Assembly Actions -
Lowercase Senate Actions - UPPERCASE |
|
---|---|
Dec 23, 2022 |
signed chap.764 |
Dec 12, 2022 |
delivered to governor |
May 18, 2022 |
returned to senate passed assembly ordered to third reading rules cal.179 substituted for a3470c |
May 18, 2022 |
substituted by s2521c |
May 16, 2022 |
ordered to third reading rules cal.179 rules report cal.179 reported |
May 11, 2022 |
reported referred to rules |
Apr 19, 2022 |
print number 3470c |
Apr 19, 2022 |
amend and recommit to ways and means |
Jan 05, 2022 |
referred to ways and means |
Jun 02, 2021 |
print number 3470b |
Jun 02, 2021 |
amend (t) and recommit to ways and means |
Mar 09, 2021 |
reported referred to ways and means |
Feb 09, 2021 |
reported referred to codes |
Jan 28, 2021 |
print number 3470a |
Jan 28, 2021 |
amend and recommit to health |
Jan 26, 2021 |
referred to health |
Assembly Bill A3470C
Signed By Governor2021-2022 Legislative Session
Relates to regulation of billing of facility fees
download bill text pdfSponsored By
GOTTFRIED
Archive: Last Bill Status Via S2521 - Signed by Governor
- 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
Actions
Votes
-
-
-
-
Floor Vote: May 17, 2022
aye (48)- Addabbo Jr.
- Akshar
- Bailey
- Biaggi
- Boyle
- Breslin
- Brisport
- Brooks
- Cleare
- Comrie
- Cooney
- Felder
- Gaughran
- Gianaris
- Gounardes
- Griffo
- Harckham
- Hinchey
- Hoylman-Sigal
- Jackson
- Kaminsky
- Kaplan
- Kavanagh
- Kennedy
- Krueger
- Liu
- Mannion
- Mattera
- May
- Mayer
- Myrie
- Parker
- Persaud
- Ramos
- Reichlin-Melnick
- Ritchie
- Rivera
- Ryan
- Salazar
- Savino
- Sepúlveda
- Serino
- Serrano
- Skoufis
- Stavisky
- Stewart-Cousins
- Thomas
- Weik
nay (13)excused (2)
-
-
-
Floor Vote: Jun 9, 2021
aye (54)- Addabbo Jr.
- Akshar
- Bailey
- Benjamin
- Biaggi
- Boyle
- Breslin
- Brisport
- Brooks
- Brouk
- Comrie
- Cooney
- Felder
- Gaughran
- Gianaris
- Gounardes
- Griffo
- Harckham
- Hinchey
- Hoylman-Sigal
- Jackson
- Kaminsky
- Kaplan
- Kavanagh
- Kennedy
- Krueger
- Liu
- Mannion
- Mattera
- May
- Mayer
- Myrie
- O'Mara
- Oberacker
- Palumbo
- Parker
- Persaud
- Ramos
- Rath III
- Reichlin-Melnick
- Ritchie
- Rivera
- Ryan
- Salazar
- Sanders Jr.
- Savino
- Sepúlveda
- Serino
- Serrano
- Skoufis
- Stavisky
- Stec
- Stewart-Cousins
- Thomas
-
Jun 7, 2021 - Rules Committee Vote
S252120Aye0Nay1Aye with Reservations0Absent0Excused0Abstained -
-
Bill Amendments
co-Sponsors
Harvey Epstein
Jonathan Jacobson
Fred Thiele
Charles Barron
Jo Anne Simon
Rebecca Seawright
Jeffrey Dinowitz
Michael Benedetto
Nader Sayegh
Karines Reyes
Deborah Glick
N. Nick Perry
Thomas Abinanti
Catalina Cruz
Amy Paulin
Steven Englebright
Michaelle C. Solages
Linda Rosenthal
Aileen Gunther
Jeffrion Aubry
Sandy Galef
Phil Steck
Yuh-Line Niou
David Weprin
Al Taylor
Kimberly Jean-Pierre
Phara Souffrant Forrest
2021-A3470 - Details
2021-A3470 - Summary
Relates to regulation of the billing of facility fees; requires notice prior to billing facility fees not covered by a patient's insurance; defines facility fees as those charged by a hospital, facility or provider designed to compensate for operational costs separate from professional fees.
2021-A3470 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 3470 2021-2022 Regular Sessions I N A S S E M B L Y January 26, 2021 ___________ Introduced by M. of A. GOTTFRIED, EPSTEIN, JACOBSON, THIELE, BARRON, SIMON, SEAWRIGHT, DINOWITZ, BENEDETTO, SAYEGH, REYES, GLICK, PERRY, ABINANTI, CRUZ, PAULIN, ENGLEBRIGHT, SOLAGES, L. ROSENTHAL, GUNTHER, AUBRY, GALEF, STECK, NIOU, WEPRIN, TAYLOR, JEAN-PIERRE, SOUFFRANT FORREST -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to medical billing and debt (Part A); to amend the public health law, in relation to defining certain terms (Part B); to amend the public health law, in relation to standardized consolidated itemized general hospital bills (Part C); to amend the public health law, in relation to regulation of the billing of facility fees (Part D); to amend the public health law, in relation to standardized patient financial liability forms (Part E); to amend the public health law, in relation to an all payer data- base (Part F); to amend the public health law, in relation to the general hospital indigent care pool; and to repeal certain provisions of such law relating thereto (Part G); to amend the civil practice law and rules, in relation to the rate of interest in medical debt actions (Part H); and to amend the financial services law, in relation to services rendered by a non-participating provider; and to amend the public health law, in relation to hospital statements of rights and responsibilities of patients (Part I) THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Short title. This act shall be known and may be cited as the "patient medical debt protection act". § 2. This act enacts into law major components of legislation which relate to patient medical debt protection. Each component is wholly contained within a Part identified as Parts A through I. The effective date for each particular provision contained within such Part is set forth in the last section of such Part. Any provision in any section contained within a Part, including the effective date of the Part, which EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
LBD00481-02-1 A. 3470 2 makes reference to a section "of this act", when used in connection with that particular component, shall be deemed to mean and refer to the corresponding section of the Part in which it is found. Section four of this act sets forth the general effective date of this act. PART A Section 1. Sections 2800 through 2827 of article 28 of the public health law are designated title 1, and a new title 2 is added to article 28, to read as follows: TITLE 2 MEDICAL BILLING AND DEBT § 2. This act shall take effect immediately. PART B Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2830 to read as follows: § 2830. DEFINITIONS. AS USED IN THIS TITLE, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT CLEARLY REQUIRES OTHER- WISE: 1. "AFFILIATED PROVIDER" MEANS A PROVIDER THAT IS: (A) EMPLOYED BY A HOSPITAL OR HEALTH SYSTEM, (B) UNDER A PROFESSIONAL SERVICES AGREEMENT WITH A HOSPITAL OR HEALTH SYSTEM, OR (C) A CLINICAL FACULTY MEMBER OF A MEDICAL SCHOOL OR OTHER SCHOOL THAT TRAINS INDIVIDUALS TO BE PROVIDERS THAT IS AFFILIATED WITH A HOSPITAL OR HEALTH SYSTEM. 2. "CAMPUS" MEANS: (A) THE PHYSICAL AREA IMMEDIATELY ADJACENT TO A HOSPITAL'S MAIN BUILDINGS AND OTHER AREAS AND STRUCTURES THAT ARE NOT STRICTLY CONTIGUOUS TO THE MAIN BUILDINGS BUT ARE LOCATED WITHIN TWO HUNDRED FIFTY YARDS OF THE MAIN BUILDINGS, OR (B) ANY OTHER AREA THAT HAS BEEN DETERMINED ON AN INDIVIDUAL CASE BASIS BY THE CENTERS FOR MEDI- CARE AND MEDICAID SERVICES TO BE PART OF A HOSPITAL'S CAMPUS. 