Add 2828, amd 2807-k, Pub Health L; amd 603, Fin Serv L; amd 5004, CPLR
Relates to denial of payment for certain medically necessary hospital services, claims payment timeframes and payment of interest, payment and billing for out-of-network hospital emergency services, claims payment performance and creation of a workgroup to study health care administrative simplification; relates to standardized patient financial liability forms; relates to the general hospital indigent care pool; and relates to services rendered by a non-participating provider.
STATE OF NEW YORK
________________________________________________________________________
8076--A
IN SENATE
March 16, 2020
___________
Introduced by Sen. RIVERA -- read twice and ordered printed, 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 standardized
patient financial liability forms; to amend the public health law, in
relation to the general hospital indigent care pool; to amend the
civil practice law and rules, in relation to claims payment interest
rates; to amend the financial services law, in relation to services
rendered by a non-participating provider
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. The public health law is amended by adding a new section
2 2828 to read as follows:
3 § 2828. Standardized patient financial liability forms. 1. Every
4 hospital, health system, hospital-based facility, affiliated provider,
5 and provider shall use the uniform patient financial liability form
6 which shall be developed by the commissioner. The standardized form
7 shall disclose to the patient whether services, supplies and drugs
8 provided to the patient are in-network or out-of-network and, to the
9 extent reasonably known by the hospital, health system, hospital-based
10 facility, affiliated provider, or provider, whether services, supplies
11 and drugs provided to the patient are a covered benefit for a third-par-
12 ty payer of the patient, and the nature and amount of the patient's
13 projected financial liability.
14 2. A patient shall not be financially liable for any services,
15 supplies or drugs subject to this section that is not charged or billed
16 in accordance with this section.
17 3. The commissioner shall develop and issue the uniform financial
18 liability form within six months of the effective date of this section.
19 The form shall be adopted and used pursuant to this section by all
20 hospitals, health systems, hospital-based facilities, affiliated provid-
21 ers, and providers not later than sixty days of after the commissioner
22 issues such form.
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15965-05-0
S. 8076--A 2
1 4. A violation of this section shall be deemed a deceptive act or
2 practice subject to enforcement under article twenty-two-A of the gener-
3 al business law. Nothing in this section shall be construed to restrict
4 any right which any person may have under any other statute or the
5 common law.
6 § 2. Subdivisions 9 and 9-a of section 2807-k of the public health
7 law, subdivision 9 as amended by section 17 of part B of chapter 60 of
8 the laws of 2014, subdivision 9-a as added by section 39-a of part A of
9 chapter 57 of the laws of 2006 and paragraph (k) of subdivision 9-a as
10 added by section 43 of part B of chapter 58 of the laws of 2008, are
11 amended to read as follows:
12 9. In order for a general hospital to participate in the distribution
13 of funds from the pool, the general hospital must implement minimum
14 collection policies and procedures [approved] provided by the commis-
15 sioner.
16 9-a. (a) As a condition for participation in pool distributions
17 authorized pursuant to this section and section twenty-eight hundred
18 seven-w of this article for periods on and after January first, two
19 thousand nine, general hospitals shall, effective for periods on and
20 after January first, two thousand [seven, establish] twenty-one, adopt
21 and implement the uniform financial [aid policies and procedures, in
22 accordance with the provisions of this subdivision] assistance form and
23 policy, to be developed and issued by the commissioner no later than one
24 hundred eighty days after the effective date of a chapter of the laws of
25 two thousand twenty that amended this subdivision. No later than thirty
26 days after the issuance of the uniform financial assistance form and
27 policy, general hospitals shall implement such form and policy, for
28 reducing hospital charges and charges for physicians who work in the
29 hospital otherwise applicable to low-income individuals without health
30 insurance, or who have [exhausted their] health insurance [benefits]
31 that does not cover or limits coverage of the service, and who can
32 demonstrate an inability to pay full charges, and also, at the hospi-
33 tal's discretion, for reducing or discounting the collection of co-pays
34 and deductible payments from those individuals who can demonstrate an
35 inability to pay such amounts. Immigration status shall not be an eligi-
36 bility criterion. General hospitals shall use the New York state of
37 health marketplace eligibility determination page to establish the
38 patient's household income and residency in lieu of the financial appli-
39 cation form, provided they have secured the consent of the patient. A
40 general hospital shall not require a patient to apply for coverage
41 through the New York state of health marketplace in order to receive
42 care or financial assistance.
