NY State Senate Bill 2019-S8076A

Senate Bill S8076A

2019-2020 Legislative Session

Relates to standardized patient financial liability forms, the general hospital indigent care pool, and claims payment timeframes; repealer

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Archive: Last Bill Status - In Senate Committee Health Committee

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
May 11, 2020	print number 8076a
May 11, 2020	amend (t) and recommit to health
Mar 16, 2020	referred to health

Bill Amendments

Original

A (Active)

2019-S8076 - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §2828, amd §2807-k, Pub Health L; amd §603, Fin Serv L; amd §5004, CPLR

2019-S8076 - Summary

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.

2019-S8076 - Sponsor Memo

                                
 
BILL NUMBER: S8076

SPONSOR: RIVERA
 
TITLE OF BILL:

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 finan-
cial services law and the civil practice law and rules, in relation to
claims payment timeframes; to amend the financial services law, in
relation to services rendered by a non-participating provider; and to
repeal certain provisions of the public health law relating to the
general hospital indigent care pool

 
PURPOSE:

To protect patients from medical debt by standardizing hospital finan-
cial assistance, shortening the statute of limitations and interest
rates for medical debt and adding network misinformation and balance
billing protections to the 2014 Surprise Bill Laws.

SUMMARY OF PROVISIONS:

Section 1 would add a new Public Health Law § 2827-b to standardize
patient financial liability forms to be used by all hospitals and health
care professionals.

Section 2 and 3 would amend Public Health Law § 2807-k to standardize
and update policies, applications, and appeal procedures related to
hospital financial assistance. It would improve public reporting of
hospital financial assistance data, increase the income limit for
assistance and clarify that immigration status does not disqualify some-
one from eligibility.

Sections 4, 5, 6 and 9 would amend Financial Services Law § 603, 605
and, 606 making various conforming amendments to hold consumers harmless
from surprise out-of-network bills, or plan and provider misinformation
about their network participation and prohibit "balance billing" for
charges other than applicable co-payments.

Section 7 and 8 would add a new Civil Practice Law §§ 213-d and 5004 to
shorten the statute of limitations on medical debt held by consumers to
three years from the current six years, and reduce the percentage rate
on medical debt judgements to 3%.

Section 10 provides an effective date.

 
JUSTIFICATION:

This legislation offers to clarify and simplify applying for financial
assistance at hospitals funded through the indigent care pool, protect
patients from medical debt, and update New York's landmark surprise
billing law to provide additional consumer protections for out of
network charges. It takes provisions from S 6757 of 2019, The Patient
Medical Debt Protection Act", as well as several proposals which were
included in the Governor's 2020-21 proposed budget.

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 lack of standardization in how hospitals implement the Hospital
Financial Assistance Law results in patients who should receive assist-
ance going without. The state's audits have repeatedly found that hospi-
tals are not complying with the law, as have audits conducted by consum-
er 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 assist-
ance.

The amount of time medical providers have to sue patients for unpaid
bills should be shortened from six years to three. Sixteen other states
and the District of Columbia have shorter statute of limitations for
medical debt actions than New York-including Arkansas which provides
eighteen months to two years. Currently, hospitals must submit their
medical claims to insurers within two years or forfeit their ability to
secure payments on the outstanding claim. This provision would ensure
that patients are afforded similar statute of limitations protections as
the insurance industry. Additionally, the interest rates that may be
charged for medical debt are reduced from 9% to 3%.

The bill would amend New York's 2014 surprise bill law to ensure that
consumers are protected from two forms of surprise medical bills that
are not currently covered:

*The first improvement would protect patients from surprise bills 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.

*The second improvement is to ensure than patients are not "balance
billed" for charges that are subject to the dispute resolution process
for which patients are held harmless. While the 2015 law held patients
harmless from costs associated with surprise bills, it did not prohibit
health care providers from continuing to bill patients. As a result,
many patients receive bills that they do not owe, and often end up
paying bills that they are not responsible for.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL:

None to state

 
EFFECTIVE DATE:
Immediately.

2019-S8076 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8076
 
                             I N  S E N A T E
 
                              March 16, 2020
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 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
   financial  services  law  and  the  civil  practice  law and rules, in
   relation to claims payment timeframes; to amend the financial services
   law, in relation to services rendered by a non-participating provider;
   and to repeal certain provisions of the public health law relating  to
   the general hospital indigent care pool
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. The public health law is amended by adding  a  new  section
 2827-a to read as follows:
   §  2827-A.  STANDARDIZED  PATIENT  FINANCIAL  LIABILITY  FORMS. 1. ALL
 HOSPITALS LICENSED UNDER THIS  ARTICLE  AND  HEALTH  CARE  PROFESSIONALS
 AUTHORIZED  UNDER  TITLE EIGHT OF THE EDUCATION LAW SHALL BE REQUIRED TO
 USE THE UNIFORM  PATIENT  FINANCIAL  LIABILITY  FORM  DEVELOPED  BY  THE
 COMMISSIONER,  IN  CONSULTATION WITH THE COMMISSIONER OF EDUCATION.  THE
 STANDARDIZED FORM SHALL DISCLOSE TO THE PATIENT WHETHER  THEIR  CARE  IS
 IN-NETWORK  OR  OUT-OF-NETWORK,  WHETHER  THE  CARE IS A COVERED BENEFIT
 UNDER THE PATIENT INSURANCE CONTRACT, THE EXACT NATURE AND AMOUNT OF THE
 PATIENT'S PROJECTED FINANCIAL LIABILITY AND SHALL SPECIFICALLY  INDICATE
 THE EXACT AMOUNT OF PERSONAL FINANCIAL LIABILITY TO BE UNDERTAKEN BY THE
 PATIENT.  IN  NO  EVENT SHALL A PATIENT BE FINANCIALLY LIABLE FOR UNDIS-
 CLOSED BILLS OR ANY BILLS RELATED TO SERVICES PROVIDED BY A PROVIDER WHO
 FAILED TO ASCERTAIN THAT HE OR SHE WAS  IN  THE  PATIENT'S  HEALTH  PLAN
 NETWORK.  THE COMMISSIONER SHALL DEVELOP THE UNIFORM FINANCIAL LIABILITY
 FORM WITHIN SIX MONTHS OF THE EFFECTIVE DATE OF A CHAPTER OF THE LAWS OF
 TWO  THOUSAND  NINETEEN THAT ADDED THIS SECTION, AND IT SHALL BE ADOPTED
 BY ALL HOSPITALS AND HEALTH CARE PROFESSIONALS WITHIN THIRTY DAYS OF THE
 ISSUANCE OF SUCH FORM BY THE COMMISSIONER.
   § 2. Subdivisions 9 and 9-a of section 2807-k  of  the  public  health
 law,  subdivision  9 as amended by section 17 of part B of chapter 60 of
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD15965-02-0

 S. 8076                             2
 
 the laws of 2014, subdivision 9-a as added by section 39-a of part A  of
 chapter  57  of the laws of 2006 and paragraph (k) of subdivision 9-a as
 added by section 43 of part B of chapter 58 of the  laws  of  2008,  are
 amended to read as follows:
   9.  In order for a general hospital to participate in the distribution
 of funds from the pool, the general hospital must ONLY implement minimum
 collection policies and procedures [approved] PROVIDED  by  the  commis-
 sioner.
   9-a.  (a)  As  a  condition  for  participation  in pool distributions
 authorized pursuant to this section  and  section  twenty-eight  hundred
 seven-w  of  this  article  for  periods on and after January first, two
 thousand nine, general hospitals shall, effective  for  periods  on  and
 after  January  first, two thousand [seven, establish] TWENTY-ONE, ADOPT
 AND IMPLEMENT THE UNIFORM financial [aid  policies  and  procedures,  in
 accordance  with  the  provisions  of  this subdivision] ASSISTANCE FORM
 POLICY, TO BE DEVELOPED AND ISSUED BY THE COMMISSIONER NO LATER THAN ONE
 HUNDRED EIGHTY DAYS AFTER THE EFFECTIVE DATE OF A CHAPTER OF THE LAWS OF
 TWO THOUSAND NINETEEN THAT AMENDED THIS SUBDIVISION. NO LATER THAN THIR-
 TY DAYS OF THE ISSUANCE OF THE UNIFORM  FINANCIAL  ASSISTANCE  FORM  AND
 POLICY,  GENERAL  HOSPITALS  SHALL  IMPLEMENT  SUCH FORM AND POLICY, for
 reducing HOSPITAL charges AND CHARGES FOR PHYSICIANS  WHO  WORK  IN  THE
 HOSPITAL  otherwise  applicable to low-income individuals without health
 insurance, or who have [exhausted  their]  health  insurance  [benefits]
 THAT  DOES  NOT  COVER  OR  LIMITS  COVERAGE OF THE SERVICE, and who can
 demonstrate an inability to pay full charges, and also,  at  the  hospi-
 tal's  discretion, for reducing or discounting the collection of co-pays
 and deductible payments from those individuals who  can  demonstrate  an
 inability to pay such amounts. IMMIGRATION STATUS SHALL NOT BE AN ELIGI-
 BILITY  CRITERION.  GENERAL  HOSPITALS  SHALL  USE THE NEW YORK STATE OF
 HEALTH MARKETPLACE  ELIGIBILITY  DETERMINATION  PAGE  TO  ESTABLISH  THE
 PATIENT'S HOUSEHOLD INCOME AND RESIDENCY IN LIEU OF THE FINANCIAL APPLI-
 CATION  FORM,  PROVIDED  THEY HAVE SECURED THE CONSENT OF THE PATIENT. A
 GENERAL HOSPITAL SHALL NOT REQUIRE  A  PATIENT  TO  APPLY  FOR  COVERAGE
 THROUGH  THE  NEW  YORK  STATE OF HEALTH MARKETPLACE IN ORDER TO RECEIVE
 CARE OR FINANCIAL ASSISTANCE.
   (b) Such reductions from charges for uninsured patients  with  incomes
 below at least [three] FOUR hundred percent of the federal poverty level
 shall  result  in a charge to such individuals that does not exceed [the
 greater of] the amount that would have been paid for the  same  services
 [by  the  "highest volume payor" for such general hospital as defined in
 subparagraph (v) of this paragraph, or for services provided pursuant to
 title XVIII of the  federal  social  security  act  (medicare),  or  for
 services]  provided pursuant to title XIX of the federal social security
 act (medicaid), and provided further that such amounts shall be adjusted
 according to income level as follows:
   (i) For patients with incomes at or below at least [one]  TWO  hundred
 percent of the federal poverty level, the hospital shall collect no more
 than a nominal payment amount, consistent with guidelines established by
 the commissioner;
   (ii)  For patients with incomes between at least [one] TWO hundred one
 percent and [one] FOUR hundred [fifty] percent of  the  federal  poverty
 level,  the  hospital  shall  collect no more than the amount identified
 after application of a proportional sliding  fee  schedule  under  which
 patients  with  lower incomes shall pay the lowest amount. Such schedule
 shall provide that the amount the hospital may collect for such patients
 increases from the nominal amount described in subparagraph (i) of  this

