Bill Text: NY S06757 | 2019-2020 | General Assembly | Amended
Bill Title: Relates to medical billing and debt (Part A); relates to defining certain terms (Part B); relates to standardized consolidated itemized general hospital bills (Part C); relates to regulation of the billing of facility fees (Part D); relates to standardized patient financial liability forms (Part E); relates to an all payer database (Part F); relates to the general hospital indigent care pool; and repeals certain provisions of such law relating thereto (Part G); relates to the rate of interest in medical debt actions (Part H); relates to services rendered by a non-participating provider; relates to hospital statements of rights and responsibilities of patients (Part I).
Spectrum: Partisan Bill (Democrat 20-0)
Status: (Introduced - Dead) 2020-09-28 - PRINT NUMBER 6757A [S06757 Detail]
Download: New_York-2019-S06757-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 6757--A 2019-2020 Regular Sessions IN SENATE September 30, 2019 ___________ Introduced by Sens. RIVERA, KRUEGER, BRESLIN, BENJAMIN, BIAGGI, CARLUC- CI, COMRIE, GOUNARDES, HARCKHAM, HOYLMAN, JACKSON, KAPLAN, MAY, METZ- GER, MONTGOMERY, MYRIE, PERSAUD, SALAZAR, SANDERS -- read twice and ordered printed, and when printed to be committed to the Committee on Rules -- 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 medical billing and debt (Part A); to amend the public health law, in relation to defining certain terms (Part B); to amend the public health law, in relation to standardized consolidated itemized general hospital bills (Part C); to amend the public health law, in relation to regulation of the billing of facility fees (Part D); to amend the public health law, in relation to standardized patient financial liability forms (Part E); to amend the public health law, in relation to an all payer data- base (Part F); to amend the public health law, in relation to the general hospital indigent care pool; and to repeal certain provisions of such law relating thereto (Part G); to amend the civil practice law and rules, in relation to the rate of interest in medical debt actions (Part H); and to amend the financial services law, in relation to services rendered by a non-participating provider; and to amend the public health law, in relation to hospital statements of rights and responsibilities of patients (Part I) The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Short title. This act shall be known and may be cited as 2 the "patient medical debt protection act". 3 § 2. This act enacts into law major components of legislation which 4 relate to patient medical debt protection. Each component is wholly 5 contained within a Part identified as Parts A through I. The effective 6 date for each particular provision contained within such Part is set EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD13193-11-0S. 6757--A 2 1 forth in the last section of such Part. Any provision in any section 2 contained within a Part, including the effective date of the Part, which 3 makes reference to a section "of this act", when used in connection with 4 that particular component, shall be deemed to mean and refer to the 5 corresponding section of the Part in which it is found. Section four of 6 this act sets forth the general effective date of this act. 7 PART A 8 Section 1. Sections 2800 through 2827 of article 28 of the public 9 health law are designated title 1, and a new title 2 is added to article 10 28, to read as follows: 11 TITLE 2 12 MEDICAL BILLING AND DEBT 13 § 2. This act shall take effect immediately. 14 PART B 15 Section 1. Title 2 of article 28 of the public health law is amended 16 by adding a new section 2830 to read as follows: 17 § 2830. Definitions. As used in this title, the following terms shall 18 have the following meanings, unless the context clearly requires other- 19 wise: 20 1. "Affiliated provider" means a provider that is: (a) employed by a 21 hospital or health system, (b) under a professional services agreement 22 with a hospital or health system, or (c) a clinical faculty member of a 23 medical school or other school that trains individuals to be providers 24 that is affiliated with a hospital or health system. 25 2. "Campus" means: (a) the physical area immediately adjacent to a 26 hospital's main buildings and other areas and structures that are not 27 strictly contiguous to the main buildings but are located within two 28 hundred fifty yards of the main buildings, or (b) any other area that 29 has been determined on an individual case basis by the Centers for Medi- 30 care and Medicaid Services to be part of a hospital's campus. 31 3. "Facility fee" means any fee charged or billed by a hospital or 32 health system for inpatient or outpatient hospital services provided in 33 a hospital-based facility that is: (a) intended to compensate the hospi- 34 tal or health system for the operational expenses of the hospital or 35 health system, and (b) separate and distinct from a fee for patient-spe- 36 cific services, supplies and drugs; "facility fee" shall not include any 37 fee charged or billed by a residential health care facility. 38 4. "Health system" means a group of one or more hospitals and provid- 39 ers affiliated through ownership, governance, membership or other means. 40 5. "Hospital-based facility" means a facility that is owned or oper- 41 ated, in whole or in part, by a hospital or health system where hospital 42 or professional health care services, supplies or drugs are provided. 