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
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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.