 S. 8076                             3
 
 paragraph in equal increments as the income of the patient increases, up
 to  a  maximum of twenty percent of the greater of the amount that would
 have been paid for the same services [by the "highest volume payor"  for
 such general hospital, as defined in subparagraph (v) of this paragraph,
 or  for  services provided pursuant to title XVIII of the federal social
 security act (medicare) or for services] provided pursuant to title  XIX
 of the federal social security act (medicaid);
   (iii)  [For  patients with incomes between at least one hundred fifty-
 one percent and two hundred fifty percent of the federal poverty  level,
 the  hospital  shall  collect  no  more than the amount identified after
 application of a proportional sliding fee schedule under which  patients
 with  lower  income  shall  pay  the lowest amounts. Such schedule shall
 provide that the amount the  hospital  may  collect  for  such  patients
 increases  from the twenty percent figure described in subparagraph (ii)
 of this paragraph in equal increments  as  the  income  of  the  patient
 increases,  up to a maximum of the greater of the amount that would have
 been paid for the same services by the "highest volume payor"  for  such
 general  hospital,  as defined in subparagraph (v) of this paragraph, or
 for services provided pursuant to title  XVIII  of  the  federal  social
 security  act  (medicare) or for services provided pursuant to title XIX
 of the federal social security act (medicaid); and
   (iv)] For patients with incomes [between at least two  hundred  fifty-
 one  percent  and  three  hundred] ABOVE FOUR HUNDRED ONE percent of the
 federal poverty level, the hospital  shall  collect  no  more  than  the
 greater  of  the  amount that would have been paid for the same services
 [by the "highest volume payor" for such general hospital as  defined  in
 subparagraph (v) of this paragraph, or for services provided pursuant to
 title  XVIII  of  the  federal  social  security  act (medicare), or for
 services] provided pursuant to title XIX of the federal social  security
 act (medicaid)[.]; AND
   [(v)  For the purposes of this paragraph, "highest volume payor" shall
 mean the insurer, corporation or  organization  licensed,  organized  or
 certified  pursuant  to  article thirty-two, forty-two or forty-three of
 the insurance law or article forty-four of this chapter, or other third-
 party payor, which has  a  contract  or  agreement  to  pay  claims  for
 services  provided  by  the  general  hospital  and incurred the highest
 volume of claims in the previous calendar year.
   (vi) A hospital may implement policies and procedures to  permit,  but
 not  require, consideration on a case-by-case basis of exceptions to the
 requirements described in subparagraphs (i) and (ii) of  this  paragraph
 based upon the existence of significant assets owned by the patient that
 should  be  taken  into  account  in determining the appropriate payment
 amount for that patient's care, provided, however,  that  such  proposed
 policies  and  procedures  shall  be  subject  to  the  prior review and
 approval of the commissioner and, if approved, shall be included in  the
 hospital's  financial  assistance  policy  established  pursuant to this
 section, and provided further that, if such  approval  is  granted,  the
 maximum amount that may be collected shall not exceed the greater of the
 amount  that  would have been paid for the same services by the "highest
 volume payor" for such general hospital as defined in  subparagraph  (v)
 of  this  paragraph, or for services provided pursuant to title XVIII of
 the federal social security act (medicare),  or  for  services  provided
 pursuant  to title XIX of the federal social security act (medicaid). In
 the event that a general hospital reviews a patient's assets  in  deter-
 mining  payment  adjustments  such  policies  and  procedures  shall not
 consider as assets a patient's primary residence, assets held in a  tax-

 S. 8076                             4

 deferred  or  comparable  retirement  savings  account,  college savings
 accounts, or cars used  regularly  by  a  patient  or  immediate  family
 members.
   (vii)]  (IV)  Nothing  in this paragraph shall be construed to limit a
 hospital's  ability  to  establish  patient  eligibility   for   payment
 discounts  at income levels higher than those specified herein and/or to
 provide greater payment  discounts  for  eligible  patients  than  those
 required by this paragraph.
   (c)  [Such  policies and procedures shall be clear, understandable, in
 writing and publicly available in summary form and  each]  EACH  general
 hospital  participating  in  the pool shall ensure that every patient is
 made aware of the existence of such [policies  and  procedures]  UNIFORM
 FINANCIAL  ASSISTANCE  FORM  AND  POLICY  and  is  provided, in a timely
 manner, with a [summary] COPY of such [policies and procedures] FORM AND
 POLICY upon request. [Any summary provided to patients shall, at a mini-
 mum, include specific information as to income levels used to  determine
 eligibility for assistance, a description of the primary service area of
 the  hospital  and  the  means  of applying for assistance. For general]
 GENERAL hospitals with twenty-four  hour  emergency  departments,  [such
 policies  and  procedures]  shall  require  the notification of patients
 during the intake and  registration  process,  through  the  conspicuous
 posting of language-appropriate information in the general hospital, and
 information  on  bills  and  statements sent to patients, that financial
 [aid] ASSISTANCE may be available  to  qualified  patients  and  how  to
 obtain  further information. For specialty hospitals without twenty-four
 hour emergency departments, such notification shall take  place  through
 written  materials  provided to patients during the intake and registra-
 tion process prior to the provision  of  any  health  care  services  or
 procedures,  and  through  information  on  bills and statements sent to
 patients, that financial [aid] ASSISTANCE may be available to  qualified
 patients  and  how to obtain further information. [Application materials
 shall include a notice to patients that upon submission of  a  completed
 application, including any information or documentation needed to deter-
 mine  the  patient's  eligibility  pursuant  to the hospital's financial
 assistance policy, the patient may disregard any bills until the  hospi-
 tal  has  rendered a decision on the application in accordance with this
 paragraph] GENERAL HOSPITALS SHALL POST THE UNIFORM FINANCIAL ASSISTANCE
 APPLICATION FORM AND POLICY IN A CONSPICUOUS  LOCATION  ON  THE  GENERAL
 HOSPITAL'S  WEBSITE.  THE  COMMISSIONER  SHALL LIKEWISE POST THE UNIFORM
 FINANCIAL ASSISTANCE  FORM  AND  POLICY  ON  THE  DEPARTMENT'S  HOSPITAL
 PROFILE PAGE RELATED TO THE GENERAL HOSPITAL'S OR ANY SUCCESSOR WEBSITE.
   (d)  THE  COMMISSIONER  SHALL PROVIDE APPLICATION MATERIALS TO GENERAL
 HOSPITALS, INCLUDING THE UNIFORM FINANCIAL ASSISTANCE  APPLICATION  FORM
 AND  POLICY.  THESE  APPLICATION  MATERIALS  SHALL  INCLUDE  A NOTICE TO
 PATIENTS THAT UPON SUBMISSION  OF  A  COMPLETED  APPLICATION  FORM,  THE
 PATIENT  MAY DISREGARD ANY BILLS UNTIL THE GENERAL HOSPITAL HAS RENDERED
 A DECISION ON THE APPLICATION IN ACCORDANCE  WITH  THIS  PARAGRAPH.  THE
 APPLICATION  MATERIALS  SHALL INCLUDE SPECIFIC INFORMATION AS THE INCOME
 LEVELS  USED  TO  DETERMINE  ELIGIBILITY  FOR  FINANCIAL  ASSISTANCE,  A
 DESCRIPTION OF THE PRIMARY SERVICE AREA OF THE HOSPITAL AND THE MEANS TO
 APPLY  FOR ASSISTANCE. Such policies and procedures shall include clear,
 objective criteria for determining a patient's ability to  pay  and  for
 providing  such adjustments to payment requirements as are necessary. In
 addition to adjustment mechanisms such  as  sliding  fee  schedules  and
 discounts  to  fixed  standards, such policies and procedures shall also
 provide for the use of installment plans for the payment of  outstanding

