S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    564
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                              January 9, 2017
                                ___________
 
 Introduced  by  M.  of  A.  ABINANTI,  SKOUFIS,  MOSLEY, CURRAN, RAIA --
   Multi-Sponsored by -- M. of A. McDONOUGH, RA -- read once and referred
   to the Committee on Health
 
 AN ACT to amend the public health law, in relation to payment of  claims
   submitted by healthcare agencies

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1.  Section 3621 of the public health law, as added by section
 57-a of part A of chapter 56 of the laws of 2013, is amended to read  as
 follows:
   § 3621. Payment of claims. 1. Notwithstanding any law to the contrary,
 the provisions of section thirty-two hundred twenty-four-a of the insur-
 ance  law, and regulations thereunder, shall apply to claims for payment
 submitted by a licensed home care services agency, certified home health
 agency, long term home health care program, or fiscal intermediary oper-
 ating under section three hundred sixty-five-f of  the  social  services
 law,  pursuant  to  a  contract  with  a  payor under section forty-four
 hundred three-f of this chapter or section three hundred sixty-four-j of
 the social services law, and such claims shall be subject to and settled
 in compliance with the standards set forth in such section.
   2. FOR THE PURPOSES OF THIS SECTION, A "CLEAN CLAIM" SHALL:
   (A) IDENTIFY THE LICENSED HOME CARE SERVICES PROGRAM,  CERTIFIED  HOME
 HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY
 OPERATING  PURSUANT  TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL
 SERVICES LAW;
   (B) SUFFICIENTLY IDENTIFY THE ELIGIBLE COVERED PERSON;
   (C) LIST THE DATE AND PLACE OF SERVICE;
   (D) SUBSTANTIATE THE APPROPRIATENESS OF THE SERVICE PROVIDED;
   (E) STATE IF PRIOR AUTHORIZATION IS REQUIRED FOR SUCH ELIGIBLE COVERED
 PERSON AND SERVICE; AND

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD03331-01-7
              

 A. 564                              2
 
   (F) STATE ANY DOCUMENTATION  AS  REASONABLY  REQUIRED  BY  ANY  ENTITY
 REFERENCED IN THIS SECTION.
   3.  EACH CLEAN CLAIM OR PAYMENT FOR SERVICES PROCESSED IN VIOLATION OF
 THIS SECTION SHALL CONSTITUTE A SEPARATE VIOLATION. IN ADDITION  TO  THE
 PENALTIES PROVIDED IN THIS CHAPTER, ANY ORGANIZATION OR CORPORATION THAT
 FAILS  TO  ADHERE  TO  THE  STANDARDS CONTAINED IN THIS SECTION SHALL BE
 OBLIGATED TO PAY TO CERTIFIED  HOME  HEALTH  AGENCIES,  LONG  TERM  HOME
 HEALTH  CARE  PROGRAMS,  LICENSED  HOME  HEALTH  CARE PROGRAMS OR FISCAL
 INTERMEDIARIES OPERATING PURSUANT TO SECTION THREE HUNDRED  SIXTY-FIVE-F
 OF  THE  SOCIAL  SERVICES  LAW  IN FULL SETTLEMENT OF THE BILL, CLAIM OR
 PAYMENT PLUS INTEREST ON THE AMOUNT OF SUCH BILL, CLAIM  OR  PAYMENT  OF
 THE  GREATER  OF  THE  RATE EQUAL TO THE RATE SET BY THE COMMISSIONER OF
 TAXATION AND FINANCE FOR CORPORATE TAXES PURSUANT TO  PARAGRAPH  ONE  OF
 SUBSECTION  (E)  OF  SECTION  ONE  THOUSAND NINETY-SIX OF THE TAX LAW OR
 TWELVE PERCENT PER ANNUM, TO BE COMPUTED FROM THE DATE THE  BILL,  CLAIM
 OR PAYMENT WAS REQUIRED TO BE MADE.
   § 2. This act shall take effect immediately.