43 6. "Fee" means any fee charged or billed by a provider for profes- 44 sional health care services provided in a hospital-based facility. 45 7. "Provider" means an individual or entity, whether for profit or 46 nonprofit, whose primary purpose is to provide professional health care 47 services. 48 § 2. This act shall take effect immediately. 49 PART CS. 6757--A 3 1 Section 1. Title 2 of article 28 of the public health law is amended 2 by adding a new section 2831 to read as follows: 3 § 2831. Standardized consolidated itemized general hospital bills. 1. 4 After a patient's discharge or release from a general hospital, or 5 completion of a discrete course of treatment by a hospital-based facili- 6 ty, the facility shall provide to the patient or to the patient's survi- 7 vor or legal guardian, as appropriate, a consolidated itemized bill. 8 The initial consolidated itemized bill shall be provided no more than 9 seven days after the patient's discharge, or release or completion of 10 the episode or course of treatment, or after a request for such 11 bill, whichever is earlier. 12 2. The consolidated itemized bill shall: 13 (a) detail in plain language, comprehensible to an ordinary layperson 14 (consistent with accuracy), the specific nature of charges or expenses 15 incurred by the patient during the hospitalization or episode or course 16 of treatment and the date of each service; 17 (b) detail all services provided to the patient during the hospitali- 18 zation or episode or course of treatment, including all professional 19 services administered and supplies and drugs, contain a statement of 20 specific services received and expenses incurred by date and provider 21 for such items of service, enumerating in detail the constituent compo- 22 nents of the services received within each department of the facility 23 and including unit price data on rates charged; 24 (c) identify each item as paid, assigned to a third-party payer, or 25 expected payment by the patient; 26 (d) include the amount due, if any from the patient, including a due 27 date; 28 (e) for any amount paid or to be paid by the patient, indicate to 29 which person or entity an amount is due; 30 (f) not include any generalized category of expenses such as "other" 31 or "miscellaneous" or similar categories; 32 (g) list drugs by brand or generic name, even where drug code numbers 33 are used; 34 (h) specifically identify physical, rehabilitative, occupational, or 35 speech therapy treatment by date, type, and length of treatment when 36 such treatment is a part of the statement or bill; and 37 (i) prominently display the telephone number of the facility's patient 38 liaison responsible for expediting the resolution of any billing dispute 39 between the patient, or the patient's survivor or legal guardian, and 40 the billing department or departments. 41 3. A provider with any financial or contractual relationship with the 42 facility may not separately bill the patient or the patient's survivor 43 or legal guardian for such services, supplies or drugs. 44 4. Any subsequent bill provided to a patient or to the patient's 45 survivor or legal guardian, as appropriate, relating to the hospitaliza- 46 tion or episode or course of treatment must include all of the informa- 47 tion required under this section, in or enclosed with the bill or by 48 reference to a previous consolidated itemized bill, with any clearly 49 delineated revisions. 50 5. The consolidated itemized bill, shall be in a form developed by 51 the commissioner, in consultation with the superintendent of financial 52 services. 53 6. Each facility shall establish policies and procedures for review- 54 ing and responding to questions from patients concerning the patient's 55 consolidated itemized bill. The response shall be provided no more than 56 seven business days after the date a question is received. If theS. 6757--A 4 1 patient is not satisfied with the response, the facility shall provide 2 the patient with the contact information of the hospital department or 3 collection entity to which the issue shall be sent for review. 4 § 2. This act shall take effect one year after it shall have become a 5 law. 6 PART D 7 Section 1. Title 2 of article 28 of the public health law is amended 8 by adding a new section 2832 to read as follows: 9 § 2832. Regulation of the billing of facility fees. No hospital or 10 health system shall bill or seek payment from a patient for a facility 11 fee: 1. related to the provision of preventive care service as defined 12 by the United States Preventive Services Task Force; or 13 2. where the facility fee is not covered for the patient by a third- 14 party payer. 