3. "FACILITY FEE" MEANS ANY FEE CHARGED OR BILLED BY A HOSPITAL OR HEALTH SYSTEM FOR INPATIENT OR OUTPATIENT HOSPITAL SERVICES PROVIDED IN A HOSPITAL-BASED FACILITY THAT IS: (A) INTENDED TO COMPENSATE THE HOSPI- TAL OR HEALTH SYSTEM FOR THE OPERATIONAL EXPENSES OF THE HOSPITAL OR HEALTH SYSTEM, AND (B) SEPARATE AND DISTINCT FROM A FEE FOR PATIENT-SPE- CIFIC SERVICES, SUPPLIES AND DRUGS; "FACILITY FEE" SHALL NOT INCLUDE ANY FEE CHARGED OR BILLED BY A RESIDENTIAL HEALTH CARE FACILITY. 4. "HEALTH SYSTEM" MEANS A GROUP OF ONE OR MORE HOSPITALS AND PROVID- ERS AFFILIATED THROUGH OWNERSHIP, GOVERNANCE, MEMBERSHIP OR OTHER MEANS. 5. "HOSPITAL-BASED FACILITY" MEANS A FACILITY THAT IS OWNED OR OPER- ATED, IN WHOLE OR IN PART, BY A HOSPITAL OR HEALTH SYSTEM WHERE HOSPITAL OR PROFESSIONAL HEALTH CARE SERVICES, SUPPLIES OR DRUGS ARE PROVIDED. 6. "FEE" MEANS ANY FEE CHARGED OR BILLED BY A PROVIDER FOR PROFES- SIONAL HEALTH CARE SERVICES PROVIDED IN A HOSPITAL-BASED FACILITY. 7. "PROVIDER" MEANS AN INDIVIDUAL OR ENTITY, WHETHER FOR PROFIT OR NONPROFIT, WHOSE PRIMARY PURPOSE IS TO PROVIDE PROFESSIONAL HEALTH CARE SERVICES. § 2. This act shall take effect immediately. PART C Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2831 to read as follows: A. 3470 3 § 2831. STANDARDIZED CONSOLIDATED ITEMIZED GENERAL HOSPITAL BILLS. 1. AFTER A PATIENT'S DISCHARGE OR RELEASE FROM A GENERAL HOSPITAL, OR COMPLETION OF A DISCRETE COURSE OF TREATMENT BY A HOSPITAL-BASED FACILI- TY, THE FACILITY SHALL PROVIDE TO THE PATIENT OR TO THE PATIENT'S SURVI- VOR OR LEGAL GUARDIAN, AS APPROPRIATE, A CONSOLIDATED ITEMIZED BILL. THE INITIAL CONSOLIDATED ITEMIZED BILL SHALL BE PROVIDED NO MORE THAN SEVEN DAYS AFTER THE PATIENT'S DISCHARGE, OR RELEASE OR COMPLETION OF THE EPISODE OR COURSE OF TREATMENT, OR AFTER A REQUEST FOR SUCH BILL, WHICHEVER IS EARLIER. 2. THE CONSOLIDATED ITEMIZED BILL SHALL: (A) DETAIL IN PLAIN LANGUAGE, COMPREHENSIBLE TO AN ORDINARY LAYPERSON (CONSISTENT WITH ACCURACY), THE SPECIFIC NATURE OF CHARGES OR EXPENSES INCURRED BY THE PATIENT DURING THE HOSPITALIZATION OR EPISODE OR COURSE OF TREATMENT AND THE DATE OF EACH SERVICE; (B) DETAIL ALL SERVICES PROVIDED TO THE PATIENT DURING THE HOSPITALI- ZATION OR EPISODE OR COURSE OF TREATMENT, INCLUDING ALL PROFESSIONAL SERVICES ADMINISTERED AND SUPPLIES AND DRUGS, CONTAIN A STATEMENT OF SPECIFIC SERVICES RECEIVED AND EXPENSES INCURRED BY DATE AND PROVIDER FOR SUCH ITEMS OF SERVICE, ENUMERATING IN DETAIL THE CONSTITUENT COMPO- NENTS OF THE SERVICES RECEIVED WITHIN EACH DEPARTMENT OF THE FACILITY AND INCLUDING UNIT PRICE DATA ON RATES CHARGED; (C) IDENTIFY EACH ITEM AS PAID, ASSIGNED TO A THIRD-PARTY PAYER, OR EXPECTED PAYMENT BY THE PATIENT; (D) INCLUDE THE AMOUNT DUE, IF ANY FROM THE PATIENT, INCLUDING A DUE DATE; (E) FOR ANY AMOUNT PAID OR TO BE PAID BY THE PATIENT, INDICATE TO WHICH PERSON OR ENTITY AN AMOUNT IS DUE; (F) NOT INCLUDE ANY GENERALIZED CATEGORY OF EXPENSES SUCH AS "OTHER" OR "MISCELLANEOUS" OR SIMILAR CATEGORIES; (G) LIST DRUGS BY BRAND OR GENERIC NAME, EVEN WHERE DRUG CODE NUMBERS ARE USED; (H) SPECIFICALLY IDENTIFY PHYSICAL, REHABILITATIVE, OCCUPATIONAL, OR SPEECH THERAPY TREATMENT BY DATE, TYPE, AND LENGTH OF TREATMENT WHEN SUCH TREATMENT IS A PART OF THE STATEMENT OR BILL; AND (I) PROMINENTLY DISPLAY THE TELEPHONE NUMBER OF THE FACILITY'S PATIENT LIAISON RESPONSIBLE FOR EXPEDITING THE RESOLUTION OF ANY BILLING DISPUTE BETWEEN THE PATIENT, OR THE PATIENT'S SURVIVOR OR LEGAL GUARDIAN, AND THE BILLING DEPARTMENT OR DEPARTMENTS. 3. A PROVIDER WITH ANY FINANCIAL OR CONTRACTUAL RELATIONSHIP WITH THE FACILITY MAY NOT SEPARATELY BILL THE PATIENT OR THE PATIENT'S SURVIVOR OR LEGAL GUARDIAN FOR SUCH SERVICES, SUPPLIES OR DRUGS. 4. ANY SUBSEQUENT BILL PROVIDED TO A PATIENT OR TO THE PATIENT'S SURVIVOR OR LEGAL GUARDIAN, AS APPROPRIATE, RELATING TO THE HOSPITALIZA- TION OR EPISODE OR COURSE OF TREATMENT MUST INCLUDE ALL OF THE INFORMA- TION REQUIRED UNDER THIS SECTION, IN OR ENCLOSED WITH THE BILL OR BY REFERENCE TO A PREVIOUS CONSOLIDATED ITEMIZED BILL, WITH ANY CLEARLY DELINEATED REVISIONS. 5. THE CONSOLIDATED ITEMIZED BILL, SHALL BE IN A FORM DEVELOPED BY THE COMMISSIONER, IN CONSULTATION WITH THE SUPERINTENDENT OF FINANCIAL SERVICES. 6. EACH FACILITY SHALL ESTABLISH POLICIES AND PROCEDURES FOR REVIEW- ING AND RESPONDING TO QUESTIONS FROM PATIENTS CONCERNING THE PATIENT'S CONSOLIDATED ITEMIZED BILL. THE RESPONSE SHALL BE PROVIDED NO MORE THAN SEVEN BUSINESS DAYS AFTER THE DATE A QUESTION IS RECEIVED. IF THE PATIENT IS NOT SATISFIED WITH THE RESPONSE, THE FACILITY SHALL PROVIDE A. 3470 4 THE PATIENT WITH THE CONTACT INFORMATION OF THE HOSPITAL DEPARTMENT OR COLLECTION ENTITY TO WHICH THE ISSUE SHALL BE SENT FOR REVIEW. § 2. Section 2807-e of the public health law is amended by adding a new subdivision 6 to read as follows: 6. THIS SECTION IS SUBJECT TO THE PROVISIONS OF SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE, AND WHERE ANY PROVISIONS OF THE TWO SECTIONS CONFLICT, THE PROVISIONS OF SECTION TWENTY-EIGHT HUNDRED THIR- TY-ONE OF THIS ARTICLE SHALL CONTROL. § 3. This act shall take effect one year after it shall have become a law. PART D Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2832 to read as follows: § 2832. REGULATION OF THE BILLING OF FACILITY FEES. NO HOSPITAL OR HEALTH SYSTEM SHALL BILL OR SEEK PAYMENT FROM A PATIENT FOR A FACILITY FEE: 1. RELATED TO THE PROVISION OF PREVENTIVE CARE SERVICE AS DEFINED BY THE UNITED STATES PREVENTIVE SERVICES TASK FORCE; OR 2. WHERE THE FACILITY FEE IS NOT COVERED FOR THE PATIENT BY A THIRD- PARTY PAYER. § 2. This act shall take effect on the one hundred eightieth day after it shall have become a law. PART E Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2833 to read as follows: § 2833. STANDARDIZED PATIENT FINANCIAL LIABILITY FORMS. EVERY HOSPI- TAL, HEALTH SYSTEM, HOSPITAL-BASED FACILITY, AFFILIATED PROVIDER OR OTHER PROVIDER SHALL USE THE UNIFORM PATIENT FINANCIAL LIABILITY FORM WHICH SHALL BE DEVELOPED BY THE COMMISSIONER. THE FORM SHALL DISCLOSE TO THE PATIENT WHETHER SERVICES, SUPPLIES AND DRUGS PROVIDED TO THE PATIENT ARE IN-NETWORK OR OUT-OF-NETWORK, WHETHER THE CARE IS A COVERED BENEFIT BY A THIRD-PARTY PAYER OF THE PATIENT, AND THE NATURE AND AMOUNT OF THE PATIENT'S PROJECTED FINANCIAL LIABILITY. A PATIENT SHALL NOT BE FINANCIALLY LIABLE FOR ANY SERVICE, SUPPLIES OR DRUGS SUBJECT TO THIS TITLE THAT IS NOT CHARGED OR BILLED IN ACCORDANCE WITH THIS TITLE. 