States Department of Treasury[, plus .5 percent] and no plan
23 shall include an accelerator or similar clause under which a higher rate
24 of interest is triggered upon a missed payment. [If such policies and
25 procedures] The policy shall not include a requirement of a deposit
26 prior to [non-emergent,] medically-necessary care[, such deposit must be
27 included as part of any financial aid consideration]. Such policies and
28 procedures shall be applied consistently to all eligible patients.
29 (e) Such policies and procedures shall permit patients to apply for
30 assistance within at least [ninety] two hundred forty days of the date
31 of discharge or date of service and provide at least [twenty] sixty days
32 for patients to submit a completed application. Such policies and proce-
33 dures may require that patients seeking payment adjustments provide
34 [appropriate] the following financial information and documentation in
35 support of their application[, provided, however, that such application
36 process shall not be unduly burdensome or complex] that are used by the
37 New York state of health marketplace: pay checks or pay stubs; rent
38 receipts; a letter from the patient's employer attesting to the
39 patient's gross income; or, if none of the aforementioned information
40 and documentation are available, a written self-attestation of the
41 patient's income. General hospitals shall, upon request, assist patients
42 in understanding the hospital's policies and procedures and in applying
43 for payment adjustments. [Application forms shall be printed] The
44 commissioner shall translate the financial assistance application form
45 and policy into the "primary languages" of each general hospital. Each
46 general hospital shall print and post these materials to its website in
47 the "primary languages" of patients served by the general hospital. For
48 the purposes of this paragraph, "primary languages" shall include any
49 language that is either (i) used to communicate, during at least five
50 percent of patient visits in a year, by patients who cannot speak, read,
51 write or understand the English language at the level of proficiency
52 necessary for effective communication with health care providers, or
53 (ii) spoken by non-English speaking individuals comprising more than one
54 percent of the primary hospital service area population, as calculated
55 using demographic information available from the United States Bureau of
56 the Census, supplemented by data from school systems. Decisions regard-
A. 8639--A 9
1 ing such applications shall be made within thirty days of receipt of a
2 completed application. Such policies and procedures shall require that
3 the hospital issue any denial/approval of such application in writing
4 with information on how to appeal the denial and shall require the
5 hospital to establish an appeals process under which it will evaluate
6 the denial of an application. [Nothing in this subdivision shall be
7 interpreted as prohibiting a hospital from making the availability of
8 financial assistance contingent upon the patient first applying for
9 coverage under title XIX of the social security act (medicaid) or anoth-
10 er insurance program if, in the judgment of the hospital, the patient
11 may be eligible for medicaid or another insurance program, and upon the
12 patient's cooperation in following the hospital's financial assistance
13 application requirements, including the provision of information needed
14 to make a determination on the patient's application in accordance with
15 the hospital's financial assistance policy.]
16 (f) Such policies and procedures shall provide that patients with
17 incomes below [three] four hundred percent of the federal poverty level
18 are deemed presumptively eligible for payment adjustments and shall
19 conform to the requirements set forth in paragraph (b) of this subdivi-
20 sion, provided, however, that nothing in this subdivision shall be
21 interpreted as precluding hospitals from extending such payment adjust-
22 ments to other patients, either generally or on a case-by-case basis.
23 Such [policies and procedures] policy shall provide financial [aid]
24 assistance for emergency hospital services, including emergency trans-
25 fers pursuant to the federal emergency medical treatment and active
26 labor act (42 USC 1395dd), to patients who reside in New York state and
27 for medically necessary hospital services for patients who reside in the
28 hospital's primary service area as determined according to criteria
29 established by the commissioner. In developing such criteria, the
30 commissioner shall consult with representatives of the hospital indus-
31 try, health care consumer advocates and local public health officials.
32 Such criteria shall be made available to the public no less than thirty
33 days prior to the date of implementation and shall, at a minimum:
34 (i) prohibit a hospital from developing or altering its primary
35 service area in a manner designed to avoid medically underserved commu-
36 nities or communities with high percentages of uninsured residents;
37 (ii) ensure that every geographic area of the state is included in at
38 least one general hospital's primary service area so that eligible
39 patients may access care and financial assistance; and
40 (iii) require the hospital to notify the commissioner upon making any
41 change to its primary service area, and to include a description of its
42 primary service area in the hospital's annual implementation report
43 filed pursuant to subdivision three of section twenty-eight hundred
44 three-l of this article.
45 (g) Nothing in this subdivision shall be interpreted as precluding
46 hospitals from extending payment adjustments for medically necessary
47 non-emergency hospital services to patients outside of the hospital's
48 primary service area. For patients determined to be eligible for finan-
49 cial [aid] assistance under the terms of [a hospital's] the uniform
50 financial [aid] assistance policy, such [policies and procedures] policy
51 shall prohibit any limitations on financial [aid] assistance for
52 services based on the medical condition of the applicant, other than
53 typical limitations or exclusions based on medical necessity or the
54 clinical or therapeutic benefit of a procedure or treatment.
