Bill Text: NY S01366 | 2023-2024 | General Assembly | Amended

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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 25-1)

Status: (Introduced) 2024-01-22 - REPORTED AND COMMITTED TO FINANCE [S01366 Detail]

Download: New_York-2023-S01366-Amended.html

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                STATE OF NEW YORK
        ________________________________________________________________________

                                         1366--B

                               2023-2024 Regular Sessions

                    IN SENATE

                                    January 11, 2023
                                       ___________

        Introduced  by  Sens. RIVERA, ASHBY, BRESLIN, CLEARE, COMRIE, FERNANDEZ,
          GALLIVAN,  GIANARIS,  GONZALEZ,  GOUNARDES,  HARCKHAM,  HOYLMAN-SIGAL,
          JACKSON,  KRUEGER,  LIU,  MAY,  MAYER, MYRIE, PERSAUD, RAMOS, SALAZAR,
          SANDERS, SEPULVEDA, SERRANO, WEBB -- read twice and  ordered  printed,
          and  when  printed  to  be  committed  to  the  Committee on Health --
          reported favorably from said committee, ordered to  first  and  second
          report,  ordered  to  a  third reading, amended and ordered reprinted,
          retaining its place in the order of third reading  --  recommitted  to
          the  Committee  on  Health in accordance 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 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 1 of subpart C of part Y of chapter 57 of the laws
     3  of 2023, is 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 by the commissioner, utiliz-
     7  ing] utilize only a uniform financial assistance policy and form  devel-
     8  oped  and  provided by the department. All general hospitals that do not
     9  participate in the indigent  care  pool  shall  also  utilize  only  the
    10  uniform  financial  assistance policy and form and otherwise comply with
    11  subdivision nine-a of this section governing the provision of  financial
    12  assistance and hospital collection procedures.
    13    §  2.   Subdivision 9-a of section 2807-k of the public health law, as
    14  added by section 39-a of part A of chapter 57 of the laws of 2006, para-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02400-06-4
        S. 1366--B                          2

     1  graph (k) as added by section 43 of part B of chapter 58 of the laws  of
     2  2008, is amended to read as follows:
     3    9-a.  (a)  (i)  As a condition for participation in pool distributions
     4  authorized pursuant to this section  and  section  twenty-eight  hundred
     5  seven-w  of  this  article  for  periods on and after January first, two
     6  thousand nine, general hospitals shall, effective  for  periods  on  and
     7  after  January first, two thousand [seven, establish] twenty-five, adopt
     8  and implement the uniform financial [aid  policies  and  procedures,  in
     9  accordance with the provisions of this subdivision,] assistance form and
    10  policy,  to  be  developed  and issued by the commissioner. This section
    11  shall apply to any general hospital including any  affiliated  providers
    12  or  entity  acting  on  the  general hospital's or affiliated provider's
    13  behalf, and shall include any third party or agent thereof if  the  debt
    14  is  transferred or sold.  As used in this section, "affiliated provider"
    15  means a provider that is billing for medical goods or services that were
    16  delivered at a general hospital that is: (A) employed by  the  hospital;
    17  (B)  under a professional services agreement with the hospital; or (C) a
    18  clinical faculty member of a medical school or other school that  trains
    19  individuals  to be providers and that is affiliated with the hospital or
    20  health system. General hospitals, shall implement the uniform policy and
    21  form for reducing general hospital charges otherwise applicable to  low-
    22  income  individuals  [without  health  insurance,  or who have exhausted
    23  their health insurance benefits, and] who can demonstrate  an  inability
    24  to  pay full charges, and also, at the hospital's discretion, for reduc-
    25  ing or discounting the collection of  co-pays  and  deductible  payments
    26  from  those  individuals  who  can  demonstrate an inability to pay such
    27  amounts. Immigration status shall not be an  eligibility  criterion  for
    28  the purpose of determining financial assistance under this section.
    29    (ii)  A  general hospital may use the New York state of health market-
    30  place eligibility determination page to establish the  patient's  house-
    31  hold  income  and  residency  in lieu of the financial application form,
    32  provided it has secured the consent of the patient. A  general  hospital
    33  shall  not  require a patient to apply for coverage through the New York
    34  state of health marketplace  in  order  to  receive  care  or  financial
    35  assistance.
    36    (iii)  Upon submission of a completed application form, the patient is
    37  not liable for any bills and no interest may accrue  until  the  general
    38  hospital  has  rendered a decision on the application in accordance with
    39  this subdivision.
    40    (b) [Such]  The  reductions  from  charges  for  [uninsured]  patients
    41  described  in  paragraph  (a) of this subdivision with incomes below [at
    42  least three] six hundred percent of  the  federal  poverty  level  shall
    43  result in a charge to such individuals that does not exceed [the greater
    44  of]  the  amount that would have been paid for the same services [by the
    45  "highest volume payor" for such general hospital as defined in  subpara-
    46  graph  (v) of this paragraph, or for services provided pursuant to title
    47  XVIII of the federal social security act (medicare),  or  for  services]
    48  provided  pursuant  to  title [XIX] XVIII of the federal social security
    49  act (medicaid), and provided further that such [amounts] amount shall be
    50  adjusted according to income level as follows:
    51    (i) For patients with incomes at or below [at least one]  two  hundred
    52  percent  of  the  federal  poverty level, the hospital shall [collect no
    53  more than a nominal payment amount, consistent  with  guidelines  estab-
    54  lished  by the commissioner] waive all charges. No nominal payment shall
    55  be collected;
        S. 1366--B                          3

