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

S02521 Summary:

BILL NOS02521A
 
SAME ASSAME AS A03470-A
 
SPONSORRIVERA
 
COSPNSRBAILEY, BENJAMIN, BIAGGI, BRESLIN, BRISPORT, BROUK, COMRIE, GIANARIS, GOUNARDES, HARCKHAM, HOYLMAN, JACKSON, KAPLAN, KAVANAGH, KRUEGER, LIU, MAY, MYRIE, PARKER, PERSAUD, RAMOS, SALAZAR, SANDERS, SEPULVEDA, SERRANO, STAVISKY, THOMAS
 
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).
Go to top    

S02521 Actions:

BILL NOS02521A
 
01/21/2021REFERRED TO HEALTH
01/29/2021AMEND AND RECOMMIT TO HEALTH
01/29/2021PRINT NUMBER 2521A
Go to top

S02521 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         2521--A
 
                               2021-2022 Regular Sessions
 
                    IN SENATE
 
                                    January 21, 2021
                                       ___________
 
        Introduced   by   Sens.   RIVERA,  BENJAMIN,  BIAGGI,  BRESLIN,  COMRIE,
          GOUNARDES, HARCKHAM, HOYLMAN, JACKSON, KAPLAN,  KRUEGER,  MAY,  MYRIE,
          PERSAUD,  SALAZAR, SANDERS, SEPULVEDA -- read twice and ordered print-
          ed, and when printed to be committed 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
     7  forth  in  the  last  section of such Part. Any provision in any section
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD00481-04-1

        S. 2521--A                          2
 
     1  contained within a Part, including the effective date of the Part, which
     2  makes reference to a section "of this act", when used in connection with
     3  that particular component, shall be deemed to  mean  and  refer  to  the
     4  corresponding  section of the Part in which it is found. Section four of
     5  this act sets forth the general effective date of this act.
 
     6                                   PART A
 
     7    Section 1. Sections 2800 through 2827 of  article  28  of  the  public
     8  health law are designated title 1, and a new title 2 is added to article
     9  28, to read as follows:
    10                                   TITLE 2
    11                          MEDICAL BILLING AND DEBT
    12    § 2. This act shall take effect immediately.
 
    13                                   PART B
 
    14    Section  1.  Title 2 of article 28 of the public health law is amended
    15  by adding a new section 2830 to read as follows:
    16    § 2830. Definitions. As used in this title, the following terms  shall
    17  have  the following meanings, unless the context clearly requires other-
    18  wise:
    19    1. "Affiliated provider" means a provider that is: (a) employed  by  a
    20  hospital  or  health system, (b) under a professional services agreement
    21  with a hospital or health system, or (c) a clinical faculty member of  a
    22  medical  school  or other school that trains individuals to be providers
    23  that is affiliated with a hospital or health system.
    24    2. "Campus" means: (a) the physical area  immediately  adjacent  to  a
    25  hospital's  main  buildings  and other areas and structures that are not
    26  strictly contiguous to the main buildings but  are  located  within  two
    27  hundred  fifty  yards  of the main buildings, or (b) any other area that
    28  has been determined on an individual case basis by the Centers for Medi-
    29  care and Medicaid Services to be part of a hospital's campus.
    30    3. "Facility fee" means any fee charged or billed  by  a  hospital  or
    31  health  system for inpatient or outpatient hospital services provided in
    32  a hospital-based facility that is: (a) intended to compensate the hospi-
    33  tal or health system for the operational expenses  of  the  hospital  or
    34  health system, and (b) separate and distinct from a fee for patient-spe-
    35  cific services, supplies and drugs; "facility fee" shall not include any
    36  fee charged or billed by a residential health care facility.
    37    4.  "Health system" means a group of one or more hospitals and provid-
    38  ers affiliated through ownership, governance, membership or other means.
    39    5. "Hospital-based facility" means a facility that is owned  or  oper-
    40  ated, in whole or in part, by a hospital or health system where hospital
    41  or professional health care services, supplies or drugs are provided.
    42    6.  "Fee"  means  any  fee charged or billed by a provider for profes-
    43  sional health care services provided in a hospital-based facility.
    44    7. "Provider" means an individual or entity,  whether  for  profit  or
    45  nonprofit,  whose primary purpose is to provide professional health care
    46  services.
    47    § 2. This act shall take effect immediately.
 