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 UNDER THIS SECTION BY EACH HOSPITAL, HEALTH SYSTEM, HOSPITAL-BASED FACILITY, AFFILIATED PROVIDER AND OTHER PROVIDER NOT LATER THAN SIXTY DAYS AFTER THE COMMISSIONER ISSUES THE FORM. § 2. This act shall take effect immediately. PART F Section 1. Subdivision 18-a of section 206 of the public health law is amended by adding a new paragraph (e) to read as follows: (E)(I) THE COMMISSIONER SHALL ENSURE THAT THE NEW YORK STATE ALL PAYER DATABASE SHALL SERVE THE INTERESTS OF NEW YORK'S HEALTH CARE CONSUMERS. (II) EVERY HOSPITAL LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAP- TER AND HEALTH CARE PROFESSIONALS AUTHORIZED UNDER TITLE EIGHT OF THE EDUCATION LAW SHALL PARTICIPATE IN THE ALL PAYER DATABASE THROUGH THEIR INSURANCE CARRIER CONTRACTS, AND MAY PARTICIPATE IN THE ALL PAYER DATA- BASE THROUGH ANY OTHER OF THE HOSPITAL'S THIRD-PARTY PAYER CONTRACTS. A. 3470 5 (III) DATA THAT IS REQUIRED TO BE SUBMITTED TO THE ALL PAYER DATABASE SHALL NOT BE CONSIDERED PROPRIETARY INFORMATION FOR THE PURPOSES OF SUBMISSION TO OR INCLUSION IN THE ALL PAYER DATABASE. § 2. This act shall take effect on the one hundred eightieth day after it shall have become a law. PART G Section 1. 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] USE ONLY THE UNIFORM FINAN- CIAL ASSISTANCE FORM PROVIDED by the commissioner. THE DEFINITIONS IN SECTION TWENTY-EIGHT HUNDRED THIRTY OF THIS ARTICLE SHALL APPLY TO THIS SUBDIVISION AND SUBDIVISION NINE-A OF THIS SECTION. 9-a. (a) (I) 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-TWO, 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 TWENTY-ONE 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 AFFILIATED PROVIDERS otherwise applicable to low-income individuals without THIRD-PARTY health [insur- ance] COVERAGE, or who have [exhausted their] THIRD-PARTY health [insur- ance benefits] COVERAGE THAT DOES NOT COVER OR LIMITS COVERAGE OF THE SERVICE, and who can demonstrate an inability to pay full charges, and also, at the hospital'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 ELIGIBILITY CRITERION. (II) A GENERAL HOSPITAL MAY USE THE NEW YORK STATE OF HEALTH MARKET- PLACE ELIGIBILITY DETERMINATION PAGE TO ESTABLISH THE PATIENT'S HOUSE- HOLD INCOME AND RESIDENCY IN LIEU OF THE FINANCIAL APPLICATION FORM, PROVIDED IT HAS 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. (III) 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. (b) Such reductions from charges for [uninsured] patients DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION 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 A. 3470 6 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 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). [(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 A. 3470 7 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- 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 hospitals with twenty-four hour emergency departments, such policies and procedures] A GENERAL HOSPITAL shall require the notification of patients THROUGH WRITTEN MATERIALS PROVIDED TO PATIENTS during the intake and registration process, through the conspicuous posting of language-appropriate information in the general hospital, and informa- tion 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 writ- ten materials provided to patients during the intake and registration process prior to the provision of any health care services or proce- dures, and through information on bills and statements sent to patients, that financial aid 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 determine the patient's eligibility pursuant to the hospital's financial assistance policy, the patient may disregard any bills until the hospital has rendered a deci- sion 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. A. 3470 8 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 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, A. 3470 9 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 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] TITLE. (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 A. 3470 10 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 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; A. 3470 11 (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- 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] TITLE, 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 penalty not to exceed ten thousand dollars for each such violation. The imposition of such civil penalties shall be subject to the provisions of section twelve-a of this chapter. § 2. 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. § 3. This act shall take effect immediately. PART H Section 1. 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 PURPOSE 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 A. 3470 12 THE CALENDAR WEEK PRECEDING THE DATE OF THE ENTRY OF THE JUDGMENT AWARD- ING 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. § 2. This act shall take effect immediately. PART I Section 1. 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 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. § 2. Paragraph (k) of subdivision 1 of section 2803 of the public health law, as added by chapter 241 of the laws of 2016, is amended to read as follows: (k) The statement regarding patient rights and responsibilities, required pursuant to paragraph (g) of this subdivision, shall include provisions informing the patient of his or her right to [choose] BE HELD HARMLESS FROM CERTAIN BILLS FOR EMERGENCY SERVICES AND SURPRISE BILLS, AND to submit surprise bills or bills for emergency services to the independent dispute process established in article six of the financial services law, and informing the patient of his or her right to view a list of the hospital's standard charges and the health plans the hospi- A. 3470 13 tal participates with consistent with section twenty-four of this chap- ter. § 3. This act shall take effect immediately. § 3. Severability clause. If any provision of this act, or any appli- cation of any provision of this act, is held to be invalid, or to violate or be inconsistent with any federal law or regulation, that shall not affect the validity or effectiveness of any other provision of this act, or of any other application of any provision of this act, which can be given effect without that provision or application; and to that end, the provisions and applications of this act are severable. § 4. This act shall take effect immediately provided, however, that the applicable effective date of Parts A through I of this act shall be as specifically set forth in the last section of such Parts. Effective immediately, the commissioner of health and the superintendent of finan- cial services shall make regulations and take other actions reasonably necessary to implement every part of this act when it takes effect.