     1    (ii) For patients with  incomes  [between  at  least  one]  above  two
     2  hundred  [one]  percent  and [one] up to four hundred [fifty] percent of
     3  the federal poverty level, the hospital shall collect no more  than  the
     4  amount identified after application of a proportional sliding fee sched-
     5  ule under which patients with lower incomes shall pay the lowest amount.
     6  [Such]  The  schedule  shall  provide  that  the amount the hospital may
     7  collect for [such patients]  the  patient  increases  from  the  nominal
     8  amount  described  in subparagraph (i) of this paragraph in equal incre-
     9  ments as the income of the patient increases, up to a maximum of  twenty
    10  percent of the [greater of the] amount that would have been paid for the
    11  same  services [by the "highest volume payor" for such general hospital,
    12  as defined in subparagraph  (v)  of  this  paragraph,  or  for  services
    13  provided  pursuant  to  title  XVIII  of the federal social security act
    14  (medicare) or for services] provided pursuant to title  [XIX]  XVIII  of
    15  the  federal social security act (medicaid). After receipt of thirty-six
    16  months of payment at the agreed upon amount, the patient's bill shall be
    17  considered paid in full and any and all  collection  activities  on  any
    18  balance that remains unpaid shall be prohibited;
    19    (iii)  [For  patients with incomes between at least one hundred fifty-
    20  one percent and two hundred fifty percent of the federal poverty  level,
    21  the  hospital  shall  collect  no  more than the amount identified after
    22  application of a proportional sliding fee schedule under which  patients
    23  with  lower  income  shall  pay  the lowest amounts. Such schedule shall
    24  provide that the amount the  hospital  may  collect  for  such  patients
    25  increases  from the twenty percent figure described in subparagraph (ii)
    26  of this paragraph in equal increments  as  the  income  of  the  patient
    27  increases,  up to a maximum of the greater of the amount that would have
    28  been paid for the same services by the "highest volume payor"  for  such
    29  general  hospital,  as defined in subparagraph (v) of this paragraph, or
    30  for services provided pursuant to title  XVIII  of  the  federal  social
    31  security  act  (medicare) or for services provided pursuant to title XIX
    32  of the federal social security act (medicaid); and
    33    (iv)] For patients with incomes [between at least two  hundred  fifty-
    34  one  percent and three hundred] above four hundred percent and up to six
    35  hundred percent of the federal poverty level, the hospital shall collect
    36  no more than the [greater of the] amount that would have been  paid  for
    37  the same services [by the "highest volume payor" for such general hospi-
    38  tal  as  defined  in subparagraph (v) of this paragraph, or for services
    39  provided pursuant to title XVIII of  the  federal  social  security  act
    40  (medicare),  or  for services] provided pursuant to title [XIX] XVIII of
    41  the federal social security  act  (medicaid).  After  receipt  of  sixty
    42  months of payment at the agreed upon amount, the patient's bill shall be
    43  considered  paid  in  full  and any and all collection activities on any
    44  balance that remains unpaid shall be prohibited.
    45    [(v) For the purposes of this paragraph, "highest volume payor"  shall
    46  mean  the  insurer,  corporation  or organization licensed, organized or
    47  certified pursuant to article thirty-two, forty-two  or  forty-three  of
    48  the insurance law or article forty-four of this chapter, or other third-
    49  party  payor,  which  has  a  contract  or  agreement  to pay claims for
    50  services provided by the  general  hospital  and  incurred  the  highest
    51  volume of claims in the previous calendar year.
    52    (vi)  A  hospital may implement policies and procedures to permit, but
    53  not require, consideration on a case-by-case basis of exceptions to  the
    54  requirements  described  in subparagraphs (i) and (ii) of this paragraph
    55  based upon the existence of significant assets owned by the patient that
    56  should be taken into account  in  determining  the  appropriate  payment
        S. 1366--B                          4