 S. 8076                             5
 
 balances by patients pursuant to the provisions of the hospital's finan-
 cial  assistance policy. The monthly payment under such a plan shall not
 exceed [ten] FIVE percent of the gross monthly income of  the  patient[,
 provided,  however,  that  if patient assets are considered under such a
 policy, then patient assets which are not excluded  assets  pursuant  to
 subparagraph (vi) of paragraph (b) of this subdivision may be considered
 in  addition  to  the  limit  on monthly payments]. The rate of interest
 charged to the patient on the unpaid balance, if any, shall  not  exceed
 the  [rate  for  a ninety-day security] FEDERAL FUNDS RATE issued by the
 United States Department of Treasury[, plus  .5  percent]  and  no  plan
 shall include an accelerator or similar clause under which a higher rate
 of  interest  is  triggered upon a missed payment. [If such policies and
 procedures] THE POLICY SHALL NOT include  a  requirement  of  a  deposit
 prior  to  non-emergent, medically-necessary care[, such deposit must be
 included as part of any financial aid consideration]. Such policies  and
 procedures shall be applied consistently to all eligible patients.
   (e)  Such  policies  and procedures shall permit patients to apply for
 assistance within at least [ninety] TWO HUNDRED FORTY days of  the  date
 of discharge or date of service and provide at least [twenty] SIXTY days
 for patients to submit a completed application. Such policies and proce-
 dures  may  require  that  patients  seeking payment adjustments provide
 [appropriate] THE FOLLOWING financial information and  documentation  in
 support  of their application[, provided, however, that such application
 process shall not be unduly burdensome or complex] THAT ARE USED BY  THE
 NEW  YORK  STATE  OF  HEALTH  MARKETPLACE: PAY CHECKS OR PAY STUBS; RENT
 RECEIPTS;  A  LETTER  FROM  THE  PATIENT'S  EMPLOYER  ATTESTING  TO  THE
 PATIENT'S  GROSS  INCOME;  OR, IF NONE OF THE AFOREMENTIONED INFORMATION
 AND DOCUMENTATION ARE  AVAILABLE,  A  WRITTEN  SELF-ATTESTATION  OF  THE
 PATIENT'S INCOME. General hospitals shall, upon request, assist patients
 in  understanding the hospital's policies and procedures and in applying
 for payment  adjustments.  [Application  forms  shall  be  printed]  THE
 COMMISSIONER  SHALL  TRANSLATE THE FINANCIAL ASSISTANCE APPLICATION FORM
 AND POLICY INTO THE "PRIMARY LANGUAGES" OF EACH GENERAL  HOSPITAL.  EACH
 GENERAL  HOSPITAL SHALL PRINT AND POST THESE MATERIALS TO ITS WEBSITE in
 the "primary languages" of patients served by the general hospital.  For
 the  purposes  of  this paragraph, "primary languages" shall include any
 language that is either (i) used to communicate, during  at  least  five
 percent of patient visits in a year, by patients who cannot speak, read,
 write  or  understand  the  English language at the level of proficiency
 necessary for effective communication with  health  care  providers,  or
 (ii) spoken by non-English speaking individuals comprising more than one
 percent  of  the primary hospital service area population, as calculated
 using demographic information available from the United States Bureau of
 the Census, supplemented by data from school systems. Decisions  regard-
 ing  such  applications shall be made within thirty days of receipt of a
 completed application. Such policies and procedures shall  require  that
 the  hospital  issue  any denial/approval of such application in writing
 with information on how to appeal  the  denial  and  shall  require  the
 hospital  to  establish  an appeals process under which it will evaluate
 the denial of an application. [Nothing  in  this  subdivision  shall  be
 interpreted  as  prohibiting  a hospital from making the availability of
 financial assistance contingent upon  the  patient  first  applying  for
 coverage under title XIX of the social security act (medicaid) or anoth-
 er  insurance  program  if, in the judgment of the hospital, the patient
 may be eligible for medicaid or another insurance program, and upon  the
 patient's  cooperation  in following the hospital's financial assistance

 S. 8076                             6

 application requirements, including the provision of information  needed
 to  make a determination on the patient's application in accordance with
 the hospital's financial assistance policy.]
   (f)  Such  policies  and  procedures  shall provide that patients with
 incomes below [three] FOUR hundred percent of the federal poverty  level
 are  deemed  presumptively  eligible  for  payment adjustments and shall
 conform to the requirements set forth in paragraph (b) of this  subdivi-
 sion,  provided,  however,  that  nothing  in  this subdivision shall be
 interpreted as precluding hospitals from extending such payment  adjust-
 ments  to  other  patients, either generally or on a case-by-case basis.
 Such [policies and procedures]  POLICY  shall  provide  financial  [aid]
 ASSISTANCE  for  emergency hospital services, including emergency trans-
 fers pursuant to the federal  emergency  medical  treatment  and  active
 labor  act (42 USC 1395dd), to patients who reside in New York state and
 for medically necessary hospital services for patients who reside in the
 hospital's primary service area  as  determined  according  to  criteria
 established  by  the  commissioner.  In  developing  such  criteria, the
 commissioner shall consult with representatives of the  hospital  indus-
 try,  health  care consumer advocates and local public health officials.
 Such criteria shall be made available to the public no less than  thirty
 days prior to the date of implementation and shall, at a minimum:
   (i)  prohibit  a  hospital  from  developing  or  altering its primary
 service area in a manner designed to avoid medically underserved  commu-
 nities or communities with high percentages of uninsured residents;
   (ii)  ensure that every geographic area of the state is included in at
 least one general hospital's  primary  service  area  so  that  eligible
 patients may access care and financial assistance; and
   (iii)  require the hospital to notify the commissioner upon making any
 change to its primary service area, and to include a description of  its
 primary  service  area  in  the  hospital's annual implementation report
 filed pursuant to subdivision  three  of  section  twenty-eight  hundred
 three-l of this article.
   (g)  Nothing  in  this  subdivision shall be interpreted as precluding
 hospitals from extending payment  adjustments  for  medically  necessary
 non-emergency  hospital  services  to patients outside of the hospital's
 primary service area. For patients determined to be eligible for  finan-
 cial  [aid]  ASSISTANCE  under  the  terms of [a hospital's] THE UNIFORM
 financial [aid] ASSISTANCE policy, such [policies and procedures] POLICY
 shall  prohibit  any  limitations  on  financial  [aid]  ASSISTANCE  for
 services  based  on  the  medical condition of the applicant, other than
 typical limitations or exclusions based  on  medical  necessity  or  the
 clinical or therapeutic benefit of a procedure or treatment.
   (h)  Such  policies and procedures shall not permit the SECURANCE OF A
 LIEN OR forced sale or foreclosure of a patient's primary  residence  in
 order  to  collect  an  outstanding  medical  bill and shall require the
 hospital to refrain from sending an account to collection if the patient
 has submitted a completed application for financial [aid, including  any
 required supporting documentation] ASSISTANCE, while the hospital deter-
 mines  the patient's eligibility for such [aid] ASSISTANCE.  Such [poli-
 cies and procedures] POLICY  shall  provide  for  written  notification,
 which  shall  include  notification  on a patient bill, to a patient not
 less than thirty days prior to the referral of debts for collection  and
 shall  require  that the collection agency obtain the hospital's written
 consent prior to commencing a legal action. Such  [policies  and  proce-
 dures] POLICY shall require all general hospital staff who interact with
 patients  or  have  responsibility  for  billing  and  collections to be

