Bill Text: NY A06027 | 2023-2024 | General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Relates to regulation of the billing by general hospitals and the distribution of funds from the general hospital indigent care pool; requires use of a uniform application form and policy.

Spectrum: Partisan Bill (Democrat 46-1)

Status: (Introduced - Dead) 2024-01-03 - referred to health [A06027 Detail]

Download: New_York-2023-A06027-Introduced.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                          6027

                               2023-2024 Regular Sessions

                   IN ASSEMBLY

                                     March 30, 2023
                                       ___________

        Introduced  by M. of A. PAULIN, SEAWRIGHT, REYES, RAMOS, SIMON, EPSTEIN,
          BICHOTTE HERMELYN, STECK, MITAYNES, McDONOUGH, L. ROSENTHAL,  BENEDET-
          TO,  FORREST,  BURGOS,  GONZALEZ-ROJAS, RIVERA, GIBBS, KELLES, THIELE,
          ZINERMAN,  DE LOS SANTOS,  JACKSON,  JEAN-PIERRE  --  read  once   and
          referred to the Committee on Health

        AN ACT to amend the public health law, in relation to the general hospi-
          tal  indigent  care pool; and to repeal certain provisions of such law
          relating thereto

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:

     1    Section  1.  Subdivision 9 of section 2807-k of the public health law,
     2  as amended by section 17 of part B of chapter 60 of the laws of 2014, is
     3  amended to read as follows:
     4    9. In order for a general hospital to participate in the  distribution
     5  of  funds  from  the  pool, the general hospital must [implement minimum
     6  collection policies and procedures approved] use only the uniform finan-
     7  cial assistance policy and form provided by the commissioner.
     8    § 2.  Subdivision 9-a of section 2807-k of the public health  law,  as
     9  added by section 39-a of part A of chapter 57 of the laws of 2006, para-
    10  graph  (k) as added by section 43 of part B of chapter 58 of the laws of
    11  2008, is amended to read as follows:
    12    9-a. (a) (i) As a condition for participation  in  pool  distributions
    13  authorized  pursuant  to  this  section and section twenty-eight hundred
    14  seven-w of this article for periods on  and  after  January  first,  two
    15  thousand  nine,  general  hospitals  shall, effective for periods on and
    16  after January first,  two  thousand  seven,  establish  financial  [aid]
    17  assistance policies and procedures, in accordance with the provisions of
    18  this  subdivision, for reducing hospital charges otherwise applicable to
    19  low-income individuals without third-party health [insurance]  coverage,
    20  or  who  have  [exhausted their] third-party health [insurance benefits]
    21  coverage that does not cover or limits coverage of the service, and  who

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02400-01-3
        A. 6027                             2

     1  can  demonstrate  an  inability  to  pay  full charges, and also, at the
     2  hospital's discretion, for reducing or  discounting  the  collection  of
     3  co-pays  and  deductible  payments from those individuals who can demon-
     4  strate an inability to pay such amounts. Immigration status shall not be
     5  an  eligibility  criterion  for  the  purpose  of  determining financial
     6  assistance under this section.
     7    (ii) A general hospital may use the New York state of  health  market-
     8  place  eligibility  determination page to establish the patient's house-
     9  hold income and residency in lieu of  the  financial  application  form,
    10  provided  it  has secured the consent of the patient. A general hospital
    11  shall not require a patient to apply for coverage through the  New  York
    12  state  of  health  marketplace  in  order  to  receive care or financial
    13  assistance.
    14    (iii) Upon submission of a completed application form, the patient  is
    15  not liable for any bills until the general hospital has rendered a deci-
    16  sion on the application in accordance with this subdivision.
    17    (b)  [Such]  The  reductions  from  charges  for  [uninsured] patients
    18  described in paragraph (a) of this subdivision with  incomes  below  [at
    19  least  three]  six  hundred  percent  of the federal poverty level shall
    20  result in a charge to such individuals that does not exceed [the greater
    21  of] the amount that would have been paid for the same services  [by  the
    22  "highest  volume payor" for such general hospital as defined in subpara-
    23  graph (v) of this paragraph, or for services provided pursuant to  title
    24  XVIII  of  the  federal social security act (medicare), or for services]
    25  provided pursuant to title [XIX] XVIII of the  federal  social  security
    26  act  [(medicaid)]  (medicare),  and provided further that such [amounts]
    27  amount shall be adjusted according to income level as follows:
    28    (i) For patients with incomes at or below [at least one]  two  hundred
    29  percent of the federal poverty level, the hospital shall collect no more
    30  than a nominal payment amount, consistent with guidelines established by
    31  the commissioner[;].
    32    (ii)  For  patients  with  incomes  [between  at  least one] above two
    33  hundred [one] percent and [one] up to four hundred  [fifty]  percent  of
    34  the  federal  poverty level, the hospital shall collect no more than the
    35  amount identified after application of a proportional sliding fee sched-
    36  ule under which patients with lower incomes shall pay the lowest amount.
    37  [Such] The schedule shall provide  that  the  amount  the  hospital  may
    38  collect  for  [such  patients]  the  patient  increases from the nominal
    39  amount described in subparagraph (i) of this paragraph in  equal  incre-
    40  ments  as the income of the patient increases, up to a maximum of twenty
    41  percent of the [greater of the] amount that would have been paid for the
    42  same services [by the "highest volume payor" for such general  hospital,
    43  as  defined  in  subparagraph  (v)  of  this  paragraph, or for services
    44  provided pursuant to title XVIII of  the  federal  social  security  act
    45  (medicare)  or  for  services] provided pursuant to title [XIX] XVIII of
    46  the federal social security act [(medicaid);] (medicare).
    47    (iii) [For patients with incomes between at least one  hundred  fifty-
    48  one  percent and two hundred fifty percent of the federal poverty level,
    49  the hospital shall collect no more  than  the  amount  identified  after
    50  application  of a proportional sliding fee schedule under which patients
    51  with lower income shall pay the  lowest  amounts.  Such  schedule  shall
    52  provide  that  the  amount  the  hospital  may collect for such patients
    53  increases from the twenty percent figure described in subparagraph  (ii)
    54  of  this  paragraph  in  equal  increments  as the income of the patient
    55  increases, up to a maximum of the greater of the amount that would  have
    56  been  paid  for the same services by the "highest volume payor" for such
        A. 6027                             3