43 (b) Such reductions from charges for uninsured patients with incomes
44 below at least [three] four hundred percent of the federal poverty level
45 shall result in a charge to such individuals that does not exceed [the
46 greater of] the amount that would have been paid for the same services
47 [by the "highest volume payor" for such general hospital as defined in
48 subparagraph (v) of this paragraph, or for services provided pursuant to
49 title XVIII of the federal social security act (medicare), or for
50 services] provided pursuant to title XIX of the federal social security
51 act (medicaid), and provided further that such amounts shall be adjusted
52 according to income level as follows:
53 (i) For patients with incomes at or below at least [one] two hundred
54 percent of the federal poverty level, the hospital shall collect no more
55 than a nominal payment amount, consistent with guidelines established by
56 the commissioner;
S. 8076--A 3
1 (ii) For patients with incomes between at least [one] two hundred one
2 percent and [one] four hundred [fifty] percent of the federal poverty
3 level, the hospital shall collect no more than the amount identified
4 after application of a proportional sliding fee schedule under which
5 patients with lower incomes shall pay the lowest amount. Such schedule
6 shall provide that the amount the hospital may collect for such patients
7 increases from the nominal amount described in subparagraph (i) of this
8 paragraph in equal increments as the income of the patient increases, up
9 to a maximum of twenty percent of the greater of the amount that would
10 have been paid for the same services [by the "highest volume payor" for
11 such general hospital, as defined in subparagraph (v) of this paragraph,
12 or for services provided pursuant to title XVIII of the federal social
13 security act (medicare) or for services] provided pursuant to title XIX
14 of the federal social security act (medicaid);
15 (iii) [For patients with incomes between at least one hundred fifty-
16 one percent and two hundred fifty percent of the federal poverty level,
17 the hospital shall collect no more than the amount identified after
18 application of a proportional sliding fee schedule under which patients
19 with lower income shall pay the lowest amounts. Such schedule shall
20 provide that the amount the hospital may collect for such patients
21 increases from the twenty percent figure described in subparagraph (ii)
22 of this paragraph in equal increments as the income of the patient
23 increases, up to a maximum of the greater of the amount that would have
24 been paid for the same services by the "highest volume payor" for such
25 general hospital, as defined in subparagraph (v) of this paragraph, or
26 for services provided pursuant to title XVIII of the federal social
27 security act (medicare) or for services provided pursuant to title XIX
28 of the federal social security act (medicaid); and
29 (iv)] For patients with incomes [between at least two hundred fifty-
30 one percent and three hundred] at or above four hundred one percent of
31 the federal poverty level, the hospital shall collect no more than the
32 greater of the amount that would have been paid for the same services
33 [by the "highest volume payor" for such general hospital as defined in
34 subparagraph (v) of this paragraph, or for services provided pursuant to
35 title XVIII of the federal social security act (medicare), or for
36 services] provided pursuant to title XIX of the federal social security
37 act (medicaid)[.]; and
38 [(v) For the purposes of this paragraph, "highest volume payor" shall
39 mean the insurer, corporation or organization licensed, organized or
40 certified pursuant to article thirty-two, forty-two or forty-three of
41 the insurance law or article forty-four of this chapter, or other third-
42 party payor, which has a contract or agreement to pay claims for
43 services provided by the general hospital and incurred the highest
44 volume of claims in the previous calendar year.
45 (vi) A hospital may implement policies and procedures to permit, but
46 not require, consideration on a case-by-case basis of exceptions to the
47 requirements described in subparagraphs (i) and (ii) of this paragraph
48 based upon the existence of significant assets owned by the patient that
49 should be taken into account in determining the appropriate payment
50 amount for that patient's care, provided, however, that such proposed
51 policies and procedures shall be subject to the prior review and
52 approval of the commissioner and, if approved, shall be included in the
53 hospital's financial assistance policy established pursuant to this
54 section, and provided further that, if such approval is granted, the
55 maximum amount that may be collected shall not exceed the greater of the
56 amount that would have been paid for the same services by the "highest
S. 8076--A 4
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). In
5 the event that a general hospital reviews a patient's assets in deter-
6 mining payment adjustments such policies and procedures shall not
7 consider as assets a patient's primary residence, assets held in a tax-
8 deferred or comparable retirement savings account, college savings
9 accounts, or cars used regularly by a patient or immediate family
10 members.