co-Sponsors
Harvey Epstein
Jonathan Jacobson
Fred Thiele
Charles Barron
Jo Anne Simon
Rebecca Seawright
Jeffrey Dinowitz
Michael Benedetto
Nader Sayegh
Karines Reyes
Deborah Glick
N. Nick Perry
Thomas Abinanti
Catalina Cruz
Amy Paulin
Michaelle C. Solages
Linda Rosenthal
Aileen Gunther
Jeffrion Aubry
Sandy Galef
Phil Steck
Yuh-Line Niou
David Weprin
Al Taylor
Kimberly Jean-Pierre
Phara Souffrant Forrest
Marcela Mitaynes
Andrew Hevesi
Jen Lunsford
Edward Braunstein
Zohran Mamdani
Stefani Zinerman
Anna Kelles
Carmen De La Rosa
John T. McDonald III
Kevin Cahill
Jessica Gonzalez-Rojas
Harry B. Bronson
Khaleel Anderson
Judy Griffin
Chris Burdick
Michael Durso
Sarah Clark
Clyde Vanel
Steven Englebright
Steven Otis
Victor M. Pichardo
2021-A3470A - Details
2021-A3470A - Summary
Relates to regulation of the billing of facility fees; requires notice prior to billing facility fees not covered by a patient's insurance; defines facility fees as those charged by a hospital, facility or provider designed to compensate for operational costs separate from professional fees.
2021-A3470A - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 3470--A 2021-2022 Regular Sessions I N A S S E M B L Y January 26, 2021 ___________ Introduced by M. of A. GOTTFRIED, EPSTEIN, JACOBSON, THIELE, BARRON, SIMON, SEAWRIGHT, DINOWITZ, BENEDETTO, SAYEGH, REYES, GLICK, PERRY, ABINANTI, CRUZ, PAULIN, ENGLEBRIGHT, SOLAGES, L. ROSENTHAL, GUNTHER, AUBRY, GALEF, STECK, NIOU, WEPRIN, TAYLOR, JEAN-PIERRE, FORREST -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to medical billing and debt (Part A); to amend the public health law, in relation to defining certain terms (Part B); to amend the public health law, in relation to standardized consolidated itemized general hospital bills (Part C); to amend the public health law, in relation to regulation of the billing of facility fees (Part D); to amend the public health law, in relation to standardized patient financial liability forms (Part E); to amend the public health law, in relation to an all payer data- base (Part F); to amend the public health law, in relation to the general hospital indigent care pool; and to repeal certain provisions of such law relating thereto (Part G); to amend the civil practice law and rules, in relation to the rate of interest in medical debt actions (Part H); and to amend the financial services law, in relation to services rendered by a non-participating provider; and to amend the public health law, in relation to hospital statements of rights and responsibilities of patients (Part I) THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Short title. This act shall be known and may be cited as the "patient medical debt protection act". § 2. This act enacts into law major components of legislation which relate to patient medical debt protection. Each component is wholly contained within a Part identified as Parts A through I. The effective date for each particular provision contained within such Part is set EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
LBD00481-03-1 A. 3470--A 2 forth in the last section of such Part. Any provision in any section contained within a Part, including the effective date of the Part, which makes reference to a section "of this act", when used in connection with that particular component, shall be deemed to mean and refer to the corresponding section of the Part in which it is found. Section four of this act sets forth the general effective date of this act. PART A Section 1. Sections 2800 through 2827 of article 28 of the public health law are designated title 1, and a new title 2 is added to article 28, to read as follows: TITLE 2 MEDICAL BILLING AND DEBT § 2. This act shall take effect immediately. PART B Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2830 to read as follows: § 2830. DEFINITIONS. AS USED IN THIS TITLE, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS, UNLESS THE CONTEXT CLEARLY REQUIRES OTHER- WISE: 1. "AFFILIATED PROVIDER" MEANS A PROVIDER THAT IS: (A) EMPLOYED BY A HOSPITAL OR HEALTH SYSTEM, (B) UNDER A PROFESSIONAL SERVICES AGREEMENT WITH A HOSPITAL OR HEALTH SYSTEM, OR (C) A CLINICAL FACULTY MEMBER OF A MEDICAL SCHOOL OR OTHER SCHOOL THAT TRAINS INDIVIDUALS TO BE PROVIDERS THAT IS AFFILIATED WITH A HOSPITAL OR HEALTH SYSTEM. 2. "CAMPUS" MEANS: (A) THE PHYSICAL AREA IMMEDIATELY ADJACENT TO A HOSPITAL'S MAIN BUILDINGS AND OTHER AREAS AND STRUCTURES THAT ARE NOT STRICTLY CONTIGUOUS TO THE MAIN BUILDINGS BUT ARE LOCATED WITHIN TWO HUNDRED FIFTY YARDS OF THE MAIN BUILDINGS, OR (B) ANY OTHER AREA THAT HAS BEEN DETERMINED ON AN INDIVIDUAL CASE BASIS BY THE CENTERS FOR MEDI- CARE AND MEDICAID SERVICES TO BE PART OF A HOSPITAL'S CAMPUS. 3. "FACILITY FEE" MEANS ANY FEE CHARGED OR BILLED BY A HOSPITAL OR HEALTH SYSTEM FOR INPATIENT OR OUTPATIENT HOSPITAL SERVICES PROVIDED IN A HOSPITAL-BASED FACILITY THAT IS: (A) INTENDED TO COMPENSATE THE HOSPI- TAL OR HEALTH SYSTEM FOR THE OPERATIONAL EXPENSES OF THE HOSPITAL OR HEALTH SYSTEM, AND (B) SEPARATE AND DISTINCT FROM A FEE FOR PATIENT-SPE- CIFIC SERVICES, SUPPLIES AND DRUGS; "FACILITY FEE" SHALL NOT INCLUDE ANY FEE CHARGED OR BILLED BY A RESIDENTIAL HEALTH CARE FACILITY. 4. "HEALTH SYSTEM" MEANS A GROUP OF ONE OR MORE HOSPITALS AND PROVID- ERS AFFILIATED THROUGH OWNERSHIP, GOVERNANCE, MEMBERSHIP OR OTHER MEANS. 5. "HOSPITAL-BASED FACILITY" MEANS A FACILITY THAT IS OWNED OR OPER- ATED, IN WHOLE OR IN PART, BY A HOSPITAL OR HEALTH SYSTEM WHERE HOSPITAL OR PROFESSIONAL HEALTH CARE SERVICES, SUPPLIES OR DRUGS ARE PROVIDED. 6. "FEE" MEANS ANY FEE CHARGED OR BILLED BY A PROVIDER FOR PROFES- SIONAL HEALTH CARE SERVICES PROVIDED IN A HOSPITAL-BASED FACILITY. 7. "PROVIDER" MEANS AN INDIVIDUAL OR ENTITY, WHETHER FOR PROFIT OR NONPROFIT, WHOSE PRIMARY PURPOSE IS TO PROVIDE PROFESSIONAL HEALTH CARE SERVICES. § 2. This act shall take effect immediately. PART C A. 3470--A 3 Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2831 to read as follows: § 2831. STANDARDIZED CONSOLIDATED ITEMIZED GENERAL HOSPITAL BILLS. 1. AFTER A PATIENT'S DISCHARGE OR RELEASE FROM A GENERAL HOSPITAL, OR COMPLETION OF A DISCRETE COURSE OF TREATMENT BY A HOSPITAL-BASED FACILI- TY, THE FACILITY SHALL PROVIDE TO THE PATIENT OR TO THE PATIENT'S SURVI- VOR OR LEGAL GUARDIAN, AS APPROPRIATE, A CONSOLIDATED ITEMIZED BILL. THE INITIAL CONSOLIDATED ITEMIZED BILL SHALL BE PROVIDED NO MORE THAN SEVEN DAYS AFTER THE PATIENT'S DISCHARGE, OR RELEASE OR COMPLETION OF THE EPISODE OR COURSE OF TREATMENT, OR AFTER A REQUEST FOR SUCH BILL, WHICHEVER IS EARLIER. 