     1  general hospital, as defined in subparagraph (v) of this  paragraph,  or
     2  for  services  provided  pursuant  to  title XVIII of the federal social
     3  security act (medicare) or for services provided pursuant to  title  XIX
     4  of the federal social security act (medicaid); and
     5    (iv)]  For  patients with incomes [between at least two hundred fifty-
     6  one percent and three hundred] above four hundred percent and up to  six
     7  hundred percent of the federal poverty level, the hospital shall collect
     8  no  more  than the [greater of the] amount that would have been paid for
     9  the same services [by the "highest volume payor" for such general hospi-
    10  tal as defined in subparagraph (v) of this paragraph,  or  for  services
    11  provided  pursuant  to  title  XVIII  of the federal social security act
    12  (medicare), or for services] provided pursuant to title [XIX]  XVIII  of
    13  the federal social security act [(medicaid)] (medicare).
    14    [(v)  For the purposes of this paragraph, "highest volume payor" shall
    15  mean the insurer, corporation or  organization  licensed,  organized  or
    16  certified  pursuant  to  article thirty-two, forty-two or forty-three of
    17  the insurance law or article forty-four of this chapter, or other third-
    18  party payor, which has  a  contract  or  agreement  to  pay  claims  for
    19  services  provided  by  the  general  hospital  and incurred the highest
    20  volume of claims in the previous calendar year.
    21    (vi) A hospital may implement policies and procedures to  permit,  but
    22  not  require, consideration on a case-by-case basis of exceptions to the
    23  requirements described in subparagraphs (i) and (ii) of  this  paragraph
    24  based upon the existence of significant assets owned by the patient that
    25  should  be  taken  into  account  in determining the appropriate payment
    26  amount for that patient's care, provided, however,  that  such  proposed
    27  policies  and  procedures  shall  be  subject  to  the  prior review and
    28  approval of the commissioner and, if approved, shall be included in  the
    29  hospital's  financial  assistance  policy  established  pursuant to this
    30  section, and provided further that, if such  approval  is  granted,  the
    31  maximum amount that may be collected shall not exceed the greater of the
    32  amount  that  would have been paid for the same services by the "highest
    33  volume payor" for such general hospital as defined in  subparagraph  (v)
    34  of  this  paragraph, or for services provided pursuant to title XVIII of
    35  the federal social security act (medicare),  or  for  services  provided
    36  pursuant  to title XIX of the federal social security act (medicaid). In
    37  the event that a general hospital reviews a patient's assets  in  deter-
    38  mining  payment  adjustments  such  policies  and  procedures  shall not
    39  consider as assets a patient's primary residence, assets held in a  tax-
    40  deferred  or  comparable  retirement  savings  account,  college savings
    41  accounts, or cars used  regularly  by  a  patient  or  immediate  family
    42  members.
    43    (vii)]  (c) Nothing in this [paragraph] subdivision shall be construed
    44  to limit a hospital's  ability  to  establish  patient  eligibility  for
    45  payment  discounts  at  income levels higher than those specified herein
    46  and/or to provide greater payment discounts for eligible  patients  than
    47  those required by this [paragraph] subdivision.
    48    [(c)] (d) Such policies and procedures shall be clear, understandable,
    49  in  writing  and  publicly  available  in  summary form and each general
    50  hospital participating in the pool shall ensure that  every  patient  is
    51  made aware of the existence of [such] the policies and procedures and is
    52  provided,  in  a timely manner, with a summary and a copy of [such poli-
    53  cies and procedures] the policy  and  form  upon  request.  Any  summary
    54  provided  to  patients shall, at a minimum, include specific information
    55  as to income levels used to  determine  eligibility  for  assistance,  a
    56  description of the primary service area of the hospital and the means of
        A. 6027                             4

     1  applying  for  assistance.  [For general hospitals with twenty-four hour
     2  emergency departments, such policies and procedures] A general  hospital
     3  shall  [require the notification of patients] notify patients by provid-
     4  ing  written  materials  to patients or their authorized representatives
     5  during the intake and  registration  process,  through  the  conspicuous
     6  posting of language-appropriate information in the general hospital, and
     7  by  including information on bills and statements sent to patients, that
     8  financial [aid] assistance may be available to  qualified  patients  and
     9  how  to  obtain  further  information.  [For specialty hospitals without
    10  twenty-four hour emergency departments,  such  notification  shall  take
    11  place  through  written materials provided to patients during the intake
    12  and registration process prior to  the  provision  of  any  health  care
    13  services  or procedures, and through information on bills and statements
    14  sent to patients, that financial  aid  may  be  available  to  qualified
    15  patients  and  how  to obtain further information. Application materials
    16  shall include a notice to patients that upon submission of  a  completed
    17  application, including any information or documentation needed to deter-
    18  mine  the  patient's  eligibility  pursuant  to the hospital's financial
    19  assistance policy, the patient may disregard any bills until the  hospi-
    20  tal  has  rendered a decision on the application in accordance with this
    21  paragraph] General hospitals shall post the financial assistance  appli-
    22  cation  policy,  procedures  and  form,  and a summary of the policy and
    23  procedures, in a conspicuous  location  and  downloadable  form  on  the
    24  general hospital's website.
    25    [(d)  Such]  (e)  The hospital's application materials shall include a
    26  notice to patients that upon submission of a completed application form,
    27  the patient shall not be liable for any bills until the general hospital
    28  has rendered a decision on  the  application  in  accordance  with  this
    29  subdivision.   The application materials shall include specific informa-
    30  tion as the income levels used to determine  eligibility  for  financial
    31  assistance,  a  description  of the primary service area of the hospital
    32  and the means to apply for assistance. Nothing in this subdivision shall
    33  be construed as precluding the use of presumptive  eligibility  determi-
    34  nations  by hospitals on behalf of patients. The policies and procedures
    35  shall include clear, objective  criteria  for  determining  a  patient's
    36  ability  to  pay  and for providing such adjustments to payment require-
    37  ments as are necessary. In addition to  adjustment  mechanisms  such  as
    38  sliding  fee  schedules  and discounts to fixed standards, such policies
    39  and procedures shall also provide for the use of installment  plans  for
    40  the  payment  of  outstanding  balances  by  patients  pursuant  to  the
    41  provisions of the hospital's financial assistance  policy.  The  monthly
    42  payment  under  such  a  plan shall not exceed [ten] five percent of the
    43  gross monthly income of the patient[, provided, however, that if patient
    44  assets are considered under such a policy, then patient assets which are
    45  not excluded assets pursuant to subparagraph (vi) of  paragraph  (b)  of
    46  this  subdivision  may be considered in addition to the limit on monthly
    47  payments]. Installment plan payments may not be required to begin before
    48  one hundred eighty days after the date  of  the  service  or  discharge,
    49  whichever  is later. The policy shall allow the patient and the hospital
    50  to mutually agree to modify the terms of an installment plan.  The  rate
    51  of  interest charged to the patient on the unpaid balance, if any, shall
    52  not exceed [the rate for a ninety-day  security  issued  by  the  United
    53  States  Department of Treasury, plus .5 percent] two percentum per annum
    54  and no plan shall include an accelerator or similar clause under which a
    55  higher rate of interest is triggered upon a missed payment.   [If  such]
    56  The policies and procedures shall not include a requirement of a deposit
        A. 6027                             5