 S. 8076                             7

 trained in such [policies and procedures] POLICY, and require the imple-
 mentation of a mechanism for the general hospital to measure its compli-
 ance with [such policies and procedures] THE POLICY. Such [policies  and
 procedures]  POLICY  shall  require  that  any  collection  agency under
 contract with a general hospital for the collection of debts follow  the
 [hospital's]  UNIFORM  financial  assistance policy, including providing
 information to patients on how to apply for financial  assistance  where
 appropriate.  Such  [policies  and  procedures]  POLICY  shall  prohibit
 collections from a patient who is determined to be eligible for  medical
 assistance  pursuant  to title XIX of the federal social security act at
 the time services were rendered and for which services medicaid  payment
 is available.
   (i) Reports required to be submitted to the department by each general
 hospital  as  a  condition  for  participation  in  the pools, and which
 contain, in accordance with applicable regulations, a certification from
 an independent  certified  public  accountant  or  independent  licensed
 public accountant or an attestation from a senior official of the hospi-
 tal  that the hospital is in compliance with conditions of participation
 in the pools, shall also contain, for reporting  periods  on  and  after
 January first, two thousand seven:
   (i)  a  report  on  hospital costs incurred and uncollected amounts in
 providing services to  [eligible]  patients  [without  insurance]  FOUND
 ELIGIBLE FOR FINANCIAL ASSISTANCE, including the amount of care provided
 for a nominal payment amount, during the period covered by the report;
   (ii)  hospital  costs incurred and uncollected amounts for deductibles
 and coinsurance for eligible patients with insurance or other third-par-
 ty payor coverage;
   (iii) the number of patients, organized  according  to  United  States
 postal  service  zip code, who applied for financial assistance pursuant
 to the [hospital's] UNIFORM financial assistance policy, and the number,
 organized according to United States  postal  service  zip  code,  whose
 applications were approved and whose applications were denied;
   (iv) the reimbursement received for indigent care from the pool estab-
 lished pursuant to this section;
   (v)  the  amount  of  funds  that have been expended on [charity care]
 FINANCIAL ASSISTANCE from charitable bequests made or trusts established
 for the purpose of providing financial assistance to  patients  who  are
 eligible in accordance with the terms of such bequests or trusts;
   (vi)  for  hospitals located in social services districts in which the
 district allows hospitals to assist patients with such applications, the
 number of applications for eligibility under title  XIX  of  the  social
 security  act (medicaid) that the hospital assisted patients in complet-
 ing and the number denied and approved;
   (vii) the hospital's financial losses resulting from services provided
 under medicaid; and
   (viii) the number of REFERRALS TO COLLECTION AGENTS OR OUTSIDE  VENDOR
 COURT CASES AND liens placed on [the primary] ANY residences of patients
 through the collection process used by a hospital.
   (j) [Within ninety days of the effective date of this subdivision each
 hospital  shall submit to the commissioner a written report on its poli-
 cies and procedures for financial assistance to patients which are  used
 by  the  hospital on the effective date of this subdivision. Such report
 shall include copies of its policies and procedures, including  material
 which  is  distributed  to patients, and a description of the hospital's
 financial aid policies and procedures. Such  description  shall  include
 the  income levels of patients on which eligibility is based, the finan-

 S. 8076                             8

 cial aid eligible patients receive and the  means  of  calculating  such
 aid,  and  the  service  area, if any, used by the hospital to determine
 eligibility] THE COMMISSIONER SHALL INCLUDE  THE  DATA  COLLECTED  UNDER
 PARAGRAPH (I) OF THIS SUBDIVISION IN REGULAR AUDITS OF THE ANNUAL GENER-
 AL HOSPITAL INSTITUTIONAL COST REPORT.
   (k)  In  the event it is determined by the commissioner that the state
 will be unable to secure all necessary federal approvals to include,  as
 part  of  the  state's  approved  state plan under title nineteen of the
 federal social security act, a requirement[, as set forth  in  paragraph
 one  of  this  subdivision,]  that compliance with this subdivision is a
 condition of participation in pool distributions authorized pursuant  to
 this  section  and section twenty-eight hundred seven-w of this article,
 then such condition of participation shall be deemed null and void  and,
 notwithstanding  section  twelve of this chapter, failure to comply with
 the provisions of this subdivision by a hospital on and after  the  date
 of such determination shall make such hospital liable for a civil penal-
 ty not to exceed ten thousand dollars for each such violation. The impo-
 sition  of  such  civil  penalties shall be subject to the provisions of
 section twelve-a of this chapter.
   § 3. Subdivision 14 of section 2807-k of  the  public  health  law  is
 REPEALED  and subdivisions 15, 16 and 17 are renumbered subdivisions 14,
 15 and 16.
   § 4. Paragraphs 1 and 2 of subsection (a) of section 605 of the finan-
 cial services law, as amended by chapter 377 of the laws  of  2019,  are
 amended to read as follows:
   (1)  When  a  health  care plan receives a bill for emergency services
 from a non-participating physician or hospital,  including  a  bill  for
 inpatient services which follow an emergency room visit, the health care
 plan  shall pay an amount that it determines is reasonable for the emer-
 gency services, INCLUDING INPATIENT SERVICES WHICH FOLLOW  AN  EMERGENCY
 ROOM  VISIT, rendered by the non-participating physician or hospital, in
 accordance with section three thousand two hundred twenty-four-a of  the
 insurance  law,  except  for  the  insured's  co-payment, coinsurance or
 deductible, if any, and shall ensure that the  insured  shall  incur  no
 greater  out-of-pocket costs for the emergency services, INCLUDING INPA-
 TIENT SERVICES WHICH FOLLOW AN EMERGENCY ROOM VISIT,  than  the  insured
 would have incurred with a participating physician or hospital [pursuant
 to subsection (c) of section three thousand two hundred forty-one of the
 insurance  law].  If  an insured assigns benefits to a non-participating
 PHYSICIAN OR hospital in relation to emergency services, INCLUDING INPA-
 TIENT SERVICES WHICH FOLLOW AN EMERGENCY ROOM VISIT,  provided  by  such
 non-participating PHYSICIAN OR hospital, the non-participating PHYSICIAN
 OR  hospital  may bill the health care plan for the [emergency] services
 rendered. Upon receipt of the bill, the health care plan shall  pay  the
 non-participating  PHYSICIAN  OR  hospital the amount prescribed by this
 section and any subsequent amount determined to be owed to the  hospital
 in  relation  to  the  emergency  services provided, INCLUDING INPATIENT
 SERVICES WHICH FOLLOW AN EMERGENCY ROOM VISIT.
   (2) A non-participating physician or hospital or a  health  care  plan
 may  submit a dispute regarding a fee or payment for emergency services,
 INCLUDING INPATIENT SERVICES WHICH FOLLOW AN EMERGENCY ROOM  VISIT,  for
 review to an independent dispute resolution entity.
   §  5.  Paragraph  1  of subsection (b) of section 605 of the financial
 services law, as amended by chapter 377 of the laws of 2019, is  amended
 to read as follows:

 S. 8076                             9
 
   (1)  A  patient  that is not an insured or the patient's physician may
 submit a dispute regarding a fee for emergency services, INCLUDING INPA-
 TIENT SERVICES WHICH FOLLOW AN EMERGENCY ROOM VISIT, for  review  to  an
 independent  dispute  resolution entity upon approval of the superinten-
 dent.
   § 6. Section 606 of the financial services law, as added by section 26
 of  part  H  of  chapter  60  of the laws of 2014, is amended to read as
 follows:
   § 606. Hold harmless and assignment of benefits [for  surprise  bills]
 for  insureds.  (A) When an insured assigns benefits for a surprise bill
 in writing to a non-participating physician that knows  the  insured  is
 insured  under a health care plan, the non-participating physician shall
 not bill the insured except for any applicable copayment, coinsurance or
 deductible that would be owed if the insured  utilized  a  participating
 physician.
   (B) WHEN AN INSURED ASSIGNS BENEFITS FOR EMERGENCY SERVICES, INCLUDING
 INPATIENT SERVICES WHICH FOLLOW AN EMERGENCY ROOM VISIT, TO A NON-PARTI-
 CIPATING PHYSICIAN OR HOSPITAL THAT KNOWS THE INSURED IS INSURED UNDER A
 HEALTH  CARE PLAN, THE NON-PARTICIPATING PHYSICIAN OR HOSPITAL SHALL NOT
 BILL THE INSURED EXCEPT FOR ANY  APPLICABLE  COPAYMENT,  COINSURANCE  OR
 DEDUCTIBLE  THAT  WOULD  BE OWED IF THE INSURED UTILIZED A PARTICIPATING
 PHYSICIAN OR HOSPITAL.
   § 7. The civil practice law and rules  is  amended  by  adding  a  new
 section 213-d to read as follows:
   §  213-D. ACTIONS TO BE COMMENCED WITHIN THREE YEARS; MEDICAL DEBT. AN
 ACTION ON A MEDICAL DEBT BY A HOSPITAL LICENSED  UNDER  ARTICLE  TWENTY-
 EIGHT  OF THE PUBLIC HEALTH LAW OR A HEALTH CARE PROFESSIONAL AUTHORIZED
 UNDER TITLE EIGHT OF THE EDUCATION LAW SHALL BE COMMENCED  WITHIN  THREE
 YEARS OF TREATMENT.
   §  8.  Section 5004 of the civil practice law and rules, as amended by
 chapter 258 of the laws of 1981, is amended to read as follows:
   § 5004. Rate of interest. Interest shall be at the rate  of  nine  per
 centum  per  annum, except where otherwise provided by statute, PROVIDED
 THAT IN MEDICAL DEBT ACTIONS BY A HOSPITAL LICENSED UNDER ARTICLE  TWEN-
 TY-EIGHT  OF THE PUBLIC HEALTH LAW OR A HEALTH CARE PROFESSIONAL AUTHOR-
 IZED UNDER TITLE EIGHT OF THE EDUCATION LAW THE INTEREST RATE  SHALL  BE
 THREE PER CENTUM PER ANNUM.
   §  9.  Subsection (h) of section 603 of the financial services law, as
 added by section 26 of part H of chapter 60 of  the  laws  of  2014,  is
 amended to read as follows:
   (h)  "Surprise bill" means a bill for health care services, other than
 emergency services, received by:
   (1) an insured for services rendered by a non-participating  physician
 at  a  participating  hospital  or  ambulatory  surgical center, where a
 participating physician is unavailable or a non-participating  physician
 renders  services without the insured's knowledge, or unforeseen medical
 services arise at the  time  the  health  care  services  are  rendered;
 provided,  however,  that a surprise bill shall not mean a bill received
 for health care services when a participating physician is available and
 the insured has elected to  obtain  services  from  a  non-participating
 physician;
   (2)  an insured for services rendered by a non-participating provider,
 where the services were referred by a participating physician to a  non-
 participating  provider  without explicit written consent of the insured
 acknowledging that the participating physician is referring the  insured