11 (vii)] (iv) Nothing in this paragraph shall be construed to limit a
12 hospital's ability to establish patient eligibility for payment
13 discounts at income levels higher than those specified herein and/or to
14 provide greater payment discounts for eligible patients than those
15 required by this paragraph.
16 (c) [Such policies and procedures shall be clear, understandable, in
17 writing and publicly available in summary form and each] Each general
18 hospital participating in the pool shall ensure that every patient is
19 made aware of the existence of such [policies and procedures] uniform
20 financial assistance form and policy and is provided, in a timely
21 manner, with a [summary] copy of such [policies and procedures] form and
22 policy upon request. [Any summary provided to patients shall, at a mini-
23 mum, include specific information as to income levels used to determine
24 eligibility for assistance, a description of the primary service area of
25 the hospital and the means of applying for assistance. For general]
26 General hospitals with twenty-four hour emergency departments, [such
27 policies and procedures] shall require the notification of patients
28 during the intake and registration process, through the conspicuous
29 posting of language-appropriate information in the general hospital, and
30 information on bills and statements sent to patients, that financial
31 [aid] assistance may be available to qualified patients and how to
32 obtain further information. For specialty hospitals without twenty-four
33 hour emergency departments, such notification shall take place through
34 written materials provided to patients during the intake and registra-
35 tion process prior to the provision of any health care services or
36 procedures, and through information on bills and statements sent to
37 patients, that financial [aid] assistance may be available to qualified
38 patients and how to obtain further information. [Application materials
39 shall include a notice to patients that upon submission of a completed
40 application, including any information or documentation needed to deter-
41 mine the patient's eligibility pursuant to the hospital's financial
42 assistance policy, the patient may disregard any bills until the hospi-
43 tal has rendered a decision on the application in accordance with this
44 paragraph] General hospitals shall post the uniform financial assistance
45 application form and policy in a conspicuous location on the general
46 hospital's website. The commissioner shall likewise post the uniform
47 financial assistance form and policy on the department's hospital
48 profile page related to the general hospital's or any successor website.
49 (d) The commissioner shall provide application materials to general
50 hospitals, including the uniform financial assistance application form
51 and policy. These application materials shall include a notice to
52 patients that upon submission of a completed application form, the
53 patient may disregard any bills until the general hospital has rendered
54 a decision on the application in accordance with this paragraph. The
55 application materials shall include specific information as the income
56 levels used to determine eligibility for financial assistance, a
S. 8076--A 5
1 description of the primary service area of the hospital and the means to
2 apply for assistance. Such policies and procedures shall include clear,
3 objective criteria for determining a patient's ability to pay and for
4 providing such adjustments to payment requirements as are necessary. In
5 addition to adjustment mechanisms such as sliding fee schedules and
6 discounts to fixed standards, such policies and procedures shall also
7 provide for the use of installment plans for the payment of outstanding
8 balances by patients pursuant to the provisions of the hospital's finan-
9 cial assistance policy. The monthly payment under such a plan shall not
10 exceed [ten] five percent of the gross monthly income of the patient[,
11 provided, however, that if patient assets are considered under such a
12 policy, then patient assets which are not excluded assets pursuant to
13 subparagraph (vi) of paragraph (b) of this subdivision may be considered
14 in addition to the limit on monthly payments]. The rate of interest
15 charged to the patient on the unpaid balance, if any, shall not exceed
16 the [rate for a ninety-day security] federal funds rate issued by the
17 United States Department of Treasury[, plus .5 percent] and no plan
18 shall include an accelerator or similar clause under which a higher rate
19 of interest is triggered upon a missed payment. [If such policies and
20 procedures] The policy shall not include a requirement of a deposit
21 prior to [non-emergent, medically-necessary] care[, such deposit must be
22 included as part of any financial aid consideration]. Such policies and
23 procedures shall be applied consistently to all eligible patients.