    48                                   PART C
 
    49    Section 1. Title 2 of article 28 of the public health law  is  amended
    50  by adding a new section 2831 to read as follows:

        S. 2521--A                          3
 
     1    §  2831. Standardized consolidated itemized general hospital bills. 1.
     2  After a patient's discharge or  release  from  a  general  hospital,  or
     3  completion of a discrete course of treatment by a hospital-based facili-
     4  ty, the facility shall provide to the patient or to the patient's survi-
     5  vor  or  legal  guardian,  as appropriate, a consolidated itemized bill.
     6  The initial consolidated itemized bill shall be provided  no  more  than
     7  seven  days  after the patient's discharge, or  release or completion of
     8  the episode or course of treatment,   or after a  request    for    such
     9  bill, whichever is earlier.
    10    2. The consolidated itemized bill shall:
    11    (a)  detail in plain language, comprehensible to an ordinary layperson
    12  (consistent with accuracy), the specific nature of charges  or  expenses
    13  incurred  by the patient during the hospitalization or episode or course
    14  of treatment and the date of each service;
    15    (b) detail all services provided to the patient during the  hospitali-
    16  zation  or  episode  or  course of treatment, including all professional
    17  services administered and supplies and drugs,  contain  a  statement  of
    18  specific  services  received  and expenses incurred by date and provider
    19  for such items of service, enumerating in detail the constituent  compo-
    20  nents  of  the  services received within each department of the facility
    21  and including unit price data on rates charged;
    22    (c) identify each item as paid, assigned to a  third-party  payer,  or
    23  expected payment by the patient;
    24    (d)  include  the amount due, if any from the patient, including a due
    25  date;
    26    (e) for any amount paid or to be paid  by  the  patient,  indicate  to
    27  which person or entity an amount is due;
    28    (f)  not  include any generalized category of expenses such as "other"
    29  or "miscellaneous" or similar categories;
    30    (g) list drugs by brand or generic name, even where drug code  numbers
    31  are used;
    32    (h)  specifically  identify physical, rehabilitative, occupational, or
    33  speech therapy treatment by date, type, and  length  of  treatment  when
    34  such treatment is a part of the statement or bill; and
    35    (i) prominently display the telephone number of the facility's patient
    36  liaison responsible for expediting the resolution of any billing dispute
    37  between  the  patient,  or the patient's survivor or legal guardian, and
    38  the billing department or departments.
    39    3.  A provider with any financial or contractual relationship with the
    40  facility may not separately bill the patient or the  patient's  survivor
    41  or legal guardian for such services, supplies or drugs.
    42    4.  Any  subsequent  bill  provided  to  a patient or to the patient's
    43  survivor or legal guardian, as appropriate, relating to the hospitaliza-
    44  tion or episode or course of treatment must include all of the  informa-
    45  tion  required  under  this  section, in or enclosed with the bill or by
    46  reference to a previous consolidated itemized  bill,  with  any  clearly
    47  delineated revisions.
    48    5.    The  consolidated itemized bill, shall be in a form developed by
    49  the commissioner, in consultation with the superintendent  of  financial
    50  services.
    51    6.   Each facility shall establish policies and procedures for review-
    52  ing and responding to questions from patients concerning  the  patient's
    53  consolidated  itemized bill. The response shall be provided no more than
    54  seven business days after the  date  a  question  is  received.  If  the
    55  patient  is  not satisfied with the response, the facility shall provide

        S. 2521--A                          4
 
     1  the patient with the contact information of the hospital  department  or
     2  collection entity to which the issue shall be sent for review.
     3    §  2.  Section  2807-e of the public health law is amended by adding a
     4  new subdivision 6 to read as follows:
     5    6. This section is subject to the provisions of  section  twenty-eight
     6  hundred  thirty-one of this article, and where any provisions of the two
     7  sections conflict, the provisions of section twenty-eight hundred  thir-
     8  ty-one of this article shall control.
     9    §  3. This act shall take effect one year after it shall have become a
    10  law.
 