     1  amount  for  that  patient's care, provided, however, that such proposed
     2  policies and procedures  shall  be  subject  to  the  prior  review  and
     3  approval  of the commissioner and, if approved, shall be included in the
     4  hospital's  financial  assistance  policy  established  pursuant to this
     5  section, and provided further that, if such  approval  is  granted,  the
     6  maximum amount that may be collected shall not exceed the greater of the
     7  amount  that  would have been paid for the same services by the "highest
     8  volume payor" for such general hospital as defined in  subparagraph  (v)
     9  of  this  paragraph, or for services provided pursuant to title XVIII of
    10  the federal social security act (medicare),  or  for  services  provided
    11  pursuant  to title XIX of the federal social security act (medicaid). In
    12  the event that a general hospital reviews a patient's assets  in  deter-
    13  mining  payment  adjustments  such  policies  and  procedures  shall not
    14  consider as assets a patient's primary residence, assets held in a  tax-
    15  deferred  or  comparable  retirement  savings  account,  college savings
    16  accounts, or cars used  regularly  by  a  patient  or  immediate  family
    17  members.
    18    (vii)]  (c) Nothing in this [paragraph] subdivision shall be construed
    19  to limit a hospital's  ability  to  establish  patient  eligibility  for
    20  payment  discounts  at  income levels higher than those specified herein
    21  and/or to provide greater payment discounts for eligible  patients  than
    22  those required by this [paragraph] subdivision.
    23    [(c)  Such  policies and procedures shall be clear, understandable, in
    24  writing and publicly available in summary form and each] (d) Each gener-
    25  al hospital participating in the pool shall ensure that every patient is
    26  made aware of the  existence  of  [such  policies  and  procedures]  the
    27  uniform financial assistance form and policy and is provided, in a time-
    28  ly  manner,  with a [summary] copy of [such policies and procedures upon
    29  request] the policy and form at intake, admission, and discharge.   [Any
    30  summary  provided  to  patients  shall,  at  a minimum, include specific
    31  information as to  income  levels  used  to  determine  eligibility  for
    32  assistance,  a  description  of the primary service area of the hospital
    33  and the means of applying for assistance.  For  general  hospitals  with
    34  twenty-four  hour emergency departments, such policies and procedures] A
    35  plain language summary of the collections  process  must  also  be  made
    36  available.  A  general  hospital  shall  [require  the  notification  of
    37  patients] notify patients by providing written materials to patients  or
    38  their  authorized  representatives  during  the  intake and registration
    39  process, by making materials available in conspicuous locations  in  the
    40  hospital including emergency departments, waiting areas and other places
    41  patients  congregate, through the conspicuous posting of language-appro-
    42  priate information in the general hospital, and by including information
    43  on bills and statements sent to patients, that financial  [aid]  assist-
    44  ance  may  be  available to qualified patients and how to obtain further
    45  information. [For specialty hospitals without twenty-four hour emergency
    46  departments, such notification shall take place through written  materi-
    47  als  provided  to  patients  during  the intake and registration process
    48  prior to the provision of any health care services  or  procedures,  and
    49  through  information  on  bills  and  statements  sent to patients, that
    50  financial aid may be available to qualified patients and how  to  obtain
    51  further  information.  Application  materials  shall include a notice to
    52  patients that upon submission of a completed application, including  any
    53  information or documentation needed to determine the patient's eligibil-
    54  ity  pursuant to the hospital's financial assistance policy, the patient
    55  may disregard any bills until the hospital has rendered  a  decision  on
    56  the  application  in  accordance  with this paragraph] General hospitals
        S. 1366--B                          5