 S. 8076                            10
 
 to  a  non-participating  provider  and  that the referral may result in
 costs not covered by the health care plan; [or]
   (3)  AN  INSURED FOR SERVICES RENDERED BY A NON-PARTICIPATING PROVIDER
 WHEN THE INSURED REASONABLY RELIED UPON AN  ORAL  OR  WRITTEN  STATEMENT
 THAT THE NON-PARTICIPATING PROVIDER WAS A PARTICIPATING PROVIDER MADE BY
 A HEALTH CARE PLAN, OR AGENT OR REPRESENTATIVE OF A HEALTH CARE PLAN, OR
 AS  SPECIFIED  IN THE HEALTH CARE PLAN PROVIDER LISTING OR DIRECTORY, OR
 PROVIDER INFORMATION ON THE HEALTH PLAN'S WEBSITE;
   (4) AN INSURED FOR SERVICES RENDERED BY A  NON-PARTICIPATING  PROVIDER
 WHEN  THE INSURED REASONABLY RELIED UPON A STATEMENT THAT THE NON-PARTI-
 CIPATING PROVIDER WAS A PARTICIPATING PROVIDER MADE BY THE  NON-PARTICI-
 PATING  PROVIDER,  OR  AGENT  OR REPRESENTATIVE OF THE NON-PARTICIPATING
 PROVIDER, OR AS SPECIFIED ON THE NON-PARTICIPATING  PROVIDER'S  WEBSITE;
 OR
   (5)  a patient who is not an insured for services rendered by a physi-
 cian at a hospital or ambulatory surgical center, where the patient  has
 not  timely received all of the disclosures required pursuant to section
 twenty-four of the public health law.
   § 10. This act shall take effect immediately.

2019-S8076A (ACTIVE) - Details

Current Committee:: Senate Health
Law Section:: Public Health Law
Laws Affected:: Add §2828, amd §2807-k, Pub Health L; amd §603, Fin Serv L; amd §5004, CPLR

2019-S8076A (ACTIVE) - Summary

2019-S8076A (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S8076A

SPONSOR: RIVERA
 
TITLE OF BILL:

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

 
PURPOSE:

To protect patients from medical debt by standardizing patient financial
liability forms and standardize and update hospital financial Assistance
policies and applications, clarifying that out of network bills incurred
by patients who relied upon an oral or written statement from a provider
or insurer that a provider was participating is a surprise bill for the
purposes of the independent dispute resolution process, and reducing
interest rates for medical debt.

 
SUMMARY OF PROVISIONS:

Section 1 would add a new Public Health Law § 2833 to standardize
patient financial liability forms to be used by all hospitals and health
care professionals.

Section 2 would amend Public Health Law § 2807-k to standardize and
update policies, applications, and appeal procedures related to hospital
financial assistance. It would improve public reporting of hospital
financial assistance data, increase the income limit for assistance,
consistent with the standards set forth in the Affordable Care Act, and
clarify that immigration status does not disqualify someone from eligi-
bility.

Section 3 would amend Civil Practice Law § 5004 to reduce the percentage
rate on medical debt judgements from the current 9% to the one year
United States treasury bill rate.

Section 4 would amend section 603 of the financial services law to
include out of network bills incurred by a patient who relied upon an
oral or written statement from a provider or insurer that a non-partici-
pating provider was a participating provider as a surprise bill and
eligible for the independent dispute resolution process.

Section 5 provides an effective date

 
JUSTIFICATION:

This legislation offers to clarify and simplify applying for financial
assistance at hospitals funded through the indigent care pool, protect
patients from medical debt, and update New York's landmark surprise
billing law to provide additional consumer protections for out of
network charges. It takes provisions from S 6757 of 2019, The Patient
Medical Debt Protection Act".

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 are sometimes unspecified, that do
not clearly indicate if a third party payer will reimburse, and for
which they cannot foreseeably budget. 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 in patient-friendly language would
adequately disclose to patients their financial responsibility in
advance and would comply with existing New York laws that protect
patients from unfair financial liability for medical care.

The lack of standardization in how hospitals implement the Hospital
Financial Assistance Law results in patients who should receive assist-
ance going without. The state's audits have repeatedly found that hospi-
tal-developed forms do not comply with the law, as have reports
conducted by consumer advocates. This bill would adopt a uniform hospi-
tal financial assistance form and policies that is consistent with
eligibility processes and guidelines already in use by the New York
State of Health Marketplace insurance exchange.

As part of the 2020-21 adopted state budget, the statute of limitation
for medical debts action was reduced from 6 to 3 years.  Unfortunately,
a provision in the Governor's proposed budget which would have reduced
interest rates for medical debt was not adopted.It is included in this
bill and would reduce medical debt from 9% to the one year US Treasury
rate.  For example, one report described a public court filing in which
a patient was charged $4,703 in interest on his $17,358 hospital bill.
See, "Discharged into Debt," Community Service Society of New York,
March 2020, page 9.

Finally, the bill would amend New York's 2014 surprise bill law to
protect patients from surprise bills 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.

 
LEGISLATIVE HISTORY:

New bill.

 
FISCAL:

None to state

 
EFFECTIVE DATE:
Immediately.

2019-S8076A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  8076--A
 
                             I N  S E N A T E
 
                              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:
 
   Section  1.  The  public health law is amended by adding a new section
 2828 to read as follows:
   § 2828. STANDARDIZED PATIENT FINANCIAL  LIABILITY  FORMS.  1.    EVERY
 HOSPITAL,  HEALTH  SYSTEM, HOSPITAL-BASED FACILITY, AFFILIATED PROVIDER,
 AND PROVIDER SHALL USE THE  UNIFORM  PATIENT  FINANCIAL  LIABILITY  FORM
 WHICH  SHALL  BE  DEVELOPED BY THE COMMISSIONER.   THE STANDARDIZED FORM
 SHALL DISCLOSE TO THE  PATIENT  WHETHER  SERVICES,  SUPPLIES  AND  DRUGS
 PROVIDED  TO  THE  PATIENT  ARE IN-NETWORK OR OUT-OF-NETWORK AND, TO THE
 EXTENT REASONABLY KNOWN BY THE HOSPITAL, HEALTH  SYSTEM,  HOSPITAL-BASED
 FACILITY,  AFFILIATED  PROVIDER, OR PROVIDER, WHETHER SERVICES, SUPPLIES
 AND DRUGS PROVIDED TO THE PATIENT ARE A COVERED BENEFIT FOR A THIRD-PAR-
 TY PAYER OF THE PATIENT, AND THE NATURE  AND  AMOUNT  OF  THE  PATIENT'S
 PROJECTED FINANCIAL LIABILITY.
   2.  A  PATIENT  SHALL  NOT  BE  FINANCIALLY  LIABLE  FOR ANY SERVICES,
 SUPPLIES OR DRUGS SUBJECT TO THIS SECTION THAT IS NOT CHARGED OR  BILLED
 IN ACCORDANCE WITH THIS SECTION.
   3.  THE  COMMISSIONER  SHALL  DEVELOP  AND ISSUE THE UNIFORM FINANCIAL
 LIABILITY FORM WITHIN SIX MONTHS OF THE EFFECTIVE DATE OF THIS  SECTION.
 THE  FORM  SHALL  BE  ADOPTED  AND  USED PURSUANT TO THIS SECTION BY ALL
 HOSPITALS, HEALTH SYSTEMS, HOSPITAL-BASED FACILITIES, AFFILIATED PROVID-
 ERS, AND PROVIDERS NOT LATER THAN SIXTY DAYS OF AFTER  THE  COMMISSIONER
 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
 