     1  prior to [non-emergent,] medically-necessary care[, such deposit must be
     2  included  as  part  of  any financial aid consideration].   The hospital
     3  shall refund any payments made by the patient before  the  determination
     4  of  eligibility  for  financial  assistance  that  exceeds the patient's
     5  liability after discounts are  applied.  Such  policies  and  procedures
     6  shall be applied consistently to all eligible patients.
     7    [(e) Such policies and procedures shall permit patients to] (f) In any
     8  legal  action  by  or on behalf of a hospital to collect a medical debt,
     9  the complaint shall be accompanied by an  affidavit  by  the  hospital's
    10  chief  financial  officer  stating  that  on  information and belief the
    11  patient does not meet the income or  residency  criteria  for  financial
    12  assistance. Patients may apply for financial assistance [within at least
    13  ninety  days  of the date of discharge or date of service and provide at
    14  least twenty days for patients to submit a completed application] at any
    15  time during the collection process, including after the commencement  of
    16  a  medical  debt  court action or upon the plaintiff obtaining a default
    17  judgment. A hospital may use credit scoring software for the purposes of
    18  establishing income eligibility and approving financial assistance,  but
    19  only  if the hospital makes clear to the patient that providing a social
    20  security number is not mandatory and the  scoring  does  not  negatively
    21  impact  the  patient's  credit score.   However, credit scoring software
    22  shall not be solely relied upon by the hospital in denying  a  patient's
    23  application  for  financial assistance.   [Such] The policies and proce-
    24  dures [may require that] shall allow patients seeking  [payment  adjust-
    25  ments]  financial  assistance  to  provide  [appropriate]  the following
    26  financial information and documentation in  support  of  their  applica-
    27  tion[,  provided,  however,  that  such application process shall not be
    28  unduly burdensome or complex]: pay checks  or  pay  stubs;  unemployment
    29  documentation;  social security income; rent receipts; a letter from the
    30  patient's employer attesting to the patient's gross income; or, if  none
    31  of  the  aforementioned  information  and documentation are available, a
    32  written self-attestation of the patient's income may  be  used.  General
    33  hospitals  shall,  upon  request,  assist  patients in understanding the
    34  hospital's application and form, policies and procedures and in applying
    35  for payment adjustments. Application forms shall be printed  and  posted
    36  to  its  website  in  the  "primary languages" of patients served by the
    37  general  hospital.  For  the  purposes  of  this   paragraph,   "primary
    38  languages"  shall include any language that is either (i) used to commu-
    39  nicate, during at least five percent of patient visits  in  a  year,  by
    40  patients  who  cannot  speak,  read,  write  or  understand  the English
    41  language at the level of proficiency necessary  for  effective  communi-
    42  cation  with health care providers, or (ii) spoken by non-English speak-
    43  ing individuals comprising more than one percent of the primary hospital
    44  service area population, as  calculated  using  demographic  information
    45  available  from  the United States Bureau of the Census, supplemented by
    46  data from school systems. Decisions regarding such applications shall be
    47  made within thirty days of receipt of a  completed  application.  [Such]
    48  The  policies  and  procedures shall require that the hospital issue any
    49  [denial/approval] denial or approval of [such] the application in  writ-
    50  ing  with  information on how to appeal the denial and shall require the
    51  hospital to establish an appeals process under which  it  will  evaluate
    52  the  denial  of  an  application.  [Nothing in this subdivision shall be
    53  interpreted as prohibiting a hospital from making  the  availability  of
    54  financial  assistance  contingent  upon  the  patient first applying for
    55  coverage under title XIX of the social security act (medicaid) or anoth-
    56  er insurance program if, in the judgment of the  hospital,  the  patient
        A. 6027                             6