     1  shall post the uniform financial assistance application policy and form,
     2  and the summary of the collection process, in a conspicuous location and
     3  downloadable form on the general hospital's  website.  The  commissioner
     4  shall post the uniform financial assistance form and policy in download-
     5  able  form  on  the  department's hospital profile page or any successor
     6  website.
     7    [(d) Such polices and procedures] (e) The commissioner  shall  provide
     8  application materials to general hospitals, including the uniform finan-
     9  cial  assistance application form and policy.  These application materi-
    10  als shall include a  notice  to  patients  that  upon  submission  of  a
    11  completed  application  form,  the  patient  shall not be liable for any
    12  bills until the general hospital has rendered a decision on the applica-
    13  tion in accordance with  this  subdivision.  The  application  materials
    14  shall  include  specific information as the income levels used to deter-
    15  mine eligibility for financial assistance and the  means  to  apply  for
    16  assistance. Nothing in this subdivision shall be construed as precluding
    17  the use of presumptive eligibility determinations by hospitals on behalf
    18  of  patients.  The  uniform  application  form  and policy shall include
    19  clear, objective criteria for determining a patient's ability to pay and
    20  for providing such adjustments to payment requirements as are necessary.
    21  In addition to adjustment mechanisms such as sliding fee  schedules  and
    22  discounts to fixed standards, [such policies and procedures] the uniform
    23  policy  shall  also  provide  for  the  use of installment plans for the
    24  payment of outstanding balances by patients [pursuant to the  provisions
    25  of  the  hospital's  financial  assistance  policy]. The monthly payment
    26  under such a plan shall not exceed  [ten]  five  percent  of  the  gross
    27  monthly  income  of  the  patient[,  provided,  however, that if patient
    28  assets are considered under such a policy, then patient assets which are
    29  not excluded assets pursuant to subparagraph (vi) of  paragraph  (b)  of
    30  this  subdivision  may be considered in addition to the limit on monthly
    31  payments]. Installment plan payments may not be required to begin before
    32  one hundred eighty days after the date  of  the  service  or  discharge,
    33  whichever  is later. The policy shall allow the patient and the hospital
    34  to mutually agree to modify the terms of an installment plan.  The  rate
    35  of  interest charged to the patient on the unpaid balance, if any, shall
    36  not exceed [the rate for a ninety-day  security  issued  by  the  United
    37  States  Department of Treasury, plus .5 percent] two percentum per annum
    38  and no plan shall include an accelerator or similar clause under which a
    39  higher rate of interest is triggered upon a missed payment.    [If  such
    40  policies and procedures] The uniform policy shall not include a require-
    41  ment  of  a  deposit prior to [non-emergent,] medically-necessary care[,
    42  such deposit must be included as part of  any  financial  aid  consider-
    43  ation].    The  hospital  shall  refund any payments made by the patient
    44  before the determination of eligibility for  financial  assistance  that
    45  exceeds  the patient's liability after discounts are applied. Such poli-
    46  cies and procedures  shall  be  applied  consistently  to  all  eligible
    47  patients.
    48    [(e) Such policies and procedures shall permit patients to] (f) In any
    49  legal  action  by  or on behalf of a hospital to collect a medical debt,
    50  the complaint shall be accompanied by an  affidavit  by  the  hospital's
    51  chief  financial  officer stating that the hospital has taken reasonable
    52  steps to determine whether the patient qualifies for  financial  assist-
    53  ance  and  upon  information  and  belief  the patient does not meet the
    54  income or residency criteria  for  financial  assistance.  Patients  may
    55  apply  for financial assistance [within at least ninety days of the date
    56  of discharge or date of service and provide at  least  twenty  days  for
        S. 1366--B                          6