15 § 2. This act shall take effect on the one hundred eightieth day after 16 it shall have become a law. 17 PART E 18 Section 1. Title 2 of article 28 of the public health law is amended 19 by adding a new section 2833 to read as follows: 20 § 2833. Standardized patient financial liability forms. Every hospi- 21 tal, health system, hospital-based facility, affiliated provider or 22 other provider shall use the uniform patient financial liability form 23 which shall be developed by the commissioner. The form shall disclose 24 to the patient whether services, supplies and drugs provided to the 25 patient are in-network or out-of-network, whether the care is a covered 26 benefit by a third-party payer of the patient, and the nature and amount 27 of the patient's projected financial liability. A patient shall not be 28 financially liable for any service, supplies or drugs subject to this 29 title that is not charged or billed in accordance with this title. The 30 commissioner shall develop and issue the uniform financial liability 31 form within six months of the effective date of this section. The form 32 shall be adopted and used under this section by each hospital, health 33 system, hospital-based facility, affiliated provider and other provider 34 not later than sixty days after the commissioner issues the form. 35 § 2. This act shall take effect immediately. 36 PART F 37 Section 1. Subdivision 18-a of section 206 of the public health law is 38 amended by adding a new paragraph (e) to read as follows: 39 (e)(i) The commissioner shall ensure that the New York state all payer 40 database shall serve the interests of New York's health care consumers. 41 (ii) Every hospital licensed under article twenty-eight of this chap- 42 ter and health care professionals authorized under title eight of the 43 education law shall participate in the all payer database through their 44 insurance carrier contracts, and may participate in the all payer data- 45 base through any other of the hospital's third-party payer contracts. 46 (iii) Data that is required to be submitted to the all payer database 47 shall not be considered proprietary information for the purposes of 48 submission to or inclusion in the all payer database. 49 § 2. This act shall take effect on the one hundred eightieth day after 50 it shall have become a law.S. 6757--A 5 1 PART G 2 Section 1. Subdivisions 9 and 9-a of section 2807-k of the public 3 health law, subdivision 9 as amended by section 17 of part B of chapter 4 60 of the laws of 2014, subdivision 9-a as added by section 39-a of part 5 A of chapter 57 of the laws of 2006 and paragraph (k) of subdivision 9-a 6 as added by section 43 of part B of chapter 58 of the laws of 2008, are 7 amended to read as follows: 8 9. In order for a general hospital to participate in the distribution 9 of funds from the pool, the general hospital must [implement minimum10collection policies and procedures approved] use only the uniform finan- 11 cial assistance form provided by the commissioner. The definitions in 12 section twenty-eight hundred thirty of this article shall apply to this 13 subdivision and subdivision nine-a of this section. 14 9-a. (a) (i) As a condition for participation in pool distributions 15 authorized pursuant to this section and section twenty-eight hundred 16 seven-w of this article for periods on and after January first, two 17 thousand nine, general hospitals shall, effective for periods on and 18 after January first, two thousand [seven, establish] twenty-one, adopt 19 and implement the uniform financial [aid policies and procedures, in20accordance with the provisions of this subdivision] assistance form 21 policy, to be developed and issued by the commissioner no later than one 22 hundred eighty days after the effective date of a chapter of the laws of 23 two thousand twenty that amended this subdivision. No later than thirty 24 days after the issuance of the uniform financial assistance form and 25 policy, general hospitals shall implement such form and policy, for 26 reducing hospital charges and charges for affiliated providers otherwise 27 applicable to low-income individuals without third-party health [insur-28ance] coverage, or who have [exhausted their] third-party health [insur-29ance benefits] coverage that does not cover or limits coverage of the 30 service, and who can demonstrate an inability to pay full charges, and 31 also, at the hospital's discretion, for reducing or discounting the 32 collection of co-pays and deductible payments from those individuals who 33 can demonstrate an inability to pay such amounts. Immigration status 34 shall not be an eligibility criterion. 35 (ii) A general hospital may use the New York state of health market- 36 place eligibility determination page to establish the patient's house- 37 hold income and residency in lieu of the financial application form, 38 provided it has secured the consent of the patient. A general hospital 39 shall not require a patient to apply for coverage through the New York 40 state of health marketplace in order to receive care or financial 41 assistance. 42 (iii) Upon submission of a completed application form, the patient may 43 disregard any bills until the general hospital has rendered a decision 44 on the application in accordance with this paragraph. 45 (b) Such reductions from charges for [uninsured] patients described in 46 paragraph (a) of this subdivision with incomes below [at least three] 47 four hundred percent of the federal poverty level shall result in a 48 charge to such individuals that does not exceed [the greater of] the 49 amount that would have been paid for the same services [by the "highest50volume payor" for such general hospital as defined in subparagraph (v)51of this paragraph, or for services provided pursuant to title XVIII of52the federal social security act (medicare), or for services] provided 53 pursuant to title XIX of the federal social security act (medicaid), and 54 provided further that such amounts shall be adjusted according to income 55 level as follows:S. 6757--A 6 1 (i) For patients with incomes at or below [at least one] two hundred 2 percent of the federal poverty level, the hospital shall collect no more 3 than a nominal payment amount, consistent with guidelines established by 4 the commissioner[;]. 