Bill Text: NY S07625 | 2021-2022 | General Assembly | Introduced
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 12-0)
Status: (Introduced - Dead) 2022-06-03 - COMMITTED TO RULES [S07625 Detail]
Download: New_York-2021-S07625-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7625 2021-2022 Regular Sessions IN SENATE December 22, 2021 ___________ Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Rules 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 minimum6collection 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 22 can demonstrate an inability to pay full charges, and also, at the 23 hospital's discretion, for reducing or discounting the collection of 24 co-pays and deductible payments from those individuals who can demon- EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD13108-04-1S. 7625 2 1 strate an inability to pay such amounts. Immigration status shall not be 2 an eligibility criterion for the purpose of determining financial 3 assistance under this section. 4 (ii) A general hospital may use the New York state of health market- 5 place eligibility determination page to establish the patient's house- 6 hold income and residency in lieu of the financial application form, 7 provided it has secured the consent of the patient. A general hospital 8 shall not require a patient to apply for coverage through the New York 9 state of health marketplace in order to receive care or financial 10 assistance. 11 (iii) Upon submission of a completed application form, the patient is 12 not liable for any bills until the general hospital has rendered a deci- 13 sion on the application in accordance with this subdivision. 14 (b) [Such] The reductions from charges for [uninsured] patients 15 described in paragraph (a) of this subdivision with incomes below [at16least three] six hundred percent of the federal poverty level shall 17 result in a charge to such individuals that does not exceed [the greater18of] the amount that would have been paid for the same services [by the19"highest volume payor" for such general hospital as defined in subpara-20graph (v) of this paragraph, or for services provided pursuant to title21XVIII of the federal social security act (medicare), or for services] 22 provided pursuant to title [XIX] XVIII of the federal social security 23 act [(medicaid)] (medicare), and provided further that such [amounts] 24 amount shall be adjusted according to income level as follows: 25 (i) For patients with incomes at or below [at least one] two hundred 26 percent of the federal poverty level, the hospital shall collect no more 27 than a nominal payment amount, consistent with guidelines established by 28 the commissioner[;]. 29 (ii) For patients with incomes [between at least one] above two 30 hundred [one] percent and [one] up to four hundred [fifty] percent of 31 the federal poverty level, the hospital shall collect no more than the 32 amount identified after application of a proportional sliding fee sched- 33 ule under which patients with lower incomes shall pay the lowest amount. 34 [Such] The schedule shall provide that the amount the hospital may 35 collect for [such patients] the patient increases from the nominal 36 amount described in subparagraph (i) of this paragraph in equal incre- 37 ments as the income of the patient increases, up to a maximum of twenty 38 percent of the [greater of the] amount that would have been paid for the 39 same services [by the "highest volume payor" for such general hospital,40as defined in subparagraph (v) of this paragraph, or for services41provided pursuant to title XVIII of the federal social security act42(medicare) or for services] provided pursuant to title [XIX] XVIII of 43 the federal social security act [(medicaid);] (medicare). 44 (iii) [For patients with incomes between at least one hundred fifty-45one percent and two hundred fifty percent of the federal poverty level,46the hospital shall collect no more than the amount identified after47application of a proportional sliding fee schedule under which patients48with lower income shall pay the lowest amounts. Such schedule shall49provide that the amount the hospital may collect for such patients50increases from the twenty percent figure described in subparagraph (ii)51of this paragraph in equal increments as the income of the patient52increases, up to a maximum of the greater of the amount that would have53been paid for the same services by the "highest volume payor" for such54general hospital, as defined in subparagraph (v) of this paragraph, or55for services provided pursuant to title XVIII of the federal socialS. 7625 3 1security act (medicare) or for services provided pursuant to title XIX2of the federal social security act (medicaid); and3(iv)] For patients with incomes [between at least two hundred fifty-4one percent and three hundred] above four hundred percent and up to six 5 hundred percent of the federal poverty level, the hospital shall collect 6 no more than the [greater of the] amount that would have been paid for 7 the same services [by the "highest volume payor" for such general hospi-8tal as defined in subparagraph (v) of this paragraph, or for services9provided pursuant to title XVIII of the federal social security act10(medicare), or for services] provided pursuant to title [XIX] XVIII of 11 the federal social security act [(medicaid)] (medicare). 12 [(v) For the purposes of this paragraph, "highest volume payor" shall13mean the insurer, corporation or organization licensed, organized or14certified pursuant to article thirty-two, forty-two or forty-three of15the insurance law or article forty-four of this chapter, or other third-16party payor, which has a contract or agreement to pay claims for17services provided by the general hospital and incurred the highest18volume of claims in the previous calendar year.19(vi) A hospital may implement policies and procedures to permit, but20not require, consideration on a case-by-case basis of exceptions to the21requirements described in subparagraphs (i) and (ii) of this paragraph22based upon the existence of significant assets owned by the patient that23should be taken into account in determining the appropriate payment24amount for that patient's care, provided, however, that such proposed25policies and procedures shall be subject to the prior review and26approval of the commissioner and, if approved, shall be included in the27hospital's financial assistance policy established pursuant to this28section, and provided further that, if such approval is granted, the29maximum amount that may be collected shall not exceed the greater of the30amount that would have been paid for the same services by the "highest31volume payor" for such general hospital as defined in subparagraph (v)32of this paragraph, or for services provided pursuant to title XVIII of33the federal social security act (medicare