     1  patients  to  submit  a  completed  application]  at any time during the
     2  collection process, including after the commencement of a  medical  debt
     3  court  action  or  upon  the  plaintiff obtaining a default judgment.  A
     4  determination  that a patient is eligible for financial assistance shall
     5  be valid for a minimum of twelve months and will apply to all  outstand-
     6  ing  medical  bills.  A hospital may use credit scoring software for the
     7  purposes of establishing  income  eligibility  and  approving  financial
     8  assistance,  but  only  if  the hospital makes clear to the patient that
     9  providing a social security number is not mandatory and the scoring does
    10  not negatively impact the patient's credit score.  However, credit scor-
    11  ing software shall not be solely relied upon by the hospital in  denying
    12  a patient's application for financial assistance. Further, propensity to
    13  pay  scores may not disqualify patients who otherwise qualify for eligi-
    14  bility from receiving financial assistance. [Such  policies  and  proce-
    15  dures may require that] The uniform policy and form shall allow patients
    16  seeking [payment adjustments] financial assistance to provide [appropri-
    17  ate] the following financial information and documentation in support of
    18  their  application[,  provided,  however,  that such application process
    19  shall not be unduly burdensome or complex]: pay  checks  or  pay  stubs;
    20  unemployment  documentation;  social  security  income; rent receipts; a
    21  letter from the patient's employer  attesting  to  the  patient's  gross
    22  income;  documentation  of eligibility for other means-tested government
    23  benefits; or, if none of the aforementioned information  and  documenta-
    24  tion  are  available, a written self-attestation of the patient's income
    25  may be used. General hospitals shall[, upon  request,]  take  reasonable
    26  steps  to assist patients in understanding the [hospital's, policies and
    27  procedures] uniform policy and form, and in applying for payment adjust-
    28  ments. [Application forms  shall  be  printed]  The  commissioner  shall
    29  translate  the  uniform financial assistance application form and policy
    30  into the "primary languages" of  each  general  hospital.  Each  general
    31  hospital  shall  print  and  post  these materials to its website in the
    32  "primary languages" of patients served by the general hospital. For  the
    33  purposes  of  this  paragraph,  "primary  languages"  shall  include any
    34  language that is either (i) used to communicate, during  at  least  five
    35  percent of patient visits in a year, by patients who cannot speak, read,
    36  write  or  understand  the  English language at the level of proficiency
    37  necessary for effective communication with  health  care  providers,  or
    38  (ii)   spoken  by  [non-English]  limited-English  speaking  individuals
    39  comprising more than one percent of the primary  hospital  service  area
    40  population,  as  calculated using demographic information available from
    41  the United States Bureau of the Census, supplemented by data from school
    42  systems. Decisions regarding such  applications  shall  be  made  within
    43  thirty  days  of  receipt of a completed application. [Such policies and
    44  procedures] The uniform financial assistance policy shall  require  that
    45  the  hospital  issue  any [denial/approval] denial or approval of [such]
    46  the application in writing which  clearly  communicates  the  amount  of
    47  assistance  granted,  any  amounts still owed with information on how to
    48  appeal the [denial] decision and shall require the hospital to establish
    49  an appeals process under which it will evaluate the [denial of] decision
    50  about an application. Nothing in this subdivision shall [be  interpreted
    51  as  prohibiting  a  hospital  from  making the availability of financial
    52  assistance contingent upon the patient first applying for coverage under
    53  title XIX of the social security act  (medicaid)  or  another  insurance
    54  program if, in the judgment of the hospital, the patient may be eligible
    55  for  medicaid or another insurance program, and upon the patient's coop-
    56  eration in following the  hospital's  financial  assistance  application
        S. 1366--B                          7