5 (ii) For patients with incomes between [at least one] two hundred one 6 percent and [one] four hundred [fifty] percent of the federal poverty 7 level, the hospital shall collect no more than the amount identified 8 after application of a proportional sliding fee schedule under which 9 patients with lower incomes shall pay the lowest amount. Such schedule 10 shall provide that the amount the hospital may collect for such patients 11 increases from the nominal amount described in subparagraph (i) of this 12 paragraph in equal increments as the income of the patient increases, up 13 to a maximum of twenty percent of the greater of the amount that would 14 have been paid for the same services [by the "highest volume payor" for15such general hospital, as defined in subparagraph (v) of this paragraph,16or for services provided pursuant to title XVIII of the federal social17security act (medicare) or for services] provided pursuant to title XIX 18 of the federal social security act (medicaid)[;]. 19 (iii) [For patients with incomes between at least one hundred fifty-20one percent and two hundred fifty percent of the federal poverty level,21the hospital shall collect no more than the amount identified after22application of a proportional sliding fee schedule under which patients23with lower income shall pay the lowest amounts. Such schedule shall24provide that the amount the hospital may collect for such patients25increases from the twenty percent figure described in subparagraph (ii)26of this paragraph in equal increments as the income of the patient27increases, up to a maximum of the greater of the amount that would have28been paid for the same services by the "highest volume payor" for such29general hospital, as defined in subparagraph (v) of this paragraph, or30for services provided pursuant to title XVIII of the federal social31security act (medicare) or for services provided pursuant to title XIX32of the federal social security act (medicaid); and33(iv)] For patients with incomes [between at least two hundred fifty-34one percent and three hundred] above four hundred one percent of the 35 federal poverty level, the hospital shall collect no more than the 36 greater of the amount that would have been paid for the same services 37 [by the "highest volume payor" for such general hospital as defined in38subparagraph (v) of this paragraph, or for services provided pursuant to39title XVIII of the federal social security act (medicare), or for40services] provided pursuant to title XIX of the federal social security 41 act (medicaid). 42 [(v) For the purposes of this paragraph, "highest volume payor" shall43mean the insurer, corporation or organization licensed, organized or44certified pursuant to article thirty-two, forty-two or forty-three of45the insurance law or article forty-four of this chapter, or other third-46party payor, which has a contract or agreement to pay claims for47services provided by the general hospital and incurred the highest48volume of claims in the previous calendar year.49(vi) A hospital may implement policies and procedures to permit, but50not require, consideration on a case-by-case basis of exceptions to the51requirements described in subparagraphs (i) and (ii) of this paragraph52based upon the existence of significant assets owned by the patient that53should be taken into account in determining the appropriate payment54amount for that patient's care, provided, however, that such proposed55policies and procedures shall be subject to the prior review and56approval of the commissioner and, if approved, shall be included in theS. 6757--A 7 1hospital's financial assistance policy established pursuant to this2section, and provided further that, if such approval is granted, the3maximum amount that may be collected shall not exceed the greater of the4amount that would have been paid for the same services by the "highest5volume payor" for such general hospital as defined in subparagraph (v)6of this paragraph, or for services provided pursuant to title XVIII of7the federal social security act (medicare), or for services provided8pursuant to title XIX of the federal social security act (medicaid). In9the event that a general hospital reviews a patient's assets in deter-10mining payment adjustments such policies and procedures shall not11consider as assets a patient's primary residence, assets held in a tax-12deferred or comparable retirement savings account, college savings13accounts, or cars used regularly by a patient or immediate family14members.15(vii)] (iv) Nothing in this paragraph shall be construed to limit a 16 hospital's ability to establish patient eligibility for payment 17 discounts at income levels higher than those specified herein and/or to 18 provide greater payment discounts for eligible patients than those 19 required by this paragraph. 