55 (h) Such policies and procedures shall not permit the securance of a
56 lien or forced sale or foreclosure of a patient's primary residence in
A. 8639--A 10
1 order to collect an outstanding medical bill and shall require the
2 hospital to refrain from sending an account to collection if the patient
3 has submitted a completed application for financial [aid, including any
4 required supporting documentation] assistance, while the hospital deter-
5 mines the patient's eligibility for such [aid] assistance. Such [poli-
6 cies and procedures] policy shall provide for written notification,
7 which shall include notification on a patient bill, to a patient not
8 less than thirty days prior to the referral of debts for collection and
9 shall require that the collection agency obtain the hospital's written
10 consent prior to commencing a legal action. Such [policies and proce-
11 dures] policy shall require all general hospital staff who interact with
12 patients or have responsibility for billing and collections to be
13 trained in such [policies and procedures] policy, and require the imple-
14 mentation of a mechanism for the general hospital to measure its compli-
15 ance with [such policies and procedures] the policy. Such [policies and
16 procedures] policy shall require that any collection agency under
17 contract with a general hospital for the collection of debts follow the
18 [hospital's] uniform financial assistance policy, including providing
19 information to patients on how to apply for financial assistance where
20 appropriate. Such [policies and procedures] policy shall prohibit
21 collections from a patient who is determined to be eligible for medical
22 assistance pursuant to title XIX of the federal social security act at
23 the time services were rendered and for which services medicaid payment
24 is available.
25 (i) Reports required to be submitted to the department by each general
26 hospital as a condition for participation in the pools, and which
27 contain, in accordance with applicable regulations, a certification from
28 an independent certified public accountant or independent licensed
29 public accountant or an attestation from a senior official of the hospi-
30 tal that the hospital is in compliance with conditions of participation
31 in the pools, shall also contain, for reporting periods on and after
32 January first, two thousand seven:
33 (i) a report on hospital costs incurred and uncollected amounts in
34 providing services to [eligible] patients [without insurance] found
35 eligible for financial assistance, including the amount of care provided
36 for a nominal payment amount, during the period covered by the report;
37 (ii) hospital costs incurred and uncollected amounts for deductibles
38 and coinsurance for eligible patients with insurance or other third-par-
39 ty payor coverage;
40 (iii) the number of patients, organized according to United States
41 postal service zip code, who applied for financial assistance pursuant
42 to the [hospital's] uniform financial assistance policy, and the number,
43 organized according to United States postal service zip code, whose
44 applications were approved and whose applications were denied;
45 (iv) the reimbursement received for indigent care from the pool estab-
46 lished pursuant to this section;
47 (v) the amount of funds that have been expended on [charity care]
48 financial assistance from charitable bequests made or trusts established
49 for the purpose of providing financial assistance to patients who are
50 eligible in accordance with the terms of such bequests or trusts;
51 (vi) for hospitals located in social services districts in which the
52 district allows hospitals to assist patients with such applications, the
53 number of applications for eligibility under title XIX of the social
54 security act (medicaid) that the hospital assisted patients in complet-
55 ing and the number denied and approved;
A. 8639--A 11
1 (vii) the hospital's financial losses resulting from services provided
2 under medicaid; and
3 (viii) the number of referrals to collection agents or outside vendor
4 court cases and liens placed on [the primary] any residences of patients
5 through the collection process used by a hospital.
6 (j) [Within ninety days of the effective date of this subdivision each
7 hospital shall submit to the commissioner a written report on its poli-
8 cies and procedures for financial assistance to patients which are used
9 by the hospital on the effective date of this subdivision. Such report
10 shall include copies of its policies and procedures, including material
11 which is distributed to patients, and a description of the hospital's
12 financial aid policies and procedures. Such description shall include
13 the income levels of patients on which eligibility is based, the finan-
14 cial aid eligible patients receive and the means of calculating such
15 aid, and the service area, if any, used by the hospital to determine
16 eligibility] The commissioner shall include the data collected under
17 paragraph (i) of this subdivision in regular audits of the annual gener-
18 al hospital institutional cost report.
19 (k) In the event it is determined by the commissioner that the state
20 will be unable to secure all necessary federal approvals to include, as
21 part of the state's approved state plan under title nineteen of the
22 federal social security act, a requirement[, as set forth in paragraph
23 one of this subdivision,] that compliance with this subdivision is a
24 condition of participation in pool distributions authorized pursuant to
25 this section and section twenty-eight hundred seven-w of this article,
26 then such condition of participation shall be deemed null and void and,
27 notwithstanding section twelve of this chapter, failure to comply with
28 the provisions of this subdivision by a hospital on and after the date
29 of such determination shall make such hospital liable for a civil penal-
30 ty not to exceed ten thousand dollars for each such violation. The impo-
31 sition of such civil penalties shall be subject to the provisions of
32 section twelve-a of this chapter.