     1  requirements,  including  the  provision of information needed to make a
     2  determination on the patient's application in accordance with the hospi-
     3  tal's financial assistance policy] prevent a hospital from informing and
     4  assisting  a  patient  with an application for health insurance coverage
     5  with a local services district or the marketplace. A hospital shall  not
     6  make  the  availability  of  financial  assistance  contingent  upon the
     7  patient's application for health insurance coverage.  The hospital shall
     8  inform patients on how to file a complaint against  the  hospital  or  a
     9  debt  collector  that  is contracted on behalf of the hospital regarding
    10  the patient's bill.  General hospitals are required to  take  reasonable
    11  measures  to determine if a patient  is  eligible  for financial assist-
    12  ance including prior to making a referral to a third-party debt  collec-
    13  tor or  other extraordinary collections measures.
    14    [(f)  Such  policies and procedures] (g) The uniform financial assist-
    15  ance policy shall provide that patients with incomes below  [three]  six
    16  hundred  percent of the federal poverty level are deemed [presumptively]
    17  eligible for payment adjustments and shall conform to  the  requirements
    18  set  forth in paragraph (b) of this subdivision, provided, however, that
    19  nothing in this subdivision shall be interpreted as precluding hospitals
    20  from extending such payment adjustments to other patients, either gener-
    21  ally or on a case-by-case basis. [Such  policies  and  procedures  shall
    22  provide  financial  aid for emergency hospital services, including emer-
    23  gency transfers pursuant to the federal emergency medical treatment  and
    24  active  labor  act  (42  USC 1395dd), to patients who reside in New York
    25  state and for medically necessary hospital  services  for  patients  who
    26  reside in the hospital's primary service area as determined according to
    27  criteria  established  by the commissioner. In developing such criteria,
    28  the commissioner shall consult  with  representatives  of  the  hospital
    29  industry,  health  care consumer advocates and local public health offi-
    30  cials. Such criteria shall be made available to the public no less  than
    31  thirty days prior to the date of implementation and shall, at a minimum:
    32    (i)  prohibit  a  hospital  from  developing  or  altering its primary
    33  service area in a manner designed to avoid medically underserved  commu-
    34  nities or communities with high percentages of uninsured residents;
    35    (ii)  ensure that every geographic area of the state is included in at
    36  least one general hospital's  primary  service  area  so  that  eligible
    37  patients may access care and financial assistance; and
    38    (iii)  require the hospital to notify the commissioner upon making any
    39  change to its primary service area, and to include a description of  its
    40  primary  service  area  in  the  hospital's annual implementation report
    41  filed pursuant to subdivision  three  of  section  twenty-eight  hundred
    42  three-l of this article.
    43    [(g)] (h) Nothing in this subdivision shall be interpreted as preclud-
    44  ing hospitals from extending payment adjustments for medically necessary
    45  non-emergency  hospital  services  to patients outside of the hospital's
    46  primary service area.] For patients determined to be eligible for finan-
    47  cial [aid] assistance under the terms  of  [a  hospital's]  the  uniform
    48  financial  [aid]  assistance  policy, [such policies and procedures] the
    49  uniform financial assistance policy shall prohibit  any  limitations  on
    50  financial  [aid]  assistance for services based on the medical condition
    51  of the applicant, other than typical limitations or exclusions based  on
    52  medical  necessity or the clinical or therapeutic benefit of a procedure
    53  or treatment.
    54    [(h) Such policies and procedures shall not permit the forced]  (i)  A
    55  hospital  or its agent shall not commence a legal action or force a sale
    56  or foreclosure of a patient's primary residence in order to  collect  an
        S. 1366--B                          8