20 (c) [Such policies and procedures shall be clear, understandable, in21writing and publicly available in summary form and each] Each general 22 hospital participating in the pool shall ensure that every patient is 23 made aware of the existence of such [policies and procedures] uniform 24 financial assistance form and policy and is provided, in a timely 25 manner, with a [summary] copy of such [policies and procedures] form and 26 policy upon request. [Any summary provided to patients shall, at a mini-27mum, include specific information as to income levels used to determine28eligibility for assistance, a description of the primary service area of29the hospital and the means of applying for assistance. For general30hospitals with twenty-four hour emergency departments, such policies and31procedures] A general hospital shall require the notification of 32 patients through written materials provided to patients during the 33 intake and registration process, through the conspicuous posting of 34 language-appropriate information in the general hospital, and informa- 35 tion on bills and statements sent to patients, that financial [aid] 36 assistance may be available to qualified patients and how to obtain 37 further information. [For specialty hospitals without twenty-four hour38emergency departments, such notification shall take place through writ-39ten materials provided to patients during the intake and registration40process prior to the provision of any health care services or proce-41dures, and through information on bills and statements sent to patients,42that financial aid may be available to qualified patients and how to43obtain further information. Application materials shall include a notice44to patients that upon submission of a completed application, including45any information or documentation needed to determine the patient's46eligibility pursuant to the hospital's financial assistance policy, the47patient may disregard any bills until the hospital has rendered a deci-48sion on the application in accordance with this paragraph] General 49 hospitals shall post the uniform financial assistance application form 50 and policy in a conspicuous location on the general hospital's website. 51 The commissioner shall likewise post the uniform financial assistance 52 form and policy on the department's hospital profile page related to the 53 general hospital's or any successor website. 54 (d) The commissioner shall provide application materials to general 55 hospitals, including the uniform financial assistance application form 56 and policy. These application materials shall include a notice toS. 6757--A 8 1 patients that upon submission of a completed application form, the 2 patient may disregard any bills until the general hospital has rendered 3 a decision on the application in accordance with this paragraph. The 4 application materials shall include specific information as the income 5 levels used to determine eligibility for financial assistance, a 6 description of the primary service area of the hospital and the means to 7 apply for assistance. Such policies and procedures shall include clear, 8 objective criteria for determining a patient's ability to pay and for 9 providing such adjustments to payment requirements as are necessary. In 10 addition to adjustment mechanisms such as sliding fee schedules and 11 discounts to fixed standards, such policies and procedures shall also 12 provide for the use of installment plans for the payment of outstanding 13 balances by patients pursuant to the provisions of the hospital's finan- 14 cial assistance policy. The monthly payment under such a plan shall not 15 exceed [ten] five percent of the gross monthly income of the patient[,16provided, however, that if patient assets are considered under such a17policy, then patient assets which are not excluded assets pursuant to18subparagraph (vi) of paragraph (b) of this subdivision may be considered19in addition to the limit on monthly payments.] The rate of interest 20 charged to the patient on the unpaid balance, if any, shall not exceed 21 the [rate for a ninety-day security] federal funds rate issued by the 22 United States Department of Treasury[, plus .5 percent] and no plan 23 shall include an accelerator or similar clause under which a higher rate 24 of interest is triggered upon a missed payment. [If such policies and25procedures] The policy shall not include a requirement of a deposit 26 prior to [non-emergent,] medically-necessary care[, such deposit must be27included as part of any financial aid consideration]. Such policies and 28 procedures shall be applied consistently to all eligible patients. 29 (e) Such policies and procedures shall permit patients to apply for 30 assistance within at least [ninety] two hundred forty days of the date 31 of discharge or date of service and provide at least [twenty] sixty days 32 for patients to submit a completed application. Such policies and proce- 33 dures may require that patients seeking payment adjustments provide 34 [appropriate] the following financial information and documentation in 35 support of their application[, provided, however, that such application36process shall not be unduly burdensome or complex] that are used by the 37 New York state of health marketplace: pay checks or pay stubs; rent 38 receipts; a letter from the patient's employer attesting to the 39 patient's gross income; or, if none of the aforementioned information 40 and documentation are available, a written self-attestation of the 41 patient's income. General hospitals shall, upon request, assist patients 42 in understanding the hospital's policies and procedures and in applying 43 for payment adjustments. [Application forms shall be printed] The 44 commissioner shall translate the financial assistance application form 45 and policy