24 (e) Such policies and procedures shall permit patients to apply for
25 assistance within at least [ninety] two hundred forty days of the date
26 of discharge or date of service and provide at least [twenty] sixty days
27 for patients to submit a completed application. Such policies and proce-
28 dures may require that patients seeking payment adjustments provide
29 [appropriate] the following financial information and documentation in
30 support of their application[, provided, however, that such application
31 process shall not be unduly burdensome or complex] that are used by the
32 New York state of health marketplace: pay checks or pay stubs; rent
33 receipts; a letter from the patient's employer attesting to the
34 patient's gross income; or, if none of the aforementioned information
35 and documentation are available, a written self-attestation of the
36 patient's income. General hospitals shall, upon request, assist patients
37 in understanding the hospital's policies and procedures and in applying
38 for payment adjustments. [Application forms shall be printed] The
39 commissioner shall translate the financial assistance application form
40 and policy into the "primary languages" of each general hospital. Each
41 general hospital shall print and post these materials to its website in
42 the "primary languages" of patients served by the general hospital. For
43 the purposes of this paragraph, "primary languages" shall include any
44 language that is either (i) used to communicate, during at least five
45 percent of patient visits in a year, by patients who cannot speak, read,
46 write or understand the English language at the level of proficiency
47 necessary for effective communication with health care providers, or
48 (ii) spoken by non-English speaking individuals comprising more than one
49 percent of the primary hospital service area population, as calculated
50 using demographic information available from the United States Bureau of
51 the Census, supplemented by data from school systems. Decisions regard-
52 ing such applications shall be made within thirty days of receipt of a
53 completed application. Such policies and procedures shall require that
54 the hospital issue any denial/approval of such application in writing
55 with information on how to appeal the denial and shall require the
56 hospital to establish an appeals process under which it will evaluate
S. 8076--A 6
1 the denial of an application. [Nothing in this subdivision shall be
2 interpreted as prohibiting a hospital from making the availability of
3 financial assistance contingent upon the patient first applying for
4 coverage under title XIX of the social security act (medicaid) or anoth-
5 er insurance program if, in the judgment of the hospital, the patient
6 may be eligible for medicaid or another insurance program, and upon the
7 patient's cooperation in following the hospital's financial assistance
8 application requirements, including the provision of information needed
9 to make a determination on the patient's application in accordance with
10 the hospital's financial assistance policy.]
11 (f) Such policies and procedures shall provide that patients with
12 incomes below [three] four hundred percent of the federal poverty level
13 are deemed presumptively eligible for payment adjustments and shall
14 conform to the requirements set forth in paragraph (b) of this subdivi-
15 sion, provided, however, that nothing in this subdivision shall be
16 interpreted as precluding hospitals from extending such payment adjust-
17 ments to other patients, either generally or on a case-by-case basis.
18 Such [policies and procedures] policy shall provide financial [aid]
19 assistance for emergency hospital services, including emergency trans-
20 fers pursuant to the federal emergency medical treatment and active
21 labor act (42 USC 1395dd), to patients who reside in New York state and
22 for medically necessary hospital services for patients who reside in the
23 hospital's primary service area as determined according to criteria
24 established by the commissioner. In developing such criteria, the
25 commissioner shall consult with representatives of the hospital indus-
26 try, health care consumer advocates and local public health officials.
27 Such criteria shall be made available to the public no less than thirty
28 days prior to the date of implementation and shall, at a minimum:
29 (i) prohibit a hospital from developing or altering its primary
30 service area in a manner designed to avoid medically underserved commu-
31 nities or communities with high percentages of uninsured residents;
32 (ii) ensure that every geographic area of the state is included in at
33 least one general hospital's primary service area so that eligible
34 patients may access care and financial assistance; and
35 (iii) require the hospital to notify the commissioner upon making any
36 change to its primary service area, and to include a description of its
37 primary service area in the hospital's annual implementation report
38 filed pursuant to subdivision three of section twenty-eight hundred
39 three-l of this article.
