S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   2521
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             January 21, 2021
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN ACT to amend the public health law, in relation  to  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
 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

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD00481-01-1
              

 S. 2521                             2
 
 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:
   § 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-

 S. 2521                             3
 
 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
 THE PATIENT WITH THE CONTACT INFORMATION OF THE HOSPITAL  DEPARTMENT  OR
 COLLECTION ENTITY TO WHICH THE ISSUE SHALL BE SENT FOR REVIEW.
   §  2. This act shall take effect one year after it shall have become a
 law.

 S. 2521                             4
 
                                  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.
   (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

 S. 2521                             5
 
 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
 volume  payor"  for such general hospital as defined in subparagraph (v)
 of this paragraph, or for services provided pursuant to title  XVIII  of
 the  federal  social  security act (medicare), or for services] provided
 pursuant to title XIX of the federal social security act (medicaid), and
 provided further that such amounts shall be adjusted according to income
 level as follows:
   (i) For patients with incomes at or below [at least one]  TWO  hundred
 percent of the federal poverty level, the hospital shall collect no more
 than a nominal payment amount, consistent with guidelines established by
 the commissioner[;].

 S. 2521                             6
 
   (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
 requirements described in subparagraphs (i) and (ii) of  this  paragraph
 based upon the existence of significant assets owned by the patient that
 should  be  taken  into  account  in determining the appropriate payment
 amount for that patient's care, provided, however,  that  such  proposed
 policies  and  procedures  shall  be  subject  to  the  prior review and
 approval of the commissioner and, if approved, shall be included in  the
 hospital's  financial  assistance  policy  established  pursuant to this
 section, and provided further that, if such  approval  is  granted,  the
 maximum amount that may be collected shall not exceed the greater of the
 amount  that  would have been paid for the same services by the "highest

 S. 2521                             7

 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.
 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

 S. 2521                             8
 
 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,
 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

 S. 2521                             9
 
 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
 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-

 S. 2521                            10
 
 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;
   (vi) for hospitals located in social services districts in  which  the
 district allows hospitals to assist patients with such applications, the
 number  of  applications  for  eligibility under title XIX of the social
 security act (medicaid) that the hospital assisted patients in  complet-
 ing and the number denied and approved;
   (vii) the hospital's financial losses resulting from services provided
 under medicaid; and
   (viii)  the number of REFERRALS TO COLLECTION AGENTS OR OUTSIDE VENDOR
 COURT CASES AND liens placed on [the primary] ANY residences of patients
 through the collection process used by a hospital.

 S. 2521                            11
 
   (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
 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

 S. 2521                            12
 
   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-
 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,

 S. 2521                            13
 
 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.

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2521--A
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             January 21, 2021
                                ___________
 
 Introduced   by   Sens.   RIVERA,  BENJAMIN,  BIAGGI,  BRESLIN,  COMRIE,
   GOUNARDES, HARCKHAM, HOYLMAN, JACKSON, KAPLAN,  KRUEGER,  MAY,  MYRIE,
   PERSAUD,  SALAZAR, SANDERS, SEPULVEDA -- read twice and ordered print-
   ed, and when printed to be committed to the  Committee  on  Health  --
   committee  discharged,  bill amended, ordered reprinted as amended and
   recommitted to said committee
 
 AN ACT to amend the public health law, in relation  to  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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00481-04-1

 S. 2521--A                          2
 
 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
 
   Section 1. Title 2 of article 28 of the public health law  is  amended
 by adding a new section 2831 to read as follows:

 S. 2521--A                          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

 S. 2521--A                          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.

 S. 2521--A                          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

 S. 2521--A                          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

 S. 2521--A                          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.

 S. 2521--A                          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] 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
 procedures and in applying for payment adjustments.  [Application  forms
 shall be printed] THE COMMISSIONER SHALL TRANSLATE THE FINANCIAL ASSIST-

 S. 2521--A                          9

 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
 primary  service  area  in  the  hospital's annual implementation report

 S. 2521--A                         10

 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
 to the [hospital's] UNIFORM financial assistance policy, and the number,

 S. 2521--A                         11
 
 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:

 S. 2521--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:

 S. 2521--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.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2521--C
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                             January 21, 2021
                                ___________
 
 Introduced  by  Sens.  RIVERA, BAILEY, BIAGGI, BRESLIN, BRISPORT, BROUK,
   CLEARE, COMRIE,  GAUGHRAN,  GIANARIS,  GOUNARDES,  HARCKHAM,  HINCHEY,
   HOYLMAN,  JACKSON, KAPLAN, KAVANAGH, KRUEGER, LIU, MAY, MYRIE, PARKER,
   PERSAUD, RAMOS, SALAZAR, SANDERS, SEPULVEDA, SERRANO, STAVISKY, THOMAS
   -- read twice and ordered printed, and when printed to be committed to
   the Committee on Health -- committee discharged, bill amended, ordered
   reprinted as amended and recommitted to said  committee  --  committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee -- recommitted to the Committee on Health in accord-
   ance with Senate Rule 6, sec. 8 -- 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.
   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:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD00481-07-2
              

 S. 2521--C                          2
 
   §  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.