into the "primary languages" of each general hospital. Each 46 general hospital shall print and post these materials to its website in 47 the "primary languages" of patients served by the general hospital. For 48 the purposes of this paragraph, "primary languages" shall include any 49 language that is either (i) used to communicate, during at least five 50 percent of patient visits in a year, by patients who cannot speak, read, 51 write or understand the English language at the level of proficiency 52 necessary for effective communication with health care providers, or 53 (ii) spoken by non-English speaking individuals comprising more than one 54 percent of the primary hospital service area population, as calculated 55 using demographic information available from the United States Bureau of 56 the Census, supplemented by data from school systems. Decisions regard-S. 6757--A 9 1 ing such applications shall be made within thirty days of receipt of a 2 completed application. Such policies and procedures shall require that 3 the hospital issue any denial/approval of such application in writing 4 with information on how to appeal the denial and shall require the 5 hospital to establish an appeals process under which it will evaluate 6 the denial of an application. [Nothing in this subdivision shall be7interpreted as prohibiting a hospital from making the availability of8financial assistance contingent upon the patient first applying for9coverage under title XIX of the social security act (medicaid) or anoth-10er insurance program if, in the judgment of the hospital, the patient11may be eligible for medicaid or another insurance program, and upon the12patient's cooperation in following the hospital's financial assistance13application requirements, including the provision of information needed14to make a determination on the patient's application in accordance with15the hospital's financial assistance policy.] 16 (f) Such policies and procedures shall provide that patients with 17 incomes below [three] four hundred percent of the federal poverty level 18 are deemed presumptively eligible for payment adjustments and shall 19 conform to the requirements set forth in paragraph (b) of this subdivi- 20 sion, provided, however, that nothing in this subdivision shall be 21 interpreted as precluding hospitals from extending such payment adjust- 22 ments to other patients, either generally or on a case-by-case basis. 23 Such [policies and procedures] policy shall provide financial [aid] 24 assistance for emergency hospital services, including emergency trans- 25 fers pursuant to the federal emergency medical treatment and active 26 labor act (42 USC 1395dd), to patients who reside in New York state and 27 for medically necessary hospital services for patients who reside in the 28 hospital's primary service area as determined according to criteria 29 established by the commissioner. In developing such criteria, the 30 commissioner shall consult with representatives of the hospital indus- 31 try, health care consumer advocates and local public health officials. 32 Such criteria shall be made available to the public no less than thirty 33 days prior to the date of implementation and shall, at a minimum: 34 (i) prohibit a hospital from developing or altering its primary 35 service area in a manner designed to avoid medically underserved commu- 36 nities or communities with high percentages of uninsured residents; 37 (ii) ensure that every geographic area of the state is included in at 38 least one general hospital's primary service area so that eligible 39 patients may access care and financial assistance; and 40 (iii) require the hospital to notify the commissioner upon making any 41 change to its primary service area, and to include a description of its 42 primary service area in the hospital's annual implementation report 43 filed pursuant to subdivision three of section twenty-eight hundred 44 three-l of this article. 45 (g) Nothing in this subdivision shall be interpreted as precluding 46 hospitals from extending payment adjustments for medically necessary 47 non-emergency hospital services to patients outside of the hospital's 48 primary service area. For patients determined to be eligible for finan- 49 cial [aid] assistance under the terms of [a hospital's] the uniform 50 financial [aid] assistance policy, such [policies and procedures] policy 51 shall prohibit any limitations on financial [aid] assistance for 52 services based on the medical condition of the applicant, other than 53 typical limitations or exclusions based on medical necessity or the 54 clinical or therapeutic benefit of a procedure or treatment. 