     1  may  be eligible for medicaid or another insurance program, and upon the
     2  patient's cooperation in following the hospital's  financial  assistance
     3  application  requirements, including the provision of information needed
     4  to  make a determination on the patient's application in accordance with
     5  the hospital's financial assistance policy] The  hospital  shall  inform
     6  patients  on  how  to  file  a  complaint against the hospital or a debt
     7  collector that is contracted on behalf of  the  hospital  regarding  the
     8  patient's bill.
     9    [(f) Such] (g) The policies and procedures shall provide that patients
    10  with  incomes  below  [three] six hundred percent of the federal poverty
    11  level are deemed [presumptively] eligible for  payment  adjustments  and
    12  shall  conform  to  the  requirements set forth in paragraph (b) of this
    13  subdivision, provided, however, that nothing in this  subdivision  shall
    14  be  interpreted  as  precluding  hospitals  from  extending such payment
    15  adjustments to other patients, either generally  or  on  a  case-by-case
    16  basis.  [Such] The policies and procedures shall provide financial [aid]
    17  assistance for emergency hospital services, including  emergency  trans-
    18  fers  pursuant  to  the  federal  emergency medical treatment and active
    19  labor act (42 USC 1395dd), to patients who reside in New York state  and
    20  for medically necessary hospital services for patients who reside in the
    21  hospital's  primary  service  area  as  determined according to criteria
    22  established by the commissioner. In developing [such] the criteria,  the
    23  commissioner  shall  consult with representatives of the hospital indus-
    24  try, health care consumer advocates and local public  health  officials.
    25  [Such]  The  criteria shall be made available to the public no less than
    26  thirty days prior to the date of implementation and shall, at a minimum:
    27    (i) prohibit a  hospital  from  developing  or  altering  its  primary
    28  service  area in a manner designed to avoid medically underserved commu-
    29  nities or communities with high percentages of uninsured residents;
    30    (ii) ensure that every geographic area of the state is included in  at
    31  least  one  general  hospital's  primary  service  area so that eligible
    32  patients may access care and financial assistance; and
    33    (iii) require the hospital to notify the commissioner upon making  any
    34  change  to its primary service area, and to include a description of its
    35  primary service area in  the  hospital's  annual  implementation  report
    36  filed  pursuant  to  subdivision  three  of section twenty-eight hundred
    37  three-l of this article.
    38    [(g)] (h) Nothing in this subdivision shall be interpreted as preclud-
    39  ing hospitals from extending payment adjustments for medically necessary
    40  non-emergency hospital services to patients outside  of  the  hospital's
    41  primary  service area. For patients determined to be eligible for finan-
    42  cial [aid] assistance under the terms of a  hospital's  financial  [aid]
    43  assistance policy, [such] the policies and procedures shall prohibit any
    44  limitations  on  financial  [aid]  assistance  for services based on the
    45  medical condition of the applicant, other than  typical  limitations  or
    46  exclusions  based  on  medical  necessity or the clinical or therapeutic
    47  benefit of a procedure or treatment.
    48    [(h) Such policies and procedures shall not permit the forced]  (i)  A
    49  hospital  or  its  agent  shall not issue, authorize or permit an income
    50  execution of a patient's wages, secure a lien or force a sale  or  fore-
    51  closure  of  a  patient's  primary  residence  in  order  to  collect an
    52  outstanding medical bill and shall [require the hospital to refrain from
    53  sending] not send an account to collection if the patient has  submitted
    54  a  completed  application  for  financial  [aid,  including any required
    55  supporting documentation] assistance, while the hospital determines  the
    56  patient's  eligibility  for [such aid] financial assistance.  [Such] The
        A. 6027                             7

     1  policies and procedures shall provide for  written  notification,  which
     2  shall include notification on a patient bill, to a patient not less than
     3  thirty  days  prior  to  the  referral of debts for collection and shall
     4  require that the collection agency obtain the hospital's written consent
     5  prior  to  commencing a legal action. [Such] The policies and procedures
     6  shall require all general hospital staff who interact with  patients  or
     7  have  responsibility for billing and collections to be trained in [such]
     8  the policies and procedures, and require the implementation of  a  mech-
     9  anism for the general hospital to measure its compliance with [such] the
    10  policies  and  procedures.    [Such]  The  policies and procedures shall
    11  require that any collection agency, lawyer or firm under contract with a
    12  general hospital for the  collection  of  debts  follow  the  hospital's
    13  financial assistance policy, including providing information to patients
    14  on  how  to apply for financial assistance where appropriate. [Such] The
    15  policies and procedures shall prohibit collections from a patient who is
    16  determined to be eligible for medical assistance [pursuant to title  XIX
    17  of  the  federal social security act] under title eleven of article five
    18  of the social services law at the time services were  rendered  and  for
    19  which services medicaid payment is available.
    20    [(i)]  (j)  Reports required to be submitted to the department by each
    21  general hospital as a condition for participation  in  the  pools[,  and
    22  which   contain,  in  accordance  with  applicable  regulations,]  shall
    23  contain: (i)  a  certification  from  an  independent  certified  public
    24  accountant  or  independent licensed public accountant or an attestation
    25  from a senior official of the hospital that the hospital is  in  compli-
    26  ance with conditions of participation in the pools[, shall also contain,
    27  for reporting periods on and after January first, two thousand seven:];
    28    [(i)] (ii) a report on hospital costs incurred and uncollected amounts
    29  in  providing  services to [eligible] patients [without insurance] found
    30  eligible for financial assistance, including the amount of care provided
    31  for a nominal payment amount, during the period covered by the report;
    32    [(ii)] (iii) hospital  costs  incurred  and  uncollected  amounts  for
    33  deductibles  and  coinsurance  for  eligible  patients with insurance or
    34  other third-party payor coverage;
    35    [(iii)] (iv) the number of patients,  organized  according  to  United
    36  States  postal service zip code, race, ethnicity and gender, who applied
    37  for financial assistance [pursuant to] under  the  hospital's  financial
    38  assistance  policy, and the number, organized according to United States
    39  postal service zip code, race, ethnicity and gender, whose  applications
    40  were approved and whose applications were denied;
    41    [(iv)]  (v) the reimbursement received for indigent care from the pool
    42  established [pursuant to] under this section;
    43    [(v)] (vi) the amount of funds that have  been  expended  on  [charity
    44  care]  financial  assistance  from  charitable  bequests  made or trusts
    45  established  for  the  purpose  of  providing  financial  assistance  to
    46  patients  who  are  eligible  in accordance with the terms of [such] the
    47  bequests or trusts;
    48    [(vi)] (vii) for hospitals located in  social  services  districts  in
    49  which  the district allows hospitals to assist patients with such appli-
    50  cations, the number of applications for eligibility for  medicaid  under
    51  title [XIX of the social security act (medicaid)] eleven of article five
    52  of  the  social  services  law  that  the  hospital assisted patients in
    53  completing and the number denied and approved;
    54    [(vii)] (viii) the hospital's financial losses resulting from services
    55  provided under medicaid; and
        A. 6027                             8