     1  outstanding medical bill and shall [require the hospital to refrain from
     2  sending] not send an account to collection [if the patient has submitted
     3  a  completed  application  for  financial  aid,  including  any required
     4  supporting  documentation,  while  the hospital determines the patient's
     5  eligibility for such aid] until the hospital  has  determined  that  the
     6  patient  is  not  eligible for financial assistance.  [Such policies and
     7  procedures] The uniform policy shall provide for  written  notification,
     8  which  shall  include  notification  on a patient bill, to a patient not
     9  less than thirty days prior to the referral of debts for collection  and
    10  shall  require  that the collection agency obtain the hospital's written
    11  consent prior to commencing a legal action. [Such  policies  and  proce-
    12  dures]  The  uniform policy shall require all general hospital staff who
    13  interact  with  patients  or  have  responsibility   for   billing   and
    14  collections  to be trained in [such policies and procedures] the uniform
    15  policy, and require the implementation of a mechanism  for  the  general
    16  hospital  to  measure its compliance with [such policies and procedures]
    17  the uniform policy. [Such policies and procedures]  The  uniform  policy
    18  shall  require that any collection agency, lawyer or firm under contract
    19  with a general hospital for the collection of debts follow  the  [hospi-
    20  tal's] uniform financial assistance policy, including providing informa-
    21  tion  to  patients on how to apply for financial assistance where appro-
    22  priate. [Such policies and procedures] The uniform policy shall prohibit
    23  collections from a patient who is determined to be eligible for  medical
    24  assistance  [pursuant  to  title XIX of the federal social security act]
    25  under title eleven of article five of the social  services  law  at  the
    26  time  services  were rendered and for which services medicaid payment is
    27  available.
    28    [(i)] (j) Reports required to be submitted to the department  by  each
    29  general  hospital  as  a  condition for participation in the pools[, and
    30  which  contain,  in  accordance  with  applicable  regulations,]   shall
    31  contain:  (i)  a  certification  from  an  independent  certified public
    32  accountant or independent licensed public accountant or  an  attestation
    33  from  a  senior official of the hospital that the hospital is in compli-
    34  ance with conditions of participation in the pools[, shall also contain,
    35  for reporting periods on and after January first, two thousand seven:];
    36    [(i)] (ii) a report on hospital costs incurred and uncollected amounts
    37  in providing services to [eligible] patients [without  insurance]  found
    38  eligible for financial assistance, including the amount of care provided
    39  for [a nominal payment amount] patients under two hundred percent pover-
    40  ty, during the period covered by the report;
    41    [(ii)]  (iii)  hospital  costs  incurred  and  uncollected amounts for
    42  deductibles and coinsurance for  eligible  patients  with  insurance  or
    43  other third-party payor coverage;
    44    [(iii)]  (iv)  the  number  of patients, organized according to United
    45  States postal service zip code, race, ethnicity and gender, who  applied
    46  for  financial  assistance  [pursuant to] under the [hospital's] uniform
    47  financial assistance policy, and  the  number,  organized  according  to
    48  United States postal service zip code, race, ethnicity and gender, whose
    49  applications were approved and whose applications were denied;
    50    [(iv)]  (v) the reimbursement received for indigent care from the pool
    51  established [pursuant to] under this section;
    52    [(v)] (vi) the amount of funds that have  been  expended  on  [charity
    53  care]  financial  assistance  from  charitable  bequests  made or trusts
    54  established  for  the  purpose  of  providing  financial  assistance  to
    55  patients  who  are  eligible  in accordance with the terms of [such] the
    56  bequests or trusts;
        S. 1366--B                          9

