Bill Text: NY A05185 | 2021-2022 | General Assembly | Introduced

---

Bill Title: Relates to payment of claims submitted by healthcare agencies.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2022-01-05 - referred to ways and means [A05185 Detail]

Download: New_York-2021-A05185-Introduced.html

---

                STATE OF NEW YORK
        ________________________________________________________________________

                                          5185

                               2021-2022 Regular Sessions

                   IN ASSEMBLY

                                    February 11, 2021
                                       ___________

        Introduced by M. of A. ABINANTI -- read once and referred to the Commit-
          tee on Health

        AN  ACT to amend the public health law, in relation to payment of claims
          submitted by healthcare agencies

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

     1    Section 1.  Section 3621 of the public health law, as added by section
     2  57-a  of part A of chapter 56 of the laws of 2013, is amended to read as
     3  follows:
     4    § 3621. Payment of claims. 1. Notwithstanding any law to the contrary,
     5  the provisions of section thirty-two hundred twenty-four-a of the insur-
     6  ance law, and regulations thereunder, shall apply to claims for  payment
     7  submitted by a licensed home care services agency, certified home health
     8  agency, long term home health care program, or fiscal intermediary oper-
     9  ating  under  section  three hundred sixty-five-f of the social services
    10  law, pursuant to a  contract  with  a  payor  under  section  forty-four
    11  hundred three-f of this chapter or section three hundred sixty-four-j of
    12  the social services law, and such claims shall be subject to and settled
    13  in compliance with the standards set forth in such section.
    14    2. The payor shall pay a clean claim (a) within thirty days of receipt
    15  of  a  claim that is transmitted via the internet or electronic mail, or
    16  (b) within forty-five days of receipt of a claim that  is  submitted  by
    17  other means, such as paper or facsimile.
    18    3.  The  payor  shall pay any undisputed portion of a claim as a clean
    19  claim as set forth in subdivision two of this section. The  payor  shall
    20  notify  a provider under this article in writing within fifteen calendar
    21  days of the receipt of an initial  claim  of  all  specific  defects  or
    22  disputes  of  such  claim  and specifically request in writing the addi-
    23  tional information or remedy needed to process any disputed portions  of
    24  the  claim. No further defect or dispute of the claim may be asserted by
    25  the payor, unless it is asserted on the basis of new information  relat-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01448-01-1
        A. 5185                             2

     1  ing  to  the  claim that the payor did not know and could not reasonably
     2  have known prior to the notification.
     3    4.  Any  disputed  claim remedied shall be paid as a clean claim under
     4  subdivision two of this section.
     5    5. For the purposes of this section, a "clean claim" means a claim for
     6  payment for services under this article for which the payor is obligated
     7  to provide payment and that shall:
     8    (a) identify the licensed home care services program,  certified  home
     9  health agency, long term home health care program or fiscal intermediary
    10  operating  pursuant  to section three hundred sixty-five-f of the social
    11  services law;
    12    (b) sufficiently identify the eligible covered person, the  nature  of
    13  the services and list the date and place of service;
    14    (c) substantiate the appropriateness of the service provided;
    15    (d)  if  prior  authorization  is  required  for such eligible covered
    16  person and service, state that such prior  authorization  was  obtained;
    17  and
    18    (e)  include  any  documentation  as reasonably required by any entity
    19  referenced in this section.
    20    6. Each clean claim or payment for services processed in violation  of
    21  this  section  shall constitute a separate violation. In addition to the
    22  penalties provided in this chapter, any organization or corporation that
    23  fails to adhere to the standards contained  in  this  section  shall  be
    24  obligated  to  pay  to  certified  home  health agencies, long term home
    25  health care programs, licensed  home  health  care  programs  or  fiscal
    26  intermediaries  operating pursuant to section three hundred sixty-five-f
    27  of the social services law in full settlement  of  the  bill,  claim  or
    28  payment  plus  interest  on the amount of such bill, claim or payment of
    29  the greater of the rate equal to the rate set  by  the  commissioner  of
    30  taxation  and  finance  for corporate taxes pursuant to paragraph one of
    31  subsection (e) of section one thousand ninety-six  of  the  tax  law  or
    32  twelve  percent  per annum, to be computed from the date the bill, claim
    33  or payment was required to be made.
    34    § 2. This act shall take effect immediately.