     1    [(viii)]  (ix)  the  number  of  referrals  to  collection  agents  or
     2  contracted  external collection vendors, court cases and liens placed on
     3  [the primary] any residences of patients through the collection  process
     4  used by a hospital.
     5    [(j)]  (k)  Within ninety days of the effective date of the chapter of
     6  the laws of two thousand twenty-three  which  amended  this  subdivision
     7  each  hospital  shall submit to the commissioner a written report on its
     8  policies and procedures for financial assistance to patients  which  are
     9  used  by the hospital [on the] as of such effective date [of this subdi-
    10  vision]. Such report shall include copies of  its  policies  and  proce-
    11  dures,  including  material  which  is  distributed  to  patients, and a
    12  description of the hospital's financial  aid  policies  and  procedures.
    13  Such  description  shall  include the income levels of patients on which
    14  eligibility is based, the financial aid eligible  patients  receive  and
    15  the means of calculating such aid, and the service area, if any, used by
    16  the hospital to determine eligibility.
    17    [(k)]  (l)  The  commissioner  shall  include the data collected under
    18  paragraph (j) of this subdivision in regular audits of the annual gener-
    19  al hospital institutional cost report.
    20    (m) In the event [it is determined by the commissioner that] the state
    21  [will be] is  unable  to  secure  all  necessary  federal  approvals  to
    22  include, as part of the state's approved state plan under title nineteen
    23  of  the  federal  social  security  act, a requirement[, as set forth in
    24  paragraph one of this subdivision,] that compliance with  this  subdivi-
    25  sion  is  a  condition of participation in pool distributions authorized
    26  pursuant to this section and section  twenty-eight  hundred  seven-w  of
    27  this  article, then such condition of participation shall be deemed null
    28  and void [and, notwithstanding]. Notwithstanding section twelve of  this
    29  chapter,  failure to comply with [the provisions of] this subdivision by
    30  a general hospital [on and after the date of such  determination]  shall
    31  make  [such]  the  hospital liable for a civil penalty not to exceed ten
    32  thousand dollars for each [such] violation. The imposition of [such] the
    33  civil penalties shall be subject to [the provisions of] section twelve-a
    34  of this chapter.
    35    (n) A hospital or its  collection  agents  shall  not  report  adverse
    36  information about a patient to a consumer or financial reporting entity,
    37  or  commence  civil  action  against  a patient or delegate a collection
    38  activity to a debt collector for nonpayment for one hundred eighty  days
    39  after  the  first  post-service bill is issued; and a hospital shall not
    40  report adverse information to a consumer reporting agency, or commence a
    41  civil action against a patient or delegate a collection  activity  to  a
    42  debt collector, if: the hospital was notified that an appeal or a review
    43  of a health insurance decision is pending within the immediately preced-
    44  ing  sixty  days; or the patient has a pending application for or quali-
    45  fied for financial assistance.  A hospital shall report the  fulfillment
    46  of  a  patient's  payment  obligation within thirty days after the obli-
    47  gation is fulfilled to a consumer or financial reporting entity to which
    48  the hospital had reported adverse information about the patient.
    49    § 3. Subdivision 9-a of section 2807-k of the  public  health  law  as
    50  amended by section two of this act, is amended to read as follows:
    51    9-a.  (a)  (i)  As a condition for participation in pool distributions
    52  authorized pursuant to this section  and  section  twenty-eight  hundred
    53  seven-w  of  this  article  for  periods on and after January first, two
    54  thousand nine, general hospitals shall, effective  for  periods  on  and
    55  after  January first, two thousand [seven, establish] twenty-five, adopt
    56  and implement the uniform financial assistance [policies and procedures,
        A. 6027                             9

     1  in accordance with the provisions of this subdivision,] form and policy,
     2  to be developed and issued by the commissioner. General hospitals  shall
     3  implement  the uniform policy and form for reducing hospital charges and
     4  charges  for  affiliated  providers  otherwise  applicable to low-income
     5  individuals without third-party health coverage, or who have third-party
     6  health coverage that does not cover or limits coverage of  the  service,
     7  and  who  can demonstrate an inability to pay full charges, and also, at
     8  the hospital's discretion, for reducing or discounting the collection of
     9  co-pays and deductible payments from those individuals  who  can  demon-
    10  strate an inability to pay such amounts. Immigration status shall not be
    11  an  eligibility  criterion  for  the  purpose  of  determining financial
    12  assistance under this section. As  used  in  this  section,  "affiliated
    13  provider"  means  a  provider that is: (A) employed by the hospital; (B)
    14  under a professional services agreement with  the  hospital;  or  (C)  a
    15  clinical  faculty member of a medical school or other school that trains
    16  individuals to be providers and that is affiliated with the hospital  or
    17  health system.
    18    (ii)  A  general hospital may use the New York state of health market-
    19  place eligibility determination page to establish the  patient's  house-
    20  hold  income  and  residency  in lieu of the financial application form,
    21  provided it has secured the consent of the patient. A  general  hospital
    22  shall  not  require a patient to apply for coverage through the New York
    23  state of health marketplace  in  order  to  receive  care  or  financial
    24  assistance.
    25    (iii)  Upon submission of a completed application form, the patient is
    26  not liable for any bills until the general hospital has rendered a deci-
    27  sion on the application in accordance with this subdivision.
    28    (b) The reductions from charges for patients  described  in  paragraph
    29  (a)  of  this  subdivision with incomes below six hundred percent of the
    30  federal poverty level shall result in a charge to such individuals  that
    31  does  not  exceed  the  amount  that  would  have been paid for the same
    32  services provided pursuant to title XVIII of the federal social security
    33  act (medicare), and provided further that such amount shall be  adjusted
    34  according to income level as follows:
    35    (i)  For  patients with incomes at or below two hundred percent of the
    36  federal poverty level, the hospital shall collect no more than a nominal
    37  payment amount, consistent with guidelines established  by  the  commis-
    38  sioner.
    39    (ii)  For  patients  with  incomes above two hundred percent and up to
    40  four hundred percent of the federal poverty level,  the  hospital  shall
    41  collect  no  more  than  the  amount  identified  after application of a
    42  proportional sliding  fee  schedule  under  which  patients  with  lower
    43  incomes shall pay the lowest amount. The schedule shall provide that the
    44  amount the hospital may collect for the patient increases from the nomi-
    45  nal  amount  described  in  subparagraph  (i) of this paragraph in equal
    46  increments as the income of the patient increases, up to  a  maximum  of
    47  twenty  percent  of  the  amount  that would have been paid for the same
    48  services provided pursuant to title XVIII of the federal social security
    49  act (medicare).
    50    (iii) For patients with incomes above four hundred percent and  up  to
    51  six  hundred  percent  of  the federal poverty level, the hospital shall
    52  collect no more than the amount that would have been paid for  the  same
    53  services provided pursuant to title XVIII of the federal social security
    54  act (medicare).
    55    (c)  Nothing  in this subdivision shall be construed to limit a hospi-
    56  tal's ability to establish patient eligibility for payment discounts  at
        A. 6027                            10