2. THE CONSOLIDATED ITEMIZED BILL SHALL: (A) DETAIL IN PLAIN LANGUAGE, COMPREHENSIBLE TO AN ORDINARY LAYPERSON (CONSISTENT WITH ACCURACY), THE SPECIFIC NATURE OF CHARGES OR EXPENSES INCURRED BY THE PATIENT DURING THE HOSPITALIZATION OR EPISODE OR COURSE OF TREATMENT AND THE DATE OF EACH SERVICE; (B) DETAIL ALL SERVICES PROVIDED TO THE PATIENT DURING THE HOSPITALI- ZATION OR EPISODE OR COURSE OF TREATMENT, INCLUDING ALL PROFESSIONAL SERVICES ADMINISTERED AND SUPPLIES AND DRUGS, CONTAIN A STATEMENT OF SPECIFIC SERVICES RECEIVED AND EXPENSES INCURRED BY DATE AND PROVIDER FOR SUCH ITEMS OF SERVICE, ENUMERATING IN DETAIL THE CONSTITUENT COMPO- NENTS OF THE SERVICES RECEIVED WITHIN EACH DEPARTMENT OF THE FACILITY AND INCLUDING UNIT PRICE DATA ON RATES CHARGED; (C) IDENTIFY EACH ITEM AS PAID, ASSIGNED TO A THIRD-PARTY PAYER, OR EXPECTED PAYMENT BY THE PATIENT; (D) INCLUDE THE AMOUNT DUE, IF ANY FROM THE PATIENT, INCLUDING A DUE DATE; (E) FOR ANY AMOUNT PAID OR TO BE PAID BY THE PATIENT, INDICATE TO WHICH PERSON OR ENTITY AN AMOUNT IS DUE; (F) NOT INCLUDE ANY GENERALIZED CATEGORY OF EXPENSES SUCH AS "OTHER" OR "MISCELLANEOUS" OR SIMILAR CATEGORIES; (G) LIST DRUGS BY BRAND OR GENERIC NAME, EVEN WHERE DRUG CODE NUMBERS ARE USED; (H) SPECIFICALLY IDENTIFY PHYSICAL, REHABILITATIVE, OCCUPATIONAL, OR SPEECH THERAPY TREATMENT BY DATE, TYPE, AND LENGTH OF TREATMENT WHEN SUCH TREATMENT IS A PART OF THE STATEMENT OR BILL; AND (I) PROMINENTLY DISPLAY THE TELEPHONE NUMBER OF THE FACILITY'S PATIENT LIAISON RESPONSIBLE FOR EXPEDITING THE RESOLUTION OF ANY BILLING DISPUTE BETWEEN THE PATIENT, OR THE PATIENT'S SURVIVOR OR LEGAL GUARDIAN, AND THE BILLING DEPARTMENT OR DEPARTMENTS. 3. A PROVIDER WITH ANY FINANCIAL OR CONTRACTUAL RELATIONSHIP WITH THE FACILITY MAY NOT SEPARATELY BILL THE PATIENT OR THE PATIENT'S SURVIVOR OR LEGAL GUARDIAN FOR SUCH SERVICES, SUPPLIES OR DRUGS. 4. ANY SUBSEQUENT BILL PROVIDED TO A PATIENT OR TO THE PATIENT'S SURVIVOR OR LEGAL GUARDIAN, AS APPROPRIATE, RELATING TO THE HOSPITALIZA- TION OR EPISODE OR COURSE OF TREATMENT MUST INCLUDE ALL OF THE INFORMA- TION REQUIRED UNDER THIS SECTION, IN OR ENCLOSED WITH THE BILL OR BY REFERENCE TO A PREVIOUS CONSOLIDATED ITEMIZED BILL, WITH ANY CLEARLY DELINEATED REVISIONS. 5. THE CONSOLIDATED ITEMIZED BILL, SHALL BE IN A FORM DEVELOPED BY THE COMMISSIONER, IN CONSULTATION WITH THE SUPERINTENDENT OF FINANCIAL SERVICES. 6. EACH FACILITY SHALL ESTABLISH POLICIES AND PROCEDURES FOR REVIEW- ING AND RESPONDING TO QUESTIONS FROM PATIENTS CONCERNING THE PATIENT'S CONSOLIDATED ITEMIZED BILL. THE RESPONSE SHALL BE PROVIDED NO MORE THAN SEVEN BUSINESS DAYS AFTER THE DATE A QUESTION IS RECEIVED. IF THE A. 3470--A 4 PATIENT IS NOT SATISFIED WITH THE RESPONSE, THE FACILITY SHALL PROVIDE THE PATIENT WITH THE CONTACT INFORMATION OF THE HOSPITAL DEPARTMENT OR COLLECTION ENTITY TO WHICH THE ISSUE SHALL BE SENT FOR REVIEW. § 2. Section 2807-e of the public health law is amended by adding a new subdivision 6 to read as follows: 6. THIS SECTION IS SUBJECT TO THE PROVISIONS OF SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE, AND WHERE ANY PROVISIONS OF THE TWO SECTIONS CONFLICT, THE PROVISIONS OF SECTION TWENTY-EIGHT HUNDRED THIR- TY-ONE OF THIS ARTICLE SHALL CONTROL. § 3. This act shall take effect one year after it shall have become a law. PART D Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2832 to read as follows: § 2832. REGULATION OF THE BILLING OF FACILITY FEES. NO HOSPITAL OR HEALTH SYSTEM SHALL BILL OR SEEK PAYMENT FROM A PATIENT FOR A FACILITY FEE: 1. RELATED TO THE PROVISION OF PREVENTIVE CARE SERVICE AS DEFINED BY THE UNITED STATES PREVENTIVE SERVICES TASK FORCE; OR 2. WHERE THE FACILITY FEE IS NOT COVERED FOR THE PATIENT BY A THIRD- PARTY PAYER. § 2. This act shall take effect on the one hundred eightieth day after it shall have become a law. PART E Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2833 to read as follows: § 2833. STANDARDIZED PATIENT FINANCIAL LIABILITY FORMS. EVERY HOSPI- TAL, HEALTH SYSTEM, HOSPITAL-BASED FACILITY, AFFILIATED PROVIDER OR OTHER PROVIDER SHALL USE THE UNIFORM PATIENT FINANCIAL LIABILITY FORM WHICH SHALL BE DEVELOPED BY THE COMMISSIONER. THE FORM SHALL DISCLOSE TO THE PATIENT WHETHER SERVICES, SUPPLIES AND DRUGS PROVIDED TO THE PATIENT ARE IN-NETWORK OR OUT-OF-NETWORK, WHETHER THE CARE IS A COVERED BENEFIT BY A THIRD-PARTY PAYER OF THE PATIENT, AND THE NATURE AND AMOUNT OF THE PATIENT'S PROJECTED FINANCIAL LIABILITY. A PATIENT SHALL NOT BE FINANCIALLY LIABLE FOR ANY SERVICE, SUPPLIES OR DRUGS SUBJECT TO THIS TITLE THAT IS NOT CHARGED OR BILLED IN ACCORDANCE WITH THIS TITLE. 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 UNDER THIS SECTION BY EACH HOSPITAL, HEALTH SYSTEM, HOSPITAL-BASED FACILITY, AFFILIATED PROVIDER AND OTHER PROVIDER NOT LATER THAN SIXTY DAYS AFTER THE COMMISSIONER ISSUES THE FORM. § 2. This act shall take effect immediately. PART F Section 1. Subdivision 18-a of section 206 of the public health law is amended by adding a new paragraph (e) to read as follows: (E)(I) THE COMMISSIONER SHALL ENSURE THAT THE NEW YORK STATE ALL PAYER DATABASE SHALL SERVE THE INTERESTS OF NEW YORK'S HEALTH CARE CONSUMERS. (II) EVERY HOSPITAL LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAP- TER AND HEALTH CARE PROFESSIONALS AUTHORIZED UNDER TITLE EIGHT OF THE EDUCATION LAW SHALL PARTICIPATE IN THE ALL PAYER DATABASE THROUGH THEIR A. 3470--A 5 INSURANCE CARRIER CONTRACTS, AND MAY PARTICIPATE IN THE ALL PAYER DATA- BASE THROUGH ANY OTHER OF THE HOSPITAL'S THIRD-PARTY PAYER CONTRACTS. (III) DATA THAT IS REQUIRED TO BE SUBMITTED TO THE ALL PAYER DATABASE SHALL NOT BE CONSIDERED PROPRIETARY INFORMATION FOR THE PURPOSES OF SUBMISSION TO OR INCLUSION IN THE ALL PAYER DATABASE. § 2. This act shall take effect on the one hundred eightieth day after it shall have become a law. PART G Section 1. 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] USE ONLY THE UNIFORM FINAN- CIAL ASSISTANCE FORM PROVIDED by the commissioner. THE DEFINITIONS IN SECTION TWENTY-EIGHT HUNDRED THIRTY OF THIS ARTICLE SHALL APPLY TO THIS SUBDIVISION AND SUBDIVISION NINE-A OF THIS SECTION. 