40 (g) Nothing in this subdivision shall be interpreted as precluding
41 hospitals from extending payment adjustments for medically necessary
42 non-emergency hospital services to patients outside of the hospital's
43 primary service area. For patients determined to be eligible for finan-
44 cial [aid] assistance under the terms of [a hospital's] the uniform
45 financial [aid] assistance policy, such [policies and procedures] policy
46 shall prohibit any limitations on financial [aid] assistance for
47 services based on the medical condition of the applicant, other than
48 typical limitations or exclusions based on medical necessity or the
49 clinical or therapeutic benefit of a procedure or treatment.
50 (h) Such policies and procedures shall not permit the securance of a
51 lien or forced sale or foreclosure of a patient's primary residence in
52 order to collect an outstanding medical bill and shall require the
53 hospital to refrain from sending an account to collection if the patient
54 has submitted a completed application for financial [aid, including any
55 required supporting documentation] assistance, while the hospital deter-
56 mines the patient's eligibility for such [aid] assistance. Such [poli-
S. 8076--A 7
1 cies and procedures] policy shall provide for written notification,
2 which shall include notification on a patient bill, to a patient not
3 less than thirty days prior to the referral of debts for collection and
4 shall require that the collection agency obtain the hospital's written
5 consent prior to commencing a legal action. Such [policies and proce-
6 dures] policy shall require all general hospital staff who interact with
7 patients or have responsibility for billing and collections to be
8 trained in such [policies and procedures] policy, and require the imple-
9 mentation of a mechanism for the general hospital to measure its compli-
10 ance with [such policies and procedures] the policy. Such [policies and
11 procedures] policy shall require that any collection agency under
12 contract with a general hospital for the collection of debts follow the
13 [hospital's] uniform financial assistance policy, including providing
14 information to patients on how to apply for financial assistance where
15 appropriate. Such [policies and procedures] policy shall prohibit
16 collections from a patient who is determined to be eligible for medical
17 assistance pursuant to title XIX of the federal social security act at
18 the time services were rendered and for which services medicaid payment
19 is available.
20 (i) Reports required to be submitted to the department by each general
21 hospital as a condition for participation in the pools, and which
22 contain, in accordance with applicable regulations, a certification from
23 an independent certified public accountant or independent licensed
24 public accountant or an attestation from a senior official of the hospi-
25 tal that the hospital is in compliance with conditions of participation
26 in the pools, shall also contain, for reporting periods on and after
27 January first, two thousand seven:
28 (i) a report on hospital costs incurred and uncollected amounts in
29 providing services to [eligible] patients [without insurance] found
30 eligible for financial assistance, including the amount of care provided
31 for a nominal payment amount, during the period covered by the report;
32 (ii) hospital costs incurred and uncollected amounts for deductibles
33 and coinsurance for eligible patients with insurance or other third-par-
34 ty payor coverage;
35 (iii) the number of patients, organized according to United States
36 postal service zip code, who applied for financial assistance pursuant
37 to the [hospital's] uniform financial assistance policy, and the number,
38 organized according to United States postal service zip code, whose
39 applications were approved and whose applications were denied;
40 (iv) the reimbursement received for indigent care from the pool estab-
41 lished pursuant to this section;
42 (v) the amount of funds that have been expended on [charity care]
43 financial assistance from charitable bequests made or trusts established
44 for the purpose of providing financial assistance to patients who are
45 eligible in accordance with the terms of such bequests or trusts;
46 (vi) for hospitals located in social services districts in which the
47 district allows hospitals to assist patients with such applications, the
48 number of applications for eligibility under title XIX of the social
49 security act (medicaid) that the hospital assisted patients in complet-
50 ing and the number denied and approved;
51 (vii) the hospital's financial losses resulting from services provided
52 under medicaid; and
53 (viii) the number of referrals to collection agents or outside vendor
54 court cases and liens placed on [the primary] any residences of patients
55 through the collection process used by a hospital.