     1  income  levels  higher  than  those  specified  herein and/or to provide
     2  greater payment discounts for eligible patients than those  required  by
     3  this subdivision.
     4    (d)  [Such  policies and procedures shall be clear, understandable, in
     5  writing and publicly available in summary form and  each]  Each  general
     6  hospital  participating  in  the pool shall ensure that every patient is
     7  made aware of the existence of [the policies and procedures] the uniform
     8  financial assistance form and  policy  and  is  provided,  in  a  timely
     9  manner, with [a summary and] a copy of the policy and form upon request.
    10  [Any  summary provided to patients shall, at a minimum, include specific
    11  information as to  income  levels  used  to  determine  eligibility  for
    12  assistance,  a  description  of the primary service area of the hospital
    13  and the means of applying for  assistance.]  A  general  hospital  shall
    14  notify  patients  by  providing  written  materials to patients or their
    15  authorized representatives during the intake and  registration  process,
    16  through  the  conspicuous posting of language-appropriate information in
    17  the general hospital, and by including information on bills  and  state-
    18  ments  sent  to  patients, that financial assistance may be available to
    19  qualified patients and how to obtain further information. General hospi-
    20  tals shall post the uniform financial  assistance  application  policy[,
    21  procedures] and form, and a summary of the policy [and procedures], in a
    22  conspicuous  location  and  downloadable  form on the general hospital's
    23  website. The commissioner shall post the  uniform  financial  assistance
    24  form  and  policy  in  downloadable  form  on  the department's hospital
    25  profile page or any successor website.
    26    (e) The [hospital's] commissioner shall provide application  materials
    27  to  general hospitals, including the uniform financial assistance appli-
    28  cation form and policy. These  application  materials  shall  include  a
    29  notice to patients that upon submission of a completed application form,
    30  the patient shall not be liable for any bills until the general hospital
    31  has  rendered  a  decision  on  the  application in accordance with this
    32  subdivision.  The application materials shall include specific  informa-
    33  tion  as  the  income levels used to determine eligibility for financial
    34  assistance, a description of the primary service area  of  the  hospital
    35  and the means to apply for assistance. Nothing in this subdivision shall
    36  be  construed  as precluding the use of presumptive eligibility determi-
    37  nations by hospitals on behalf of patients.  The  [policies  and  proce-
    38  dures]  uniform  application form and policy shall include clear, objec-
    39  tive criteria for  determining  a  patient's  ability  to  pay  and  for
    40  providing  such adjustments to payment requirements as are necessary. In
    41  addition to adjustment mechanisms such  as  sliding  fee  schedules  and
    42  discounts to fixed standards, [such policies and procedures] the uniform
    43  policy  shall  also  provide  for  the  use of installment plans for the
    44  payment of outstanding balances by patients [pursuant to the  provisions
    45  of  the  hospital's  financial  assistance  policy]. The monthly payment
    46  under such a plan shall not exceed five percent  of  the  gross  monthly
    47  income  of the patient. Installment plan payments may not be required to
    48  begin before one hundred eighty days after the date of  the  service  or
    49  discharge,  whichever  is  later. The policy shall allow the patient and
    50  the hospital to mutually agree to modify the  terms  of  an  installment
    51  plan.    The  rate  of  interest  charged  to  the patient on the unpaid
    52  balance, if any, shall not exceed two percentum per annum  and  no  plan
    53  shall include an accelerator or similar clause under which a higher rate
    54  of interest is triggered upon a missed payment. The [policies and proce-
    55  dures] uniform policy shall not include a requirement of a deposit prior
    56  to medically-necessary care. The hospital shall refund any payments made
        A. 6027                            11