   4.  A  VIOLATION  OF  THIS  SECTION SHALL BE DEEMED A DECEPTIVE ACT OR
 PRACTICE SUBJECT TO ENFORCEMENT UNDER ARTICLE TWENTY-TWO-A OF THE GENER-
 AL BUSINESS LAW. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO  RESTRICT
 ANY  RIGHT  WHICH  ANY  PERSON  MAY  HAVE UNDER ANY OTHER STATUTE OR THE
 COMMON LAW.
   §  2.  Subdivisions  9  and 9-a of section 2807-k of the public health
 law, subdivision 9 as amended by section 17 of part B of chapter  60  of
 the  laws of 2014, subdivision 9-a as added by section 39-a of part A of
 chapter 57 of the laws of 2006 and paragraph (k) of subdivision  9-a  as
 added  by  section  43  of part B of chapter 58 of the laws of 2008, are
 amended to read as follows:
   9. In order for a general hospital to participate in the  distribution
 of  funds  from  the  pool,  the general hospital must implement minimum
 collection policies and procedures [approved] PROVIDED  by  the  commis-
 sioner.
   9-a.  (a)  As  a  condition  for  participation  in pool distributions
 authorized pursuant to this section  and  section  twenty-eight  hundred
 seven-w  of  this  article  for  periods on and after January first, two
 thousand nine, general hospitals shall, effective  for  periods  on  and
 after  January  first, two thousand [seven, establish] TWENTY-ONE, ADOPT
 AND IMPLEMENT THE UNIFORM financial [aid  policies  and  procedures,  in
 accordance  with the provisions of this subdivision] ASSISTANCE FORM AND
 POLICY, TO BE DEVELOPED AND ISSUED BY THE COMMISSIONER NO LATER THAN ONE
 HUNDRED EIGHTY DAYS AFTER THE EFFECTIVE DATE OF A CHAPTER OF THE LAWS OF
 TWO THOUSAND TWENTY THAT AMENDED THIS SUBDIVISION. NO LATER THAN  THIRTY
 DAYS  AFTER  THE  ISSUANCE  OF THE UNIFORM FINANCIAL ASSISTANCE FORM AND
 POLICY, GENERAL HOSPITALS SHALL IMPLEMENT  SUCH  FORM  AND  POLICY,  for
 reducing  HOSPITAL  charges  AND  CHARGES FOR PHYSICIANS WHO WORK IN THE
 HOSPITAL otherwise applicable to low-income individuals  without  health
 insurance,  or  who  have  [exhausted their] health insurance [benefits]
 THAT DOES NOT COVER OR LIMITS COVERAGE  OF  THE  SERVICE,  and  who  can
 demonstrate  an  inability  to pay full charges, and also, at the hospi-
 tal's discretion, for reducing or discounting the collection of  co-pays
 and  deductible  payments  from those individuals who can demonstrate an
 inability to pay such amounts. IMMIGRATION STATUS SHALL NOT BE AN ELIGI-
 BILITY CRITERION. GENERAL HOSPITALS SHALL USE  THE  NEW  YORK  STATE  OF
 HEALTH  MARKETPLACE  ELIGIBILITY  DETERMINATION  PAGE  TO  ESTABLISH THE
 PATIENT'S HOUSEHOLD INCOME AND RESIDENCY IN LIEU OF THE FINANCIAL APPLI-
 CATION FORM, PROVIDED THEY HAVE SECURED THE CONSENT OF  THE  PATIENT.  A
 GENERAL  HOSPITAL  SHALL  NOT  REQUIRE  A  PATIENT TO APPLY FOR COVERAGE
 THROUGH THE NEW YORK STATE OF HEALTH MARKETPLACE  IN  ORDER  TO  RECEIVE
 CARE OR FINANCIAL ASSISTANCE.
   (b)  Such  reductions from charges for uninsured patients with incomes
 below at least [three] FOUR hundred percent of the federal poverty level
 shall result in a charge to such individuals that does not  exceed  [the
 greater  of]  the amount that would have been paid for the same services
 [by the "highest volume payor" for such general hospital as  defined  in
 subparagraph (v) of this paragraph, or for services provided pursuant to
 title  XVIII  of  the  federal  social  security  act (medicare), or for
 services] provided pursuant to title XIX of the federal social  security
 act (medicaid), and provided further that such amounts shall be adjusted
 according to income level as follows:
   (i)  For  patients with incomes at or below at least [one] TWO hundred
 percent of the federal poverty level, the hospital shall collect no more
 than a nominal payment amount, consistent with guidelines established by
 the commissioner;

 S. 8076--A                          3

   (ii) For patients with incomes between at least [one] TWO hundred  one
 percent  and  [one]  FOUR hundred [fifty] percent of the federal poverty
 level, the hospital shall collect no more  than  the  amount  identified
 after  application  of  a  proportional sliding fee schedule under which
 patients  with  lower incomes shall pay the lowest amount. Such schedule
 shall provide that the amount the hospital may collect for such patients
 increases from the nominal amount described in subparagraph (i) of  this
 paragraph in equal increments as the income of the patient increases, up
 to  a  maximum of twenty percent of the greater of the amount that would
 have been paid for the same services [by the "highest volume payor"  for
 such general hospital, as defined in subparagraph (v) of this paragraph,
 or  for  services provided pursuant to title XVIII of the federal social
 security act (medicare) or for services] provided pursuant to title  XIX
 of the federal social security act (medicaid);
   (iii)  [For  patients with incomes between at least one hundred fifty-
 one percent and two hundred fifty percent of the federal poverty  level,
 the  hospital  shall  collect  no  more than the amount identified after
 application of a proportional sliding fee schedule under which  patients
 with  lower  income  shall  pay  the lowest amounts. Such schedule shall
 provide that the amount the  hospital  may  collect  for  such  patients
 increases  from the twenty percent figure described in subparagraph (ii)
 of this paragraph in equal increments  as  the  income  of  the  patient
 increases,  up to a maximum of the greater of the amount that would have
 been paid for the same services by the "highest volume payor"  for  such
 general  hospital,  as defined in subparagraph (v) of this paragraph, or
 for services provided pursuant to title  XVIII  of  the  federal  social
 security  act  (medicare) or for services provided pursuant to title XIX
 of the federal social security act (medicaid); and
   (iv)] For patients with incomes [between at least two  hundred  fifty-
 one  percent  and three hundred] AT OR ABOVE FOUR HUNDRED ONE percent of
 the federal poverty level, the hospital shall collect no more  than  the
 greater  of  the  amount that would have been paid for the same services
 [by the "highest volume payor" for such general hospital as  defined  in
 subparagraph (v) of this paragraph, or for services provided pursuant to
 title  XVIII  of  the  federal  social  security  act (medicare), or for
 services] provided pursuant to title XIX of the federal social  security
 act (medicaid)[.]; AND
   [(v)  For the purposes of this paragraph, "highest volume payor" shall
 mean the insurer, corporation or  organization  licensed,  organized  or
 certified  pursuant  to  article thirty-two, forty-two or forty-three of
 the insurance law or article forty-four of this chapter, or other third-
 party payor, which has  a  contract  or  agreement  to  pay  claims  for
 services  provided  by  the  general  hospital  and incurred the highest
 volume of claims in the previous calendar year.
   (vi) A hospital may implement policies and procedures to  permit,  but
 not  require, consideration on a case-by-case basis of exceptions to the
 requirements described in subparagraphs (i) and (ii) of  this  paragraph
 based upon the existence of significant assets owned by the patient that
 should  be  taken  into  account  in determining the appropriate payment
 amount for that patient's care, provided, however,  that  such  proposed
 policies  and  procedures  shall  be  subject  to  the  prior review and
 approval of the commissioner and, if approved, shall be included in  the
 hospital's  financial  assistance  policy  established  pursuant to this
 section, and provided further that, if such  approval  is  granted,  the
 maximum amount that may be collected shall not exceed the greater of the
 amount  that  would have been paid for the same services by the "highest

 S. 8076--A                          4

 volume payor" for such general hospital as defined in  subparagraph  (v)
 of  this  paragraph, or for services provided pursuant to title XVIII of
 the federal social security act (medicare),  or  for  services  provided
 pursuant  to title XIX of the federal social security act (medicaid). In
 the event that a general hospital reviews a patient's assets  in  deter-
 mining  payment  adjustments  such  policies  and  procedures  shall not
 consider as assets a patient's primary residence, assets held in a  tax-
 deferred  or  comparable  retirement  savings  account,  college savings
 accounts, or cars used  regularly  by  a  patient  or  immediate  family
 members.
   (vii)]  (IV)  Nothing  in this paragraph shall be construed to limit a
 hospital's  ability  to  establish  patient  eligibility   for   payment
 discounts  at income levels higher than those specified herein and/or to
 provide greater payment  discounts  for  eligible  patients  than  those
 required by this paragraph.
   (c)  [Such  policies and procedures shall be clear, understandable, in
 writing and publicly available in summary form and  each]  EACH  general
 hospital  participating  in  the pool shall ensure that every patient is
 made aware of the existence of such [policies  and  procedures]  UNIFORM
 FINANCIAL  ASSISTANCE  FORM  AND  POLICY  and  is  provided, in a timely
 manner, with a [summary] COPY of such [policies and procedures] FORM AND
 POLICY upon request. [Any summary provided to patients shall, at a mini-
 mum, include specific information as to income levels used to  determine
 eligibility for assistance, a description of the primary service area of
 the  hospital  and  the  means  of applying for assistance. For general]
 GENERAL hospitals with twenty-four  hour  emergency  departments,  [such
 policies  and  procedures]  shall  require  the notification of patients
 during the intake and  registration  process,  through  the  conspicuous
 posting of language-appropriate information in the general hospital, and
 information  on  bills  and  statements sent to patients, that financial
 [aid] ASSISTANCE may be available  to  qualified  patients  and  how  to
 obtain  further information. For specialty hospitals without twenty-four
 hour emergency departments, such notification shall take  place  through
 written  materials  provided to patients during the intake and registra-
 tion process prior to the provision  of  any  health  care  services  or
 procedures,  and  through  information  on  bills and statements sent to
 patients, that financial [aid] ASSISTANCE may be available to  qualified
 patients  and  how to obtain further information. [Application materials
 shall include a notice to patients that upon submission of  a  completed
 application, including any information or documentation needed to deter-
 mine  the  patient's  eligibility  pursuant  to the hospital's financial
 assistance policy, the patient may disregard any bills until the  hospi-
 tal  has  rendered a decision on the application in accordance with this
 paragraph] GENERAL HOSPITALS SHALL POST THE UNIFORM FINANCIAL ASSISTANCE
 APPLICATION FORM AND POLICY IN A CONSPICUOUS  LOCATION  ON  THE  GENERAL
 HOSPITAL'S  WEBSITE.  THE  COMMISSIONER  SHALL LIKEWISE POST THE UNIFORM
 FINANCIAL ASSISTANCE  FORM  AND  POLICY  ON  THE  DEPARTMENT'S  HOSPITAL
 PROFILE PAGE RELATED TO THE GENERAL HOSPITAL'S OR ANY SUCCESSOR WEBSITE.
   (d)  THE  COMMISSIONER  SHALL PROVIDE APPLICATION MATERIALS TO GENERAL
 HOSPITALS, INCLUDING THE UNIFORM FINANCIAL ASSISTANCE  APPLICATION  FORM
 AND  POLICY.  THESE  APPLICATION  MATERIALS  SHALL  INCLUDE  A NOTICE TO
 PATIENTS THAT UPON SUBMISSION  OF  A  COMPLETED  APPLICATION  FORM,  THE
 PATIENT  MAY DISREGARD ANY BILLS UNTIL THE GENERAL HOSPITAL HAS RENDERED
 A DECISION ON THE APPLICATION IN ACCORDANCE  WITH  THIS  PARAGRAPH.  THE
 APPLICATION  MATERIALS  SHALL INCLUDE SPECIFIC INFORMATION AS THE INCOME
 LEVELS  USED  TO  DETERMINE  ELIGIBILITY  FOR  FINANCIAL  ASSISTANCE,  A