55 (h) Such policies and procedures shall not permit the securance of a 56 lien or forced sale or foreclosure of a patient's primary residence inS. 6757--A 10 1 order to collect an outstanding medical bill and shall require the 2 hospital to refrain from sending an account to collection if the patient 3 has submitted a completed application for financial [aid, including any4required supporting documentation] assistance, while the hospital deter- 5 mines the patient's eligibility for such [aid] assistance. Such [poli-6cies and procedures] policy shall provide for written notification, 7 which shall include notification on a patient bill, to a patient not 8 less than thirty days prior to the referral of debts for collection and 9 shall require that the collection agency obtain the hospital's written 10 consent prior to commencing a legal action. Such [policies and proce-11dures] policy shall require all general hospital staff who interact with 12 patients or have responsibility for billing and collections to be 13 trained in such [policies and procedures] policy, and require the imple- 14 mentation of a mechanism for the general hospital to measure its compli- 15 ance with [such policies and procedures] the policy. Such [policies and16procedures] policy shall require that any collection agency under 17 contract with a general hospital for the collection of debts follow the 18 [hospital's] uniform financial assistance policy, including providing 19 information to patients on how to apply for financial assistance where 20 appropriate. Such [policies and procedures] policy shall prohibit 21 collections from a patient who is determined to be eligible for medical 22 assistance pursuant to title XIX of the federal social security act at 23 the time services were rendered and for which services medicaid payment 24 is available. 25 (i) Reports required to be submitted to the department by each general 26 hospital as a condition for participation in the pools, and which 27 contain, in accordance with applicable regulations, a certification from 28 an independent certified public accountant or independent licensed 29 public accountant or an attestation from a senior official of the hospi- 30 tal that the hospital is in compliance with conditions of participation 31 in the pools, shall also contain, for reporting periods on and after 32 January first, two thousand seven: 33 (i) a report on hospital costs incurred and uncollected amounts in 34 providing services to [eligible] patients [without insurance] found 35 eligible for financial assistance, including the amount of care provided 36 for a nominal payment amount, during the period covered by the report; 37 (ii) hospital costs incurred and uncollected amounts for deductibles 38 and coinsurance for eligible patients with insurance or other third-par- 39 ty payor coverage; 40 (iii) the number of patients, organized according to United States 41 postal service zip code, who applied for financial assistance pursuant 42 to the [hospital's] uniform financial assistance policy, and the number, 43 organized according to United States postal service zip code, whose 44 applications were approved and whose applications were denied; 45 (iv) the reimbursement received for indigent care from the pool estab- 46 lished pursuant to this section; 47 (v) the amount of funds that have been expended on [charity care] 48 financial assistance from charitable bequests made or trusts established 49 for the purpose of providing financial assistance to patients who are 50 eligible in accordance with the terms of such bequests or trusts; 51 (vi) for hospitals located in social services districts in which the 52 district allows hospitals to assist patients with such applications, the 53 number of applications for eligibility under title XIX of the social 54 security act (medicaid) that the hospital assisted patients in complet- 55 ing and the number denied and approved;S. 6757--A 11 1 (vii) the hospital's financial losses resulting from services provided 2 under medicaid; and 3 (viii) the number of referrals to collection agents or outside vendor 4 court cases and liens placed on [the primary] any residences of patients 5 through the collection process used by a hospital. 6 (j) [Within ninety days of the effective date of this subdivision each7hospital shall submit to the commissioner a written report on its poli-8cies and procedures for financial assistance to patients which are used9by the hospital on the effective date of this subdivision. Such report10shall include copies of its policies and procedures, including material11which is distributed to patients, and a description of the hospital's12financial aid policies and procedures. Such description shall include13the income levels of patients on which eligibility is based, the finan-14cial aid eligible patients receive and the means of calculating such15aid, and the service area, if any, used by the hospital to determine16eligibility] The commissioner shall include the data collected under 17 paragraph (i) of this subdivision in regular audits of the annual gener- 18 al hospital institutional cost report. 19 (k) In the event it is determined by the commissioner that the state 20 will be unable to secure all necessary federal approvals to include, as 21 part of the state's approved state plan under title nineteen of the 22 federal social security act, a requirement[, as set forth in paragraph23one of this subdivision,] that compliance with this subdivision is a 24 condition of participation in pool distributions authorized pursuant to 25 this section and section twenty-eight hundred seven-w of this article, 26 then such condition of participation shall be deemed null and void and, 27 notwithstanding section twelve of this chapter, failure to comply with 28 the provisions of this subdivision by a hospital on and after the date 29 of such determination shall make such hospital liable for a civil penal- 30 ty not to exceed ten thousand dollars for each such violation. The impo- 31 sition of such civil penalties shall be subject to the provisions of 32 section twelve-a of this chapter. 33 § 2. Subdivision 14 of section 2807-k of the public health law is 34 REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions 14, 35 15 and 16. 