     1  by  the  patient  before  the determination of eligibility for financial
     2  assistance that exceeds the  patient's  liability  after  discounts  are
     3  applied.   Such policies and procedures shall be applied consistently to
     4  all eligible patients.
     5    (f)  In  any  legal  action by or on behalf of a hospital to collect a
     6  medical debt, the complaint shall be accompanied by an affidavit by  the
     7  hospital's  chief  financial  officer  stating  that  on information and
     8  belief the patient does not meet the income or  residency  criteria  for
     9  financial assistance. Patients may apply for financial assistance at any
    10  time  during the collection process, including after the commencement of
    11  a medical debt court action or upon the plaintiff  obtaining  a  default
    12  judgment. A hospital may use credit scoring software for the purposes of
    13  establishing  income eligibility and approving financial assistance, but
    14  only if the hospital makes clear to the patient that providing a  social
    15  security  number  is  not  mandatory and the scoring does not negatively
    16  impact the patient's credit score.   However,  credit  scoring  software
    17  shall  not  be solely relied upon by the hospital in denying a patient's
    18  application for financial  assistance.  The  [policies  and  procedures]
    19  uniform  policy  and form shall allow patients seeking financial assist-
    20  ance to provide the following financial information and documentation in
    21  support of their application:   pay checks or  pay  stubs;  unemployment
    22  documentation;  social security income; rent receipts; a letter from the
    23  patient's employer attesting to the patient's gross income; or, if  none
    24  of  the  aforementioned  information  and documentation are available, a
    25  written self-attestation of the patient's income may  be  used.  General
    26  hospitals  shall,  upon  request,  assist  patients in understanding the
    27  [hospital's application  and  form,  policies  and  procedures]  uniform
    28  financial  assistance  application  form  and policy and in applying for
    29  payment adjustments. [Application forms shall be printed and posted] The
    30  commissioner shall translate the uniform financial  assistance  applica-
    31  tion form and policy into the "primary languages" of each general hospi-
    32  tal.  Each  general hospital shall print and post these materials to its
    33  website in the "primary languages" of patients  served  by  the  general
    34  hospital.  For the purposes of this paragraph, "primary languages" shall
    35  include any language that is either (i) used to communicate,  during  at
    36  least  five  percent of patient visits in a year, by patients who cannot
    37  speak, read, write or understand the English language at  the  level  of
    38  proficiency  necessary  for  effective  communication  with  health care
    39  providers, or (ii) spoken by non-English speaking individuals comprising
    40  more than one percent of the primary hospital service  area  population,
    41  as  calculated  using  demographic information available from the United
    42  States Bureau of the Census, supplemented by data from  school  systems.
    43  Decisions  regarding  such applications shall be made within thirty days
    44  of receipt of a completed application.  The  [policies  and  procedures]
    45  uniform  financial  assistance  policy  shall  require that the hospital
    46  issue any denial or approval of the application in writing with informa-
    47  tion on how to appeal the denial  and  shall  require  the  hospital  to
    48  establish  an appeals process under which it will evaluate the denial of
    49  an application. The hospital shall inform patients  on  how  to  file  a
    50  complaint against the hospital or a debt collector that is contracted on
    51  behalf of the hospital regarding the patient's bill.
    52    (g)  The [policies and procedures] uniform financial assistance policy
    53  shall provide that patients with incomes below six  hundred  percent  of
    54  the  federal  poverty  level are deemed eligible for payment adjustments
    55  and shall conform to the requirements set forth in paragraph (b) of this
    56  subdivision, provided, however, that nothing in this  subdivision  shall
        A. 6027                            12

     1  be  interpreted  as  precluding  hospitals  from  extending such payment
     2  adjustments to other patients, either generally  or  on  a  case-by-case
     3  basis. The [policies and procedures] uniform policy shall provide finan-
     4  cial  assistance  for  emergency  hospital services, including emergency
     5  transfers pursuant to the federal emergency medical treatment and active
     6  labor act (42 USC 1395dd), to patients who reside in New York state  and
     7  for medically necessary hospital services for patients who reside in the
     8  hospital's  primary  service  area  as  determined according to criteria
     9  established by the commissioner. In developing the criteria, the commis-
    10  sioner shall consult with  representatives  of  the  hospital  industry,
    11  health  care  consumer  advocates and local public health officials. The
    12  criteria shall be made available to the public no less than thirty  days
    13  prior to the date of implementation and shall, at a minimum:
    14    (i)  prohibit  a  hospital  from  developing  or  altering its primary
    15  service area in a manner designed to avoid medically underserved  commu-
    16  nities or communities with high percentages of uninsured residents;
    17    (ii)  ensure that every geographic area of the state is included in at
    18  least one general hospital's  primary  service  area  so  that  eligible
    19  patients may access care and financial assistance; and
    20    (iii)  require the hospital to notify the commissioner upon making any
    21  change to its primary service area, and to include a description of  its
    22  primary  service  area  in  the  hospital's annual implementation report
    23  filed pursuant to subdivision  three  of  section  twenty-eight  hundred
    24  three-l of this article.
    25    (h)  Nothing  in  this  subdivision shall be interpreted as precluding
    26  hospitals from extending payment  adjustments  for  medically  necessary
    27  non-emergency  hospital  services  to patients outside of the hospital's
    28  primary service area. For patients determined to be eligible for  finan-
    29  cial  assistance under the terms of [a hospital's] the uniform financial
    30  assistance policy, the [policies and  procedures]  financial  assistance
    31  policy  shall  prohibit  any  limitations  on  financial  assistance for
    32  services based on the medical condition of  the  applicant,  other  than
    33  typical  limitations  or  exclusions  based  on medical necessity or the
    34  clinical or therapeutic benefit of a procedure or treatment.
    35    (i) A hospital or its agent shall not issue, authorize  or  permit  an
    36  income  execution of a patient's wages, secure a lien or force a sale or
    37  foreclosure of a patient's primary residence  in  order  to  collect  an
    38  outstanding  medical bill and shall not send an account to collection if
    39  the patient has submitted a completed application for financial  assist-
    40  ance, while the hospital determines the patient's eligibility for finan-
    41  cial  assistance.    The  [policies and procedures] uniform policy shall
    42  provide for written notification, which shall include notification on  a
    43  patient bill, to a patient not less than thirty days prior to the refer-
    44  ral of debts for collection and shall require that the collection agency
    45  obtain  the  hospital's  written  consent  prior  to  commencing a legal
    46  action.  The [policies and procedures] uniform policy shall require  all
    47  general hospital staff who interact with patients or have responsibility
    48  for  billing  and  collections to be trained in the [policies and proce-
    49  dures] policy, and require the implementation of  a  mechanism  for  the
    50  general hospital to measure its compliance with the [policies and proce-
    51  dures]  policy.  The  [policies  and  procedures]  uniform  policy shall
    52  require that any collection agency, lawyer or firm under contract with a
    53  general hospital for the collection of  debts  follow  the  [hospital's]
    54  uniform  financial assistance policy, including providing information to
    55  patients on how to apply for  financial  assistance  where  appropriate.
    56  The  [policies and procedures] uniform policy shall prohibit collections
        A. 6027                            13