S. 8076--A 8
1 (j) [Within ninety days of the effective date of this subdivision each
2 hospital shall submit to the commissioner a written report on its poli-
3 cies and procedures for financial assistance to patients which are used
4 by the hospital on the effective date of this subdivision. Such report
5 shall include copies of its policies and procedures, including material
6 which is distributed to patients, and a description of the hospital's
7 financial aid policies and procedures. Such description shall include
8 the income levels of patients on which eligibility is based, the finan-
9 cial aid eligible patients receive and the means of calculating such
10 aid, and the service area, if any, used by the hospital to determine
11 eligibility] The commissioner shall include the data collected under
12 paragraph (i) of this subdivision in regular audits of the annual gener-
13 al hospital institutional cost report.
14 (k) In the event it is determined by the commissioner that the state
15 will be unable to secure all necessary federal approvals to include, as
16 part of the state's approved state plan under title nineteen of the
17 federal social security act, a requirement[, as set forth in paragraph
18 one of this subdivision,] that compliance with this subdivision is a
19 condition of participation in pool distributions authorized pursuant to
20 this section and section twenty-eight hundred seven-w of this article,
21 then such condition of participation shall be deemed null and void and,
22 notwithstanding section twelve of this chapter, failure to comply with
23 the provisions of this subdivision by a hospital on and after the date
24 of such determination shall make such hospital liable for a civil penal-
25 ty not to exceed ten thousand dollars for each such violation. The impo-
26 sition of such civil penalties shall be subject to the provisions of
27 section twelve-a of this chapter.
28 § 3. Section 5004 of the civil practice law and rules, as amended by
29 chapter 258 of the laws of 1981, is amended to read as follows:
30 § 5004. Rate of interest. Interest shall be at the rate of nine per
31 centum per annum, except where otherwise provided by statute, provided
32 that in medical debt actions by a hospital licensed under article twen-
33 ty-eight of the public health law or a health care professional author-
34 ized under title eight of the education law the interest rate shall be
35 calculated at the one-year United States treasury bill rate. For
36 the purposes of this section, the "one-year United States treasury bill
37 rate" means the weekly average one-year constant maturity treasury
38 yield, as published by the board of governors of the federal reserve
39 system, for the calendar week preceding the date of the entry of the
40 judgment awarding damages. Provided however, that this section shall
41 not apply to any provision of the tax law which provides for the annual
42 rate of interest to be paid on a judgment or accrued claim.
43 § 4. Subsection (h) of section 603 of the financial services law, as
44 added by section 26 of part H of chapter 60 of the laws of 2014, is
45 amended to read as follows:
46 (h) "Surprise bill" means a bill for health care services, other than
47 emergency services, received by:
48 (1) an insured for services rendered by a non-participating physician
49 at a participating hospital or ambulatory surgical center, where a
50 participating physician is unavailable or a non-participating physician
51 renders services without the insured's knowledge, or unforeseen medical
52 services arise at the time the health care services are rendered;
53 provided, however, that a surprise bill shall not mean a bill received
54 for health care services when a participating physician is available and
55 the insured has elected to obtain services from a non-participating
56 physician;
S. 8076--A 9
1 (2) an insured for services rendered by a non-participating provider,
2 where the services were referred by a participating physician to a non-
3 participating provider without explicit written consent of the insured
4 acknowledging that the participating physician is referring the insured
5 to a non-participating provider and that the referral may result in
6 costs not covered by the health care plan; [or]
7 (3) an insured for services rendered by a non-participating provider
8 when the insured reasonably relied upon an oral or written statement
9 that the non-participating provider was a participating provider made by
10 a health care plan, or agent or representative of a health care plan, or
11 as specified in the health care plan provider listing or directory, or
12 provider information on the health plan's website;
13 (4) an insured for services rendered by a non-participating provider
14 when the insured reasonably relied upon a statement that the non-parti-
15 cipating provider was a participating provider made by the non-partici-
16 pating provider, or agent or representative of the non-participating
17 provider, or as specified on the non-participating provider's website;
18 or
19 (5) a patient who is not an insured for services rendered by a physi-
20 cian at a hospital or ambulatory surgical center, where the patient has
21 not timely received all of the disclosures required pursuant to section
22 twenty-four of the public health law.
23 § 5. This act shall take effect immediately.