     1    [(vi)] (vii) for hospitals located in  social  services  districts  in
     2  which  the district allows hospitals to assist patients with such appli-
     3  cations, the number of applications for eligibility for  medicaid  under
     4  title [XIX of the social security act (medicaid)] eleven of article five
     5  of  the  social  services  law  that  the  hospital assisted patients in
     6  completing and the number denied and approved;
     7    [(vii)] (viii) the hospital's financial losses resulting from services
     8  provided under medicaid; and
     9    [(viii)]  (ix)  the  number  of  referrals  to  collection  agents  or
    10  contracted  external collection vendors, court cases and liens placed on
    11  [the primary] any residences of patients through the collection  process
    12  used by a hospital.
    13    [(j) Within ninety days of the effective date of this subdivision each
    14  hospital  shall submit to the commissioner a written report on its poli-
    15  cies and procedures for financial assistance to patients which are  used
    16  by  the  hospital on the effective date of this subdivision. Such report
    17  shall include copies of its policies and procedures, including  material
    18  which  is  distributed  to patients, and a description of the hospital's
    19  financial aid policies and procedures. Such  description  shall  include
    20  the  income levels of patients on which eligibility is based, the finan-
    21  cial aid eligible patients receive and the  means  of  calculating  such
    22  aid,  and  the  service  area, if any, used by the hospital to determine
    23  eligibility.]
    24    (k) The commissioner shall include the data collected under  paragraph
    25  (i) of this subdivision in regular audits of the annual general hospital
    26  institutional cost report.
    27    (1) In the event [it is determined by the commissioner that] the state
    28  [will  be]  is  unable  to  secure  all  necessary  federal approvals to
    29  include, as part of the state's approved state plan under title nineteen
    30  of the federal social security act, a  requirement[,  as  set  forth  in
    31  paragraph  one  of this subdivision,] that compliance with this subdivi-
    32  sion is a condition of participation in  pool  distributions  authorized
    33  pursuant  to  this  section  and section twenty-eight hundred seven-w of
    34  this article, then such condition of participation shall be deemed  null
    35  and  void [and, notwithstanding]. Notwithstanding section twelve of this
    36  chapter, failure to comply with [the provisions of] this subdivision  by
    37  a  general  hospital [on and after the date of such determination] shall
    38  make [such] the hospital liable for a civil penalty not  to  exceed  ten
    39  thousand dollars for each [such] violation. The imposition of [such] the
    40  civil penalties shall be subject to [the provisions of] section twelve-a
    41  of this chapter.
    42    (m)  A  hospital  or  its  collection agent shall not commence a civil
    43  action against a patient or delegate a collection  activity  to  a  debt
    44  collector  for  nonpayment  for  one hundred eighty days after the first
    45  post-service bill is issued and until a  hospital  has  made  reasonable
    46  efforts  to  determine whether a patient qualifies for financial assist-
    47  ance. A hospital or its collection agency,  lawyer  or  firm  shall  not
    48  commence  a  civil  action  against  a  patient or delegate a collection
    49  activity to a debt collector, if: the  hospital  was  notified  that  an
    50  appeal  or a review of a health insurance decision is pending within the
    51  immediately preceding sixty days; or the patient has a pending  applica-
    52  tion for or qualifies for financial assistance.
    53    §  3.  Subdivision  14  of  section 2807-k of the public health law is
    54  REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions  14,
    55  15 and 16.
    56    § 4. This act shall take effect January 1, 2025.