 S. 8076--A                          5
 
 DESCRIPTION OF THE PRIMARY SERVICE AREA OF THE HOSPITAL AND THE MEANS TO
 APPLY  FOR ASSISTANCE. Such policies and procedures shall include clear,
 objective criteria for determining a patient's ability to  pay  and  for
 providing  such adjustments to payment requirements as are necessary. In
 addition to adjustment mechanisms such  as  sliding  fee  schedules  and
 discounts  to  fixed  standards, such policies and procedures shall also
 provide for the use of installment plans for the payment of  outstanding
 balances by patients pursuant to the provisions of the hospital's finan-
 cial  assistance policy. The monthly payment under such a plan shall not
 exceed [ten] FIVE percent of the gross monthly income of  the  patient[,
 provided,  however,  that  if patient assets are considered under such a
 policy, then patient assets which are not excluded  assets  pursuant  to
 subparagraph (vi) of paragraph (b) of this subdivision may be considered
 in  addition  to  the  limit  on monthly payments]. The rate of interest
 charged to the patient on the unpaid balance, if any, shall  not  exceed
 the  [rate  for  a ninety-day security] FEDERAL FUNDS RATE issued by the
 United States Department of Treasury[, plus  .5  percent]  and  no  plan
 shall include an accelerator or similar clause under which a higher rate
 of  interest  is  triggered upon a missed payment. [If such policies and
 procedures] THE POLICY SHALL NOT include  a  requirement  of  a  deposit
 prior to [non-emergent, medically-necessary] care[, such deposit must be
 included  as part of any financial aid consideration]. Such policies and
 procedures shall be applied consistently to all eligible patients.
   (e) Such policies and procedures shall permit patients  to  apply  for
 assistance  within  at least [ninety] TWO HUNDRED FORTY days of the date
 of discharge or date of service and provide at least [twenty] SIXTY days
 for patients to submit a completed application. Such policies and proce-
 dures may require that  patients  seeking  payment  adjustments  provide
 [appropriate]  THE  FOLLOWING financial information and documentation in
 support of their application[, provided, however, that such  application
 process  shall not be unduly burdensome or complex] THAT ARE USED BY THE
 NEW YORK STATE OF HEALTH MARKETPLACE: PAY  CHECKS  OR  PAY  STUBS;  RENT
 RECEIPTS;  A  LETTER  FROM  THE  PATIENT'S  EMPLOYER  ATTESTING  TO  THE
 PATIENT'S GROSS INCOME; OR, IF NONE OF  THE  AFOREMENTIONED  INFORMATION
 AND  DOCUMENTATION  ARE  AVAILABLE,  A  WRITTEN  SELF-ATTESTATION OF THE
 PATIENT'S INCOME. General hospitals shall, upon request, assist patients
 in understanding the hospital's policies and procedures and in  applying
 for  payment  adjustments.  [Application  forms  shall  be  printed] THE
 COMMISSIONER SHALL TRANSLATE THE FINANCIAL ASSISTANCE  APPLICATION  FORM
 AND  POLICY  INTO THE "PRIMARY LANGUAGES" OF EACH GENERAL HOSPITAL. EACH
 GENERAL HOSPITAL SHALL PRINT AND POST THESE MATERIALS TO ITS WEBSITE  in
 the  "primary languages" of patients served by the general hospital. For
 the purposes of this paragraph, "primary languages"  shall  include  any
 language  that  is  either (i) used to communicate, during at least five
 percent of patient visits in a year, by patients who cannot speak, read,
 write or understand the English language at  the  level  of  proficiency
 necessary  for  effective  communication  with health care providers, or
 (ii) spoken by non-English speaking individuals comprising more than one
 percent of the primary hospital service area population,  as  calculated
 using demographic information available from the United States Bureau of
 the  Census, supplemented by data from school systems. Decisions regard-
 ing such applications shall be made within thirty days of receipt  of  a
 completed  application.  Such policies and procedures shall require that
 the hospital issue any denial/approval of such  application  in  writing
 with  information  on  how  to  appeal  the denial and shall require the
 hospital to establish an appeals process under which  it  will  evaluate

 S. 8076--A                          6
 
 the  denial  of  an  application.  [Nothing in this subdivision shall be
 interpreted as prohibiting a hospital from making  the  availability  of
 financial  assistance  contingent  upon  the  patient first applying for
 coverage under title XIX of the social security act (medicaid) or anoth-
 er  insurance  program  if, in the judgment of the hospital, the patient
 may be eligible for medicaid or another insurance program, and upon  the
 patient's  cooperation  in following the hospital's financial assistance
 application requirements, including the provision of information  needed
 to  make a determination on the patient's application in accordance with
 the hospital's financial assistance policy.]
   (f) Such policies and procedures  shall  provide  that  patients  with
 incomes  below [three] FOUR hundred percent of the federal poverty level
 are deemed presumptively eligible  for  payment  adjustments  and  shall
 conform  to the requirements set forth in paragraph (b) of this subdivi-
 sion, provided, however, that  nothing  in  this  subdivision  shall  be
 interpreted  as precluding hospitals from extending such payment adjust-
 ments to other patients, either generally or on  a  case-by-case  basis.
 Such  [policies  and  procedures]  POLICY  shall provide financial [aid]
 ASSISTANCE for emergency hospital services, including  emergency  trans-
 fers  pursuant  to  the  federal  emergency medical treatment and active
 labor act (42 USC 1395dd), to patients who reside in New York state  and
 for medically necessary hospital services for patients who reside in the
 hospital's  primary  service  area  as  determined according to criteria
 established by  the  commissioner.  In  developing  such  criteria,  the
 commissioner  shall  consult with representatives of the hospital indus-
 try, health care consumer advocates and local public  health  officials.
 Such  criteria shall be made available to the public no less than thirty
 days prior to the date of implementation and shall, at a minimum:
   (i) prohibit a  hospital  from  developing  or  altering  its  primary
 service  area in a manner designed to avoid medically underserved commu-
 nities or communities with high percentages of uninsured residents;
   (ii) ensure that every geographic area of the state is included in  at
 least  one  general  hospital's  primary  service  area so that eligible
 patients may access care and financial assistance; and
   (iii) require the hospital to notify the commissioner upon making  any
 change  to its primary service area, and to include a description of its
 primary service area in  the  hospital's  annual  implementation  report
 filed  pursuant  to  subdivision  three  of section twenty-eight hundred
 three-l of this article.
   (g) Nothing in this subdivision shall  be  interpreted  as  precluding
 hospitals  from  extending  payment  adjustments for medically necessary
 non-emergency hospital services to patients outside  of  the  hospital's
 primary  service area. For patients determined to be eligible for finan-
 cial [aid] ASSISTANCE under the terms  of  [a  hospital's]  THE  UNIFORM
 financial [aid] ASSISTANCE policy, such [policies and procedures] POLICY
 shall  prohibit  any  limitations  on  financial  [aid]  ASSISTANCE  for
 services based on the medical condition of  the  applicant,  other  than
 typical  limitations  or  exclusions  based  on medical necessity or the
 clinical or therapeutic benefit of a procedure or treatment.
   (h) Such policies and procedures shall not permit the SECURANCE  OF  A
 LIEN  OR  forced sale or foreclosure of a patient's primary residence in
 order to collect an outstanding  medical  bill  and  shall  require  the
 hospital to refrain from sending an account to collection if the patient
 has  submitted a completed application for financial [aid, including any
 required supporting documentation] ASSISTANCE, while the hospital deter-
 mines the patient's eligibility for such [aid] ASSISTANCE.  Such  [poli-