33 § 2. Subdivision 14 of section 2807-k of the public health law is
34 REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions 14,
35 15 and 16.
36 § 3. This act shall take effect immediately.
37 PART H
38 Section 1. Section 5004 of the civil practice law and rules, as
39 amended by chapter 258 of the laws of 1981, is amended to read as
40 follows:
41 § 5004. Rate of interest. Interest shall be at the rate of nine per
42 centum per annum, except where otherwise provided by statute, provided
43 that in medical debt actions by a hospital licensed under article twen-
44 ty-eight of the public health law or a health care professional author-
45 ized under title eight of the education law the interest rate shall be
46 calculated at the one-year United States treasury bill rate. For the
47 purpose of this section, the "one-year United States treasury bill rate"
48 means the weekly average one-year constant maturity treasury yield, as
49 published by the board of governors of the federal reserve system, for
50 the calendar week preceding the date of the entry of the judgment award-
51 ing damages. Provided however, that this section shall not apply to any
52 provision of the tax law which provides for the annual rate of interest
53 to be paid on a judgment or accrued claim.
54 § 2. This act shall take effect immediately.
A. 8639--A 12
1 PART I
2 Section 1. Subsection (h) of section 603 of the financial services
3 law, as added by section 26 of part H of chapter 60 of the laws of 2014,
4 is amended to read as follows:
5 (h) "Surprise bill" means a bill for health care services, other than
6 emergency services, received by:
7 (1) an insured for services rendered by a non-participating physician
8 at a participating hospital or ambulatory surgical center, where a
9 participating physician is unavailable or a non-participating physician
10 renders services without the insured's knowledge, or unforeseen medical
11 services arise at the time the health care services are rendered;
12 provided, however, that a surprise bill shall not mean a bill received
13 for health care services when a participating physician is available and
14 the insured has elected to obtain services from a non-participating
15 physician;
16 (2) an insured for services rendered by a non-participating provider,
17 where the services were referred by a participating physician to a non-
18 participating provider without explicit written consent of the insured
19 acknowledging that the participating physician is referring the insured
20 to a non-participating provider and that the referral may result in
21 costs not covered by the health care plan; [or]
22 (3) an insured for services rendered by a non-participating provider
23 when the insured reasonably relied upon an oral or written statement
24 that the non-participating provider was a participating provider made by
25 a health care plan, or agent or representative of a health care plan, or
26 as specified in the health care plan provider listing or directory, or
27 provider information on the health plan's website;
28 (4) an insured for services rendered by a non-participating provider
29 when the insured reasonably relied upon a statement that the non-parti-
30 cipating provider was a participating provider made by the non-partici-
31 pating provider, or agent or representative of the non-participating
32 provider, or as specified on the non-participating provider's website;
33 or
34 (5) a patient who is not an insured for services rendered by a physi-
35 cian at a hospital or ambulatory surgical center, where the patient has
36 not timely received all of the disclosures required pursuant to section
37 twenty-four of the public health law.
38 § 2. Paragraph (k) of subdivision 1 of section 2803 of the public
39 health law, as added by chapter 241 of the laws of 2016, is amended to
40 read as follows:
41 (k) The statement regarding patient rights and responsibilities,
42 required pursuant to paragraph (g) of this subdivision, shall include
43 provisions informing the patient of his or her right to [choose] be held
44 harmless from certain bills for emergency services and surprise bills,
45 and to submit surprise bills or bills for emergency services to the
46 independent dispute process established in article six of the financial
47 services law, and informing the patient of his or her right to view a
48 list of the hospital's standard charges and the health plans the hospi-
49 tal participates with consistent with section twenty-four of this chap-
50 ter.
51 § 3. This act shall take effect immediately.
52 § 3. Severability clause. If any provision of this act, or any appli-
53 cation of any provision of this act, is held to be invalid, or to
54 violate or be inconsistent with any federal law or regulation, that
55 shall not affect the validity or effectiveness of any other provision of
A. 8639--A 13
1 this act, or of any other application of any provision of this act,
2 which can be given effect without that provision or application; and to
3 that end, the provisions and applications of this act are severable.
4 § 4. This act shall take effect immediately provided, however, that
5 the applicable effective date of Parts A through I of this act shall be
6 as specifically set forth in the last section of such Parts. Effective
7 immediately, the commissioner of health and the superintendent of finan-
8 cial services shall make regulations and take other actions reasonably
9 necessary to implement every part of this act when it takes effect.