9-a. (a) (I) 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-TWO, 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 TWENTY-ONE 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 AFFILIATED PROVIDERS otherwise applicable to low-income individuals without THIRD-PARTY health [insur- ance] COVERAGE, or who have [exhausted their] THIRD-PARTY health [insur- ance benefits] COVERAGE THAT DOES NOT COVER OR LIMITS COVERAGE OF THE SERVICE, and who can demonstrate an inability to pay full charges, and also, at the hospital'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 ELIGIBILITY CRITERION. (II) A GENERAL HOSPITAL MAY USE THE NEW YORK STATE OF HEALTH MARKET- PLACE ELIGIBILITY DETERMINATION PAGE TO ESTABLISH THE PATIENT'S HOUSE- HOLD INCOME AND RESIDENCY IN LIEU OF THE FINANCIAL APPLICATION FORM, PROVIDED IT HAS 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. (III) 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. (b) Such reductions from charges for [uninsured] patients DESCRIBED IN PARAGRAPH (A) OF THIS SUBDIVISION with incomes below [at least three] FOUR hundred percent of the federal poverty level shall result in a A. 3470--A 6 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 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). [(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. A. 3470--A 7 (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- 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 hospitals with twenty-four hour emergency departments, such policies and procedures] A GENERAL HOSPITAL shall require the notification of patients THROUGH WRITTEN MATERIALS PROVIDED TO PATIENTS during the intake and registration process, through the conspicuous posting of language-appropriate information in the general hospital, and informa- tion 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 writ- ten materials provided to patients during the intake and registration process prior to the provision of any health care services or proce- dures, and through information on bills and statements sent to patients, that financial aid 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 determine the patient's eligibility pursuant to the hospital's financial assistance policy, the patient may disregard any bills until the hospital has rendered a deci- sion on the application in accordance with this paragraph] GENERAL A. 3470--A 8 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 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] POLICY shall [permit patients to] REQUIRE THE HOSPITAL'S CHIEF FINANCIAL OFFICER TO PROVIDE A SWORN AFFI- DAVIT, THAT MUST BE FILED WITH A COMPLAINT FOR MEDICAL DEBT COLLECTION ACTION IN A COURT OF JURISDICTION, THAT THE PATIENT DOES NOT MEET THE INCOME OR RESIDENCY CRITERIA FOR FINANCIAL ASSISTANCE. PATIENTS MAY apply for assistance [within at least ninety days of the date of discharge or date of service and provide at least twenty days for patients to submit a completed application] AT ANY TIME DURING THE COLLECTION PROCESS, INCLUDING AFTER THE COMMENCEMENT OF A MEDICAL DEBT COURT ACTION OR UPON SECURING A DEFAULT JUDGMENT IN A COURT OF JURISDIC- TION. Such policies and procedures may require that patients seeking payment adjustments provide [appropriate] THE FOLLOWING financial infor- mation 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 AFOREMEN- TIONED 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 A. 3470--A 9 procedures and in applying for payment adjustments. [Application forms shall be printed] THE COMMISSIONER SHALL TRANSLATE THE FINANCIAL ASSIST- ANCE APPLICATION FORM AND POLICY INTO THE "PRIMARY LANGUAGES" OF EACH GENERAL HOSPITAL. EACH GENERAL HOSPITAL SHALL PRINT AND POST THESE MATE- RIALS 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 commu- nicate, 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 communi- cation with health care providers, or (ii) spoken by non-English speak- ing 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 regarding 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 applica- tion. [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 another 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 follow- ing 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 A. 3470--A 10 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] TITLE. (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 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 A. 3470--A 11 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- 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] TITLE, 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 penalty not to exceed ten thousand dollars for each such violation. The imposition of such civil penalties shall be subject to the provisions of section twelve-a of this chapter. § 2. 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. § 3. This act shall take effect immediately. PART H Section 1. 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: A. 3470--A 12 § 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 PURPOSE 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 AWARD- ING 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. § 2. This act shall take effect immediately. PART I Section 1. 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 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. § 2. Paragraph (k) of subdivision 1 of section 2803 of the public health law, as added by chapter 241 of the laws of 2016, is amended to read as follows: A. 3470--A 13 (k) The statement regarding patient rights and responsibilities, required pursuant to paragraph (g) of this subdivision, shall include provisions informing the patient of his or her right to [choose] BE HELD HARMLESS FROM CERTAIN BILLS FOR EMERGENCY SERVICES AND SURPRISE BILLS, AND to submit surprise bills or bills for emergency services to the independent dispute process established in article six of the financial services law, and informing the patient of his or her right to view a list of the hospital's standard charges and the health plans the hospi- tal participates with consistent with section twenty-four of this chap- ter. § 3. This act shall take effect immediately. § 3. Severability clause. If any provision of this act, or any appli- cation of any provision of this act, is held to be invalid, or to violate or be inconsistent with any federal law or regulation, that shall not affect the validity or effectiveness of any other provision of this act, or of any other application of any provision of this act, which can be given effect without that provision or application; and to that end, the provisions and applications of this act are severable. § 4. This act shall take effect immediately provided, however, that the applicable effective date of Parts A through I of this act shall be as specifically set forth in the last section of such Parts. Effective immediately, the commissioner of health and the superintendent of finan- cial services shall make regulations and take other actions reasonably necessary to implement every part of this act when it takes effect.