     1  from a patient who is determined to be eligible for  medical  assistance
     2  under  title  eleven  of  article five of the social services law at the
     3  time services were rendered and for which services medicaid  payment  is
     4  available.
     5    (j) Reports required to be submitted to the department by each general
     6  hospital as a condition for participation in the pools shall contain:
     7    (i) a certification from an independent certified public accountant or
     8  independent  licensed  public accountant or an attestation from a senior
     9  official of the hospital that the hospital is in compliance with  condi-
    10  tions of participation in the pools;
    11    (ii)  a  report  on hospital costs incurred and uncollected amounts in
    12  providing services to patients found eligible for financial  assistance,
    13  including  the  amount  of  care  provided for a nominal payment amount,
    14  during the period covered by the report;
    15    (iii) hospital costs incurred and uncollected amounts for  deductibles
    16  and coinsurance for eligible patients with insurance or other third-par-
    17  ty payor coverage;
    18    (iv)  the  number  of  patients,  organized according to United States
    19  postal service zip code, race, ethnicity and  gender,  who  applied  for
    20  financial assistance under the [hospital's] uniform financial assistance
    21  policy,  and  the  number,  organized  according to United States postal
    22  service zip code, race, ethnicity and gender,  whose  applications  were
    23  approved and whose applications were denied;
    24    (v)  the reimbursement received for indigent care from the pool estab-
    25  lished under this section;
    26    (vi) the amount of funds that have been expended on financial  assist-
    27  ance from charitable bequests made or trusts established for the purpose
    28  of  providing  financial  assistance  to  patients  who  are eligible in
    29  accordance with the terms of the bequests or trusts;
    30    (vii) for hospitals located in social services districts in which  the
    31  district allows hospitals to assist patients with such applications, the
    32  number  of  applications for eligibility for medicaid under title eleven
    33  of article five of the social services law that  the  hospital  assisted
    34  patients in completing and the number denied and approved;
    35    (viii)   the  hospital's  financial  losses  resulting  from  services
    36  provided under medicaid; and
    37    (ix) the number  of  referrals  to  collection  agents  or  contracted
    38  external  collection  vendors, court cases and liens placed on any resi-
    39  dences of patients through the collection process used by a hospital.
    40    (k) [Within ninety days of the effective date of the  chapter  of  the
    41  laws  of  two  thousand twenty-three which amended this subdivision each
    42  hospital shall submit to the commissioner a written report on its  poli-
    43  cies  and procedures for financial assistance to patients which are used
    44  by the hospital as of such effective date.  Such  report  shall  include
    45  copies  of  its  policies  and  procedures,  including material which is
    46  distributed to patients, and a description of the  hospital's  financial
    47  aid  policies  and procedures. Such description shall include the income
    48  levels of patients on which eligibility  is  based,  the  financial  aid
    49  eligible patients receive and the means of calculating such aid, and the
    50  service area, if any, used by the hospital to determine eligibility.
    51    (l)] The commissioner shall include the data collected under paragraph
    52  (j) of this subdivision in regular audits of the annual general hospital
    53  institutional cost report.
    54    [(m)]  (l)  In  the  event the state is unable to secure all necessary
    55  federal approvals to include, as part of the state's approved state plan
    56  under title nineteen of the federal social security act,  a  requirement
        A. 6027                            14

     1  that compliance with this subdivision is a condition of participation in
     2  pool distributions authorized pursuant to this section and section twen-
     3  ty-eight hundred seven-w of this article, then such condition of partic-
     4  ipation shall be deemed null and void. Notwithstanding section twelve of
     5  this  chapter,  failure  to  comply  with  this subdivision by a general
     6  hospital shall make the hospital liable  for  a  civil  penalty  not  to
     7  exceed  ten  thousand  dollars for each violation. The imposition of the
     8  civil penalties shall be subject to section twelve-a of this chapter.
     9    [(n)] (m) A hospital or its collection agents shall not report adverse
    10  information about a patient to a consumer or financial reporting entity,
    11  or commence civil action against a  patient  or  delegate  a  collection
    12  activity  to a debt collector for nonpayment for one hundred eighty days
    13  after the first post-service bill is issued; and a  hospital  shall  not
    14  report adverse information to a consumer reporting agency, or commence a
    15  civil  action  against  a patient or delegate a collection activity to a
    16  debt collector, if: the hospital was notified that an appeal or a review
    17  of a health insurance decision is pending within the immediately preced-
    18  ing sixty days; or the patient has a pending application for  or  quali-
    19  fied  for financial assistance.  A hospital shall report the fulfillment
    20  of a patient's payment obligation within thirty  days  after  the  obli-
    21  gation is fulfilled to a consumer or financial reporting entity to which
    22  the hospital had reported adverse information about the patient.
    23    §  4.  Subdivision  14  of  section 2807-k of the public health law is
    24  REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions  14,
    25  15 and 16.
    26    §  5.  This  act  shall  take  effect immediately; provided   that (a)
    27  section two of this act shall take effect on the one  hundred  twentieth
    28  day  after it shall have become a law; and (b) sections one and three of
    29  this act shall take effect October 1, 2024 and apply to funding distrib-
    30  utions made on or after January 1, 2025.    Effective  immediately,  the
    31  commissioner  of  health  may  make  regulations  and take other actions
    32  reasonably necessary to implement sections one, two and  three  of  this
    33  act on their respective effective dates.