36 § 3. This act shall take effect immediately. 37 PART H 38 Section 1. Section 5004 of the civil practice law and rules, as 39 amended by chapter 258 of the laws of 1981, is amended to read as 40 follows: 41 § 5004. Rate of interest. Interest shall be at the rate of nine per 42 centum per annum, except where otherwise provided by statute, provided 43 that in medical debt actions by a hospital licensed under article twen- 44 ty-eight of the public health law or a health care professional author- 45 ized under title eight of the education law the interest rate shall be 46 calculated at the one-year United States treasury bill rate. For the 47 purpose of this section, the "one-year United States treasury bill rate" 48 means the weekly average one-year constant maturity treasury yield, as 49 published by the board of governors of the federal reserve system, for 50 the calendar week preceding the date of the entry of the judgment award- 51 ing damages. Provided however, that this section shall not apply to any 52 provision of the tax law which provides for the annual rate of interest 53 to be paid on a judgment or accrued claim. 54 § 2. This act shall take effect immediately.S. 6757--A 12 1 PART I 2 Section 1. Subsection (h) of section 603 of the financial services 3 law, as added by section 26 of part H of chapter 60 of the laws of 2014, 4 is amended to read as follows: 5 (h) "Surprise bill" means a bill for health care services, other than 6 emergency services, received by: 7 (1) an insured for services rendered by a non-participating physician 8 at a participating hospital or ambulatory surgical center, where a 9 participating physician is unavailable or a non-participating physician 10 renders services without the insured's knowledge, or unforeseen medical 11 services arise at the time the health care services are rendered; 12 provided, however, that a surprise bill shall not mean a bill received 13 for health care services when a participating physician is available and 14 the insured has elected to obtain services from a non-participating 15 physician; 16 (2) an insured for services rendered by a non-participating provider, 17 where the services were referred by a participating physician to a non- 18 participating provider without explicit written consent of the insured 19 acknowledging that the participating physician is referring the insured 20 to a non-participating provider and that the referral may result in 21 costs not covered by the health care plan; [or] 22 (3) an insured for services rendered by a non-participating provider 23 when the insured reasonably relied upon an oral or written statement 24 that the non-participating provider was a participating provider made by 25 a health care plan, or agent or representative of a health care plan, or 26 as specified in the health care plan provider listing or directory, or 27 provider information on the health plan's website; 28 (4) an insured for services rendered by a non-participating provider 29 when the insured reasonably relied upon a statement that the non-parti- 30 cipating provider was a participating provider made by the non-partici- 31 pating provider, or agent or representative of the non-participating 32 provider, or as specified on the non-participating provider's website; 33 or 34 (5) a patient who is not an insured for services rendered by a physi- 35 cian at a hospital or ambulatory surgical center, where the patient has 36 not timely received all of the disclosures required pursuant to section 37 twenty-four of the public health law. 38 § 2. Paragraph (k) of subdivision 1 of section 2803 of the public 39 health law, as added by chapter 241 of the laws of 2016, is amended to 40 read as follows: 41 (k) The statement regarding patient rights and responsibilities, 42 required pursuant to paragraph (g) of this subdivision, shall include 43 provisions informing the patient of his or her right to [choose] be held 44 harmless from certain bills for emergency services and surprise bills, 45 and to submit surprise bills or bills for emergency services to the 46 independent dispute process established in article six of the financial 47 services law, and informing the patient of his or her right to view a 48 list of the hospital's standard charges and the health plans the hospi- 49 tal participates with consistent with section twenty-four of this chap- 50 ter. 51 § 3. This act shall take effect immediately. 52 § 3. Severability clause. If any provision of this act, or any appli- 53 cation of any provision of this act, is held to be invalid, or to 54 violate or be inconsistent with any federal law or regulation, that 55 shall not affect the validity or effectiveness of any other provision ofS. 6757--A 13 1 this act, or of any other application of any provision of this act, 2 which can be given effect without that provision or application; and to 3 that end, the provisions and applications of this act are severable. 4 § 4. This act shall take effect immediately provided, however, that 5 the applicable effective date of Parts A through I of this act shall be 6 as specifically set forth in the last section of such Parts. Effective 7 immediately, the commissioner of health and the superintendent of finan- 8 cial services shall make regulations and take other actions reasonably 9 necessary to implement every part of this act when it takes effect.