co-Sponsors
Harvey Epstein
Jonathan Jacobson
Fred Thiele
Charles Barron
Jo Anne Simon
Rebecca Seawright
Jeffrey Dinowitz
Michael Benedetto
Nader Sayegh
Karines Reyes
Deborah Glick
N. Nick Perry
Thomas Abinanti
Catalina Cruz
Amy Paulin
Michaelle C. Solages
Linda Rosenthal
Aileen Gunther
Jeffrion Aubry
Sandy Galef
Phil Steck
Yuh-Line Niou
David Weprin
Al Taylor
Kimberly Jean-Pierre
Phara Souffrant Forrest
Marcela Mitaynes
Andrew Hevesi
Jen Lunsford
Edward Braunstein
Zohran Mamdani
Stefani Zinerman
Anna Kelles
Carmen De La Rosa
John T. McDonald III
Kevin Cahill
Jessica Gonzalez-Rojas
Harry B. Bronson
Khaleel Anderson
Judy Griffin
Chris Burdick
Michael Durso
Sarah Clark
Clyde Vanel
Steven Englebright
Steven Otis
Victor M. Pichardo
Rodneyse Bichotte Hermelyn
Kenny Burgos
Jose Rivera
Eddie Gibbs
Ron Kim
Patricia Fahy
Nathalia Fernandez
Philip Ramos
Robert C. Carroll
2021-A3470B - Details
2021-A3470B - Summary
Relates to regulation of the billing of facility fees; requires notice prior to billing facility fees not covered by a patient's insurance; defines facility fees as those charged by a hospital, facility or provider designed to compensate for operational costs separate from professional fees.
2021-A3470B - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 3470--B 2021-2022 Regular Sessions I N A S S E M B L Y January 26, 2021 ___________ Introduced by M. of A. GOTTFRIED, EPSTEIN, JACOBSON, THIELE, BARRON, SIMON, SEAWRIGHT, DINOWITZ, BENEDETTO, SAYEGH, REYES, GLICK, PERRY, ABINANTI, CRUZ, PAULIN, SOLAGES, L. ROSENTHAL, GUNTHER, AUBRY, GALEF, STECK, NIOU, WEPRIN, TAYLOR, JEAN-PIERRE, FORREST, MITAYNES, HEVESI, LUNSFORD, BRAUNSTEIN, MAMDANI, ZINERMAN, KELLES, DE LA ROSA, McDONALD, CAHILL, GONZALEZ-ROJAS, BRONSON, ANDERSON, GRIFFIN, BURDICK, DURSO, CLARK, VANEL, ENGLEBRIGHT, OTIS, PICHARDO -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- reported and referred to the Committee on Codes -- reported and referred to the Committee on Ways and Means -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to regulation of the billing of facility fees THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 2801 of the public health law is amended by adding four new subdivisions 12, 13, 14 and 15 to read as follows: 12. "FACILITY FEE" MEANS ANY FEE CHARGED OR BILLED BY A HOSPITAL OR BY A HEALTH CARE PROFESSIONAL AUTHORIZED UNDER TITLE EIGHT OF THE EDUCATION LAW THAT IS: (A) INTENDED TO COMPENSATE THE HOSPITAL OR HEALTH CARE PROFESSIONAL FOR THE OPERATIONAL EXPENSES REGARDLESS OF THE MODALITY THROUGH WHICH THE HEALTH CARE SERVICES ARE PROVIDED; AND (B) SEPARATE AND DISTINCT FROM A PROFESSIONAL FEE. "FACILITY FEE" SHALL NOT INCLUDE ANY FEE CHARGED OR BILLED BY A RESIDENTIAL HEALTH CARE FACILITY. 13. "HEALTH SYSTEM" MEANS A GROUP OF ONE OR MORE HOSPITALS AND PROVID- ERS AFFILIATED THROUGH OWNERSHIP, GOVERNANCE, MEMBERSHIP OR OTHER MEANS. 14. "FEE" MEANS ANY FEE CHARGED OR BILLED BY A PROVIDER FOR PROFES- SIONAL HEALTH CARE SERVICES PROVIDED IN A HOSPITAL-BASED FACILITY. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD00481-05-1
A. 3470--B 2 15. "PROVIDER" MEANS AN INDIVIDUAL OR ENTITY, WHETHER FOR PROFIT OR NONPROFIT, WHOSE PRIMARY PURPOSE IS TO PROVIDE PROFESSIONAL HEALTH CARE SERVICES. § 2. The public health law is amended by adding a new section 2829 to read as follows: § 2829. REGULATION OF THE BILLING OF FACILITY FEES. NO HOSPITAL OR HEALTH SYSTEM OR HEALTH CARE PROVIDER SHALL BILL OR SEEK PAYMENT FROM A PATIENT FOR A FACILITY FEE THAT IS NOT COVERED BY THE PATIENT'S HEALTH INSURANCE CARRIER UNLESS THE PATIENT WAS NOTIFIED PRIOR TO THE DATE OF SERVICE THAT A FACILITY FEE WOULD BE APPLICABLE. IF A HEALTH CARE PROVIDER ENTERS INTO A BUSINESS RELATIONSHIP WITH A HOSPITAL OR HEALTH SYSTEM THAT WILL RESULT IN THE PROVIDER'S PATIENTS BEING SUBJECT TO FACILITY FEES, THE HEALTH CARE PROVIDER MUST NOTIFY ITS PATIENTS OF THE CHANGE AND THAT FACILITY FEES WILL NOW BE APPLICABLE TO SERVICES RECEIVED FROM THE HEALTH CARE PROVIDER. THE NOTICE SHALL BE PROVIDED IN WRITING AT LEAST SEVEN DAYS IN ADVANCE OF EACH DATE OF SERVICE AND SHALL EXPLAIN THE AMOUNT OF THE FEE, THE PURPOSE OF THE FEE, WHETHER THE PATIENT'S INSURANCE PLAN WILL PAY THE FEE, AND FOR UNINSURED PATIENTS, HOW TO APPLY FOR FINANCIAL ASSISTANCE. IF ADVANCE WRITTEN NOTICE IS INFEASIBLE BECAUSE THE VISIT WAS SECURED LESS THAN SEVEN DAYS IN ADVANCE, THEN A WRITTEN NOTICE SHALL BE PROVIDED ON THE DATE THE SERVICE IS RENDERED. THE NOTICE SHALL BE PROVIDED IN PLAIN LANGUAGE IN CONSPICU- OUS TWELVE-POINT BOLD FACE TYPE AND SHALL BE AVAILABLE IN THE TOP SIX LANGUAGES SPOKEN IN THE HOSPITAL'S SERVICE AREA. IN NO EVENT SHALL A FACILITY FEE BE CHARGED FOR SERVICES RELATED TO THE PROVISION OF PREVEN- TIVE CARE SERVICE AS DEFINED BY THE UNITED STATES PREVENTIVE SERVICES TASK FORCE. § 3. This act shall take effect on the one hundred eightieth day after it shall have become a law.