 S. 8076--A                          7

 cies  and  procedures]  POLICY  shall  provide for written notification,
 which shall include notification on a patient bill,  to  a  patient  not
 less  than thirty days prior to the referral of debts for collection and
 shall  require  that the collection agency obtain the hospital's written
 consent prior to commencing a legal action. Such  [policies  and  proce-
 dures] POLICY shall require all general hospital staff who interact with
 patients  or  have  responsibility  for  billing  and  collections to be
 trained in such [policies and procedures] POLICY, and require the imple-
 mentation of a mechanism for the general hospital to measure its compli-
 ance with [such policies and procedures] THE POLICY. Such [policies  and
 procedures]  POLICY  shall  require  that  any  collection  agency under
 contract with a general hospital for the collection of debts follow  the
 [hospital's]  UNIFORM  financial  assistance policy, including providing
 information to patients on how to apply for financial  assistance  where
 appropriate.  Such  [policies  and  procedures]  POLICY  shall  prohibit
 collections from a patient who is determined to be eligible for  medical
 assistance  pursuant  to title XIX of the federal social security act at
 the time services were rendered and for which services medicaid  payment
 is available.
   (i) Reports required to be submitted to the department by each general
 hospital  as  a  condition  for  participation  in  the pools, and which
 contain, in accordance with applicable regulations, a certification from
 an independent  certified  public  accountant  or  independent  licensed
 public accountant or an attestation from a senior official of the hospi-
 tal  that the hospital is in compliance with conditions of participation
 in the pools, shall also contain, for reporting  periods  on  and  after
 January first, two thousand seven:
   (i)  a  report  on  hospital costs incurred and uncollected amounts in
 providing services to  [eligible]  patients  [without  insurance]  FOUND
 ELIGIBLE FOR FINANCIAL ASSISTANCE, including the amount of care provided
 for a nominal payment amount, during the period covered by the report;
   (ii)  hospital  costs incurred and uncollected amounts for deductibles
 and coinsurance for eligible patients with insurance or other third-par-
 ty payor coverage;
   (iii) the number of patients, organized  according  to  United  States
 postal  service  zip code, who applied for financial assistance pursuant
 to the [hospital's] UNIFORM financial assistance policy, and the number,
 organized according to United States  postal  service  zip  code,  whose
 applications were approved and whose applications were denied;
   (iv) the reimbursement received for indigent care from the pool estab-
 lished pursuant to this section;
   (v)  the  amount  of  funds  that have been expended on [charity care]
 FINANCIAL ASSISTANCE from charitable bequests made or trusts established
 for the purpose of providing financial assistance to  patients  who  are
 eligible in accordance with the terms of such bequests or trusts;
   (vi)  for  hospitals located in social services districts in which the
 district allows hospitals to assist patients with such applications, the
 number of applications for eligibility under title  XIX  of  the  social
 security  act (medicaid) that the hospital assisted patients in complet-
 ing and the number denied and approved;
   (vii) the hospital's financial losses resulting from services provided
 under medicaid; and
   (viii) the number of REFERRALS TO COLLECTION AGENTS OR OUTSIDE  VENDOR
 COURT CASES AND liens placed on [the primary] ANY residences of patients
 through the collection process used by a hospital.

 S. 8076--A                          8
 
   (j) [Within ninety days of the effective date of this subdivision each
 hospital  shall submit to the commissioner a written report on its poli-
 cies and procedures for financial assistance to patients which are  used
 by  the  hospital on the effective date of this subdivision. Such report
 shall  include copies of its policies and procedures, including material
 which is distributed to patients, and a description  of  the  hospital's
 financial  aid  policies  and procedures. Such description shall include
 the income levels of patients on which eligibility is based, the  finan-
 cial  aid  eligible  patients  receive and the means of calculating such
 aid, and the service area, if any, used by  the  hospital  to  determine
 eligibility]  THE  COMMISSIONER  SHALL  INCLUDE THE DATA COLLECTED UNDER
 PARAGRAPH (I) OF THIS SUBDIVISION IN REGULAR AUDITS OF THE ANNUAL GENER-
 AL HOSPITAL INSTITUTIONAL COST REPORT.
   (k) In the event it is determined by the commissioner that  the  state
 will  be unable to secure all necessary federal approvals to include, as
 part of the state's approved state plan  under  title  nineteen  of  the
 federal  social  security act, a requirement[, as set forth in paragraph
 one of this subdivision,] that compliance with  this  subdivision  is  a
 condition  of participation in pool distributions authorized pursuant to
 this section and section twenty-eight hundred seven-w of  this  article,
 then  such condition of participation shall be deemed null and void and,
 notwithstanding section twelve of this chapter, failure to  comply  with
 the  provisions  of this subdivision by a hospital on and after the date
 of such determination shall make such hospital liable for a civil penal-
 ty not to exceed ten thousand dollars for each such violation. The impo-
 sition of such civil penalties shall be subject  to  the  provisions  of
 section twelve-a of this chapter.
   §  3.  Section 5004 of the civil practice law and rules, as amended by
 chapter 258 of the laws of 1981, is amended to read as follows:
   § 5004. Rate of interest. Interest shall be at the rate  of  nine  per
 centum  per  annum, except where otherwise provided by statute, PROVIDED
 THAT IN MEDICAL DEBT ACTIONS BY A HOSPITAL LICENSED UNDER ARTICLE  TWEN-
 TY-EIGHT  OF THE PUBLIC HEALTH LAW OR A HEALTH CARE PROFESSIONAL AUTHOR-
 IZED UNDER TITLE EIGHT OF THE EDUCATION LAW THE INTEREST RATE  SHALL  BE
 CALCULATED   AT  THE ONE-YEAR  UNITED  STATES  TREASURY  BILL  RATE. FOR
 THE PURPOSES OF THIS SECTION, THE "ONE-YEAR UNITED STATES TREASURY  BILL
 RATE"  MEANS  THE  WEEKLY  AVERAGE  ONE-YEAR  CONSTANT MATURITY TREASURY
 YIELD, AS  PUBLISHED  BY THE  BOARD  OF GOVERNORS OF THE FEDERAL RESERVE
 SYSTEM, FOR THE CALENDAR WEEK PRECEDING THE DATE OF  THE  ENTRY  OF  THE
 JUDGMENT  AWARDING   DAMAGES. PROVIDED  HOWEVER, THAT THIS SECTION SHALL
 NOT APPLY TO ANY PROVISION OF THE TAX LAW WHICH PROVIDES FOR THE  ANNUAL
 RATE OF INTEREST TO BE PAID ON A JUDGMENT OR ACCRUED CLAIM.
   §  4.  Subsection (h) of section 603 of the financial services law, as
 added by section 26 of part H of chapter 60 of  the  laws  of  2014,  is
 amended to read as follows:
   (h)  "Surprise bill" means a bill for health care services, other than
 emergency services, received by:
   (1) an insured for services rendered by a non-participating  physician
 at  a  participating  hospital  or  ambulatory  surgical center, where a
 participating physician is unavailable or a non-participating  physician
 renders  services without the insured's knowledge, or unforeseen medical
 services arise at the  time  the  health  care  services  are  rendered;
 provided,  however,  that a surprise bill shall not mean a bill received
 for health care services when a participating physician is available and
 the insured has elected to  obtain  services  from  a  non-participating
 physician;

 S. 8076--A                          9
 
   (2)  an insured for services rendered by a non-participating provider,
 where the services were referred by a participating physician to a  non-
 participating  provider  without explicit written consent of the insured
 acknowledging that the participating physician is referring the  insured
 to  a  non-participating  provider  and  that the referral may result in
 costs not covered by the health care plan; [or]
   (3) AN INSURED FOR SERVICES RENDERED BY A  NON-PARTICIPATING  PROVIDER
 WHEN  THE  INSURED  REASONABLY  RELIED UPON AN ORAL OR WRITTEN STATEMENT
 THAT THE NON-PARTICIPATING PROVIDER WAS A PARTICIPATING PROVIDER MADE BY
 A HEALTH CARE PLAN, OR AGENT OR REPRESENTATIVE OF A HEALTH CARE PLAN, OR
 AS SPECIFIED IN THE HEALTH CARE PLAN PROVIDER LISTING OR  DIRECTORY,  OR
 PROVIDER INFORMATION ON THE HEALTH PLAN'S WEBSITE;
   (4)  AN  INSURED FOR SERVICES RENDERED BY A NON-PARTICIPATING PROVIDER
 WHEN THE INSURED REASONABLY RELIED UPON A STATEMENT THAT THE  NON-PARTI-
 CIPATING  PROVIDER WAS A PARTICIPATING PROVIDER MADE BY THE NON-PARTICI-
 PATING PROVIDER, OR AGENT OR  REPRESENTATIVE  OF  THE  NON-PARTICIPATING
 PROVIDER,  OR  AS SPECIFIED ON THE NON-PARTICIPATING PROVIDER'S WEBSITE;
 OR
   (5) a patient who is not an insured for services rendered by a  physi-
 cian  at a hospital or ambulatory surgical center, where the patient has
 not timely received all of the disclosures required pursuant to  section
 twenty-four of the public health law.
   § 5. This act shall take effect immediately.

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