    11                                   PART D
 
    12    Section 1. Title 2 of article 28 of the public health law  is  amended
    13  by adding a new section 2832 to read as follows:
    14    §  2832.  Regulation  of the billing of facility fees.  No hospital or
    15  health system shall bill or seek payment from a patient for  a  facility
    16  fee:  1.  related to the provision of preventive care service as defined
    17  by the United States Preventive Services Task Force; or
    18    2. where the facility fee is not covered for the patient by  a  third-
    19  party payer.
    20    § 2. This act shall take effect on the one hundred eightieth day after
    21  it shall have become a law.
 
    22                                   PART E
 
    23    Section  1.  Title 2 of article 28 of the public health law is amended
    24  by adding a new section 2833 to read as follows:
    25    § 2833. Standardized patient financial liability forms.  Every  hospi-
    26  tal,  health  system,  hospital-based  facility,  affiliated provider or
    27  other provider shall use the uniform patient  financial  liability  form
    28  which  shall  be developed by the commissioner.  The form shall disclose
    29  to the patient whether services, supplies  and  drugs  provided  to  the
    30  patient  are in-network or out-of-network, whether the care is a covered
    31  benefit by a third-party payer of the patient, and the nature and amount
    32  of the patient's projected financial liability.  A patient shall not  be
    33  financially  liable  for  any service, supplies or drugs subject to this
    34  title that is not charged or billed in accordance with this title.   The
    35  commissioner  shall  develop  and  issue the uniform financial liability
    36  form within six months of the effective date of this section.  The  form
    37  shall  be  adopted  and used under this section by each hospital, health
    38  system, hospital-based facility, affiliated provider and other  provider
    39  not later than sixty days after the commissioner issues the form.
    40    § 2. This act shall take effect immediately.
 
    41                                   PART F
 
    42    Section 1. Subdivision 18-a of section 206 of the public health law is
    43  amended by adding a new paragraph (e) to read as follows:
    44    (e)(i) The commissioner shall ensure that the New York state all payer
    45  database shall serve the interests of New York's health care consumers.
    46    (ii)  Every hospital licensed under article twenty-eight of this chap-
    47  ter and health care professionals authorized under title  eight  of  the
    48  education  law shall participate in the all payer database through their
    49  insurance carrier contracts, and may participate in the all payer  data-
    50  base through any other of the hospital's third-party payer contracts.

        S. 2521--A                          5
 
     1    (iii)  Data that is required to be submitted to the all payer database
     2  shall not be considered proprietary  information  for  the  purposes  of
     3  submission to or inclusion in the all payer database.
     4    § 2. This act shall take effect on the one hundred eightieth day after
     5  it shall have become a law.
 
     6                                   PART G
 
     7    Section  1.  Subdivisions  9  and  9-a of section 2807-k of the public
     8  health law, subdivision 9 as amended by section 17 of part B of  chapter
     9  60 of the laws of 2014, subdivision 9-a as added by section 39-a of part
    10  A of chapter 57 of the laws of 2006 and paragraph (k) of subdivision 9-a
    11  as  added by section 43 of part B of chapter 58 of the laws of 2008, are
    12  amended to read as follows:
    13    9. In order for a general hospital to participate in the  distribution
    14  of  funds  from  the  pool, the general hospital must [implement minimum
    15  collection policies and procedures approved] use only the uniform finan-
    16  cial assistance form provided by the commissioner.  The  definitions  in
    17  section  twenty-eight hundred thirty of this article shall apply to this
    18  subdivision and subdivision nine-a of this section.
    19    9-a. (a) (i) As a condition for participation  in  pool  distributions
    20  authorized  pursuant  to  this  section and section twenty-eight hundred
    21  seven-w of this article for periods on  and  after  January  first,  two
    22  thousand  nine,  general  hospitals  shall, effective for periods on and
    23  after January first, two thousand [seven, establish]  twenty-two,  adopt
    24  and  implement  the  uniform  financial [aid policies and procedures, in
    25  accordance with the provisions  of  this  subdivision]  assistance  form
    26  policy, to be developed and issued by the commissioner no later than one
    27  hundred eighty days after the effective date of a chapter of the laws of
    28  two  thousand  twenty-one  that  amended this subdivision. No later than
    29  thirty days after the issuance of the uniform financial assistance  form
    30  and  policy, general hospitals shall implement such form and policy, for
    31  reducing hospital charges and charges for affiliated providers otherwise
    32  applicable to low-income individuals without third-party health  [insur-
    33  ance] coverage, or who have [exhausted their] third-party health [insur-
    34  ance  benefits]  coverage  that does not cover or limits coverage of the
    35  service, and who can demonstrate an inability to pay full  charges,  and
    36  also,  at  the  hospital's  discretion,  for reducing or discounting the
    37  collection of co-pays and deductible payments from those individuals who
    38  can demonstrate an inability to pay  such  amounts.  Immigration  status
    39  shall not be an eligibility criterion.
    40    (ii)  A  general hospital may use the New York state of health market-
    41  place eligibility determination page to establish the  patient's  house-
    42  hold  income  and  residency  in lieu of the financial application form,
    43  provided it has secured the consent of the patient. A  general  hospital
    44  shall  not  require a patient to apply for coverage through the New York
    45  state of health marketplace  in  order  to  receive  care  or  financial
    46  assistance.
    47    (iii) Upon submission of a completed application form, the patient may
    48  disregard  any  bills until the general hospital has rendered a decision
    49  on the application in accordance with this paragraph.
    50    (b) Such reductions from charges for [uninsured] patients described in
    51  paragraph (a) of this subdivision with incomes below  [at  least  three]
    52  four  hundred  percent  of  the  federal poverty level shall result in a
    53  charge to such individuals that does not exceed  [the  greater  of]  the
    54  amount  that would have been paid for the same services [by the "highest

        S. 2521--A                          6

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

        S. 2521--A                          7

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

        S. 2521--A                          8
 
     1  The  commissioner  shall  likewise post the uniform financial assistance
     2  form and policy on the department's hospital profile page related to the
     3  general hospital's or any successor website.
     4    (d)  The  commissioner  shall provide application materials to general
     5  hospitals, including the uniform financial assistance  application  form
     6  and  policy.  These  application  materials  shall  include  a notice to
     7  patients that upon submission  of  a  completed  application  form,  the
     8  patient  may disregard any bills until the general hospital has rendered
     9  a decision on the application in accordance  with  this  paragraph.  The
    10  application  materials  shall include specific information as the income
    11  levels  used  to  determine  eligibility  for  financial  assistance,  a
    12  description of the primary service area of the hospital and the means to
    13  apply  for assistance. Such policies and procedures shall include clear,
    14  objective criteria for determining a patient's ability to  pay  and  for
    15  providing  such adjustments to payment requirements as are necessary. In
    16  addition to adjustment mechanisms such  as  sliding  fee  schedules  and
    17  discounts  to  fixed  standards, such policies and procedures shall also
    18  provide for the use of installment plans for the payment of  outstanding
    19  balances by patients pursuant to the provisions of the hospital's finan-
    20  cial  assistance policy. The monthly payment under such a plan shall not
    21  exceed [ten] five percent of the gross monthly income of  the  patient[,
    22  provided,  however,  that  if patient assets are considered under such a
    23  policy, then patient assets which are not excluded  assets  pursuant  to
    24  subparagraph (vi) of paragraph (b) of this subdivision may be considered
    25  in  addition  to  the  limit  on monthly payments.] The rate of interest
    26  charged to the patient on the unpaid balance, if any, shall  not  exceed
    27  the  [rate  for  a ninety-day security] federal funds rate issued by the
    28  United States Department of Treasury[, plus  .5  percent]  and  no  plan
    29  shall include an accelerator or similar clause under which a higher rate
    30  of  interest  is  triggered upon a missed payment. [If such policies and
    31  procedures] The policy shall not include  a  requirement  of  a  deposit
    32  prior to [non-emergent,] medically-necessary care[, such deposit must be
    33  included  as part of any financial aid consideration]. Such policies and
    34  procedures shall be applied consistently to all eligible patients.
    35    (e) Such [policies and procedures] policy shall [permit  patients  to]
    36  require  the hospital's chief financial officer to provide a sworn affi-
    37  davit, that must be filed with a complaint for medical  debt  collection
    38  action  in  a  court of jurisdiction, that the patient does not meet the
    39  income or residency criteria  for  financial  assistance.  Patients  may
    40  apply  for  assistance  [within  at  least  ninety  days  of the date of
    41  discharge or date of service  and  provide  at  least  twenty  days  for
    42  patients  to  submit  a  completed  application]  at any time during the
    43  collection process, including after the commencement of a  medical  debt
    44  court action or upon securing a default judgment in a court of jurisdic-
    45  tion.    Such  policies and procedures may require that patients seeking
    46  payment adjustments provide [appropriate] the following financial infor-
    47  mation and documentation in support  of  their  application[,  provided,
    48  however, that such application process shall not be unduly burdensome or
    49  complex]  that are used by the New York state of health marketplace: pay
    50  checks or pay stubs; rent receipts; a letter from the patient's employer
    51  attesting to the patient's gross income; or, if none  of  the  aforemen-
    52  tioned  information  and  documentation  are  available, a written self-
    53  attestation of the  patient's  income.  General  hospitals  shall,  upon
    54  request,  assist  patients  in understanding the hospital's policies and
    55  procedures and in applying for payment adjustments.  [Application  forms
    56  shall be printed] The commissioner shall translate the financial assist-

        S. 2521--A                          9

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

        S. 2521--A                         10

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

        S. 2521--A                         11
 
     1  organized according to United States  postal  service  zip  code,  whose
     2  applications were approved and whose applications were denied;
     3    (iv) the reimbursement received for indigent care from the pool estab-
     4  lished pursuant to this section;
     5    (v)  the  amount  of  funds  that have been expended on [charity care]
     6  financial assistance from charitable bequests made or trusts established
     7  for the purpose of providing financial assistance to  patients  who  are
     8  eligible in accordance with the terms of such bequests or trusts;
     9    (vi)  for  hospitals located in social services districts in which the
    10  district allows hospitals to assist patients with such applications, the
    11  number of applications for eligibility under title  XIX  of  the  social
    12  security  act (medicaid) that the hospital assisted patients in complet-
    13  ing and the number denied and approved;
    14    (vii) the hospital's financial losses resulting from services provided
    15  under medicaid; and
    16    (viii) the number of referrals to collection agents or outside  vendor
    17  court cases and liens placed on [the primary] any residences of patients
    18  through the collection process used by a hospital.
    19    (j) [Within ninety days of the effective date of this subdivision each
    20  hospital  shall submit to the commissioner a written report on its poli-
    21  cies and procedures for financial assistance to patients which are  used
    22  by  the  hospital on the effective date of this subdivision. Such report
    23  shall include copies of its policies and procedures, including  material
    24  which  is  distributed  to patients, and a description of the hospital's
    25  financial aid policies and procedures. Such  description  shall  include
    26  the  income levels of patients on which eligibility is based, the finan-
    27  cial aid eligible patients receive and the  means  of  calculating  such
    28  aid,  and  the  service  area, if any, used by the hospital to determine
    29  eligibility] The commissioner shall include  the  data  collected  under
    30  paragraph (i) of this subdivision in regular audits of the annual gener-
    31  al hospital institutional cost report.
    32    (k)  In  the event it is determined by the commissioner that the state
    33  will be unable to secure all necessary federal approvals to include,  as
    34  part  of  the  state's  approved  state plan under title nineteen of the
    35  federal social security act, a requirement[, as set forth  in  paragraph
    36  one  of  this  subdivision,]  that compliance with this subdivision is a
    37  condition of participation in pool distributions authorized pursuant  to
    38  this  section and section twenty-eight hundred seven-w of this [article]
    39  title, then such condition of participation shall  be  deemed  null  and
    40  void  and,  notwithstanding  section  twelve of this chapter, failure to
    41  comply with the provisions of this subdivision  by  a  hospital  on  and
    42  after the date of such determination shall make such hospital liable for
    43  a  civil  penalty  not  to  exceed  ten  thousand  dollars for each such
    44  violation. The imposition of such civil penalties shall  be  subject  to
    45  the provisions of section twelve-a of this chapter.
    46    §  2.  Subdivision  14  of  section 2807-k of the public health law is
    47  REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions  14,
    48  15 and 16.
    49    § 3. This act shall take effect immediately.
 
    50                                   PART H
 
    51    Section  1.    Section  5004  of  the civil practice law and rules, as
    52  amended by chapter 258 of the laws  of  1981,  is  amended  to  read  as
    53  follows:

        S. 2521--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:

        S. 2521--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.
Go to top