co-Sponsors
Harvey Epstein
Jonathan Jacobson
Fred Thiele
Charles Barron
Jo Anne Simon
Rebecca Seawright
Jeffrey Dinowitz
Michael Benedetto
Nader Sayegh
Karines Reyes
Deborah Glick
N. Nick Perry
Thomas Abinanti
Catalina Cruz
Amy Paulin
Michaelle C. Solages
Linda Rosenthal
Aileen Gunther
Jeffrion Aubry
Sandy Galef
Phil Steck
Yuh-Line Niou
David Weprin
Al Taylor
Kimberly Jean-Pierre
Phara Souffrant Forrest
Marcela Mitaynes
Andrew Hevesi
Jen Lunsford
Edward Braunstein
Zohran Mamdani
Stefani Zinerman
Anna Kelles
John T. McDonald III
Kevin Cahill
Jessica Gonzalez-Rojas
Harry B. Bronson
Khaleel Anderson
Judy Griffin
Chris Burdick
Michael Durso
Sarah Clark
Clyde Vanel
Steven Englebright
Steven Otis
Victor M. Pichardo
Rodneyse Bichotte Hermelyn
Kenny Burgos
Jose Rivera
Eddie Gibbs
Ron Kim
Patricia Fahy
Nathalia Fernandez
Philip Ramos
Robert C. Carroll
Maritza Davila
Manny De Los Santos
Chantel Jackson
Jake Ashby
2021-A3470C (ACTIVE) - Details
2021-A3470C (ACTIVE) - Summary
Relates to regulation of the billing of facility fees; requires notice prior to billing facility fees not covered by a patient's insurance; defines facility fees as those charged by a hospital, facility or provider designed to compensate for operational costs separate from professional fees.
2021-A3470C (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 3470--C 2021-2022 Regular Sessions I N A S S E M B L Y January 26, 2021 ___________ Introduced by M. of A. GOTTFRIED, EPSTEIN, JACOBSON, THIELE, SIMON, SEAWRIGHT, DINOWITZ, BENEDETTO, SAYEGH, REYES, GLICK, ABINANTI, CRUZ, PAULIN, SOLAGES, L. ROSENTHAL, GUNTHER, AUBRY, GALEF, STECK, NIOU, WEPRIN, TAYLOR, JEAN-PIERRE, FORREST, MITAYNES, HEVESI, LUNSFORD, BRAUNSTEIN, MAMDANI, ZINERMAN, KELLES, McDONALD, CAHILL, GONZALEZ-RO- JAS, BRONSON, ANDERSON, GRIFFIN, BURDICK, DURSO, CLARK, VANEL, ENGLE- BRIGHT, OTIS, BICHOTTE HERMELYN, BURGOS, J. RIVERA, GIBBS, KIM, FAHY, FERNANDEZ, RAMOS, CARROLL -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- reported and referred to the Committee on Codes -- reported and referred to the Committee on Ways and Means -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to regulation of the billing of facility fees THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 2801 of the public health law is amended by adding three new subdivisions 12, 13 and 14 to read as follows: 12. "FACILITY FEE" MEANS ANY FEE CHARGED OR BILLED BY A HOSPITAL OR BY A HEALTH CARE PROFESSIONAL AUTHORIZED UNDER TITLE EIGHT OF THE EDUCATION LAW THAT IS: (A) INTENDED TO COMPENSATE THE HOSPITAL OR HEALTH CARE PROFESSIONAL FOR THE OPERATIONAL EXPENSES REGARDLESS OF THE MODALITY THROUGH WHICH THE HEALTH CARE SERVICES ARE PROVIDED; AND (B) SEPARATE AND DISTINCT FROM A PROFESSIONAL FEE. "FACILITY FEE" SHALL NOT INCLUDE ANY FEE CHARGED OR BILLED BY A RESIDENTIAL HEALTH CARE FACILITY. 13. "HEALTH SYSTEM" MEANS A GROUP OF ONE OR MORE HOSPITALS AND PROVID- ERS AFFILIATED THROUGH OWNERSHIP, GOVERNANCE, MEMBERSHIP OR OTHER MEANS. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD00481-08-2 A. 3470--C 2
14. "PROVIDER" MEANS AN INDIVIDUAL OR ENTITY, WHETHER FOR PROFIT OR NONPROFIT, WHOSE PRIMARY PURPOSE IS TO PROVIDE PROFESSIONAL HEALTH CARE SERVICES. § 2. The public health law is amended by adding a new section 2830 to read as follows: § 2830. REGULATION OF THE BILLING OF FACILITY FEES. 1. FOR THE PURPOSES OF THIS SECTION, "FEE" MEANS ANY AMOUNT CHARGED OR BILLED BY A PROVIDER FOR PROFESSIONAL HEALTH CARE SERVICES PROVIDED IN A HOSPITAL- BASED FACILITY. 2. NO HOSPITAL OR HEALTH SYSTEM OR HEALTH CARE PROVIDER SHALL BILL OR SEEK PAYMENT FROM A PATIENT FOR A FACILITY FEE THAT IS NOT COVERED BY THE PATIENT'S HEALTH INSURANCE CARRIER UNLESS THE PATIENT WAS NOTIFIED PRIOR TO THE DATE OF SERVICE THAT A FACILITY FEE WOULD BE APPLICABLE. IF A HEALTH CARE PROVIDER ENTERS INTO A BUSINESS RELATIONSHIP WITH A HOSPI- TAL OR HEALTH SYSTEM THAT WILL RESULT IN THE PROVIDER'S PATIENTS BEING SUBJECT TO FACILITY FEES, THE HEALTH CARE PROVIDER MUST NOTIFY ITS PATIENTS OF THE CHANGE AND THAT FACILITY FEES WILL NOW BE APPLICABLE TO SERVICES RECEIVED FROM THE HEALTH CARE PROVIDER. THE NOTICE SHALL BE PROVIDED IN WRITING AT LEAST SEVEN DAYS IN ADVANCE OF EACH DATE OF SERVICE AND SHALL EXPLAIN THE AMOUNT OF THE FEE, THE PURPOSE OF THE FEE, WHETHER THE PATIENT'S INSURANCE PLAN WILL PAY THE FEE, AND FOR UNINSURED PATIENTS, HOW TO APPLY FOR FINANCIAL ASSISTANCE. IF ADVANCE WRITTEN NOTICE IS INFEASIBLE BECAUSE THE VISIT WAS SECURED LESS THAN SEVEN DAYS IN ADVANCE, THEN A WRITTEN NOTICE SHALL BE PROVIDED ON THE DATE THE SERVICE IS RENDERED. THE NOTICE SHALL BE PROVIDED IN PLAIN LANGUAGE IN CONSPICUOUS TWELVE-POINT BOLD FACE TYPE AND SHALL BE AVAILABLE IN THE TOP SIX LANGUAGES SPOKEN IN THE HOSPITAL'S SERVICE AREA. IN NO EVENT SHALL A FACILITY FEE BE CHARGED FOR SERVICES RELATED TO THE PROVISION OF PREVENTIVE CARE SERVICE AS DEFINED BY THE UNITED STATES PREVENTIVE SERVICES TASK FORCE. § 3. This act shall take effect on the one hundred eightieth day after it shall have become a law.
Comments
Open Legislation is a forum for New York State legislation. All comments are subject to review and community moderation is encouraged.
Comments deemed off-topic, commercial, campaign-related, self-promotional; or that contain profanity, hate or toxic speech; or that link to sites outside of the nysenate.gov domain are not permitted, and will not be published. Attempts to intimidate and silence contributors or deliberately deceive the public, including excessive or extraneous posting/posts, or coordinated activity, are prohibited and may result in the temporary or permanent banning of the user. Comment moderation is generally performed Monday through Friday. By contributing or voting you agree to the Terms of Participation and verify you are over 13.
Create an account. An account allows you to sign petitions with a single click, officially support or oppose key legislation, and follow issues, committees, and bills that matter to you. When you create an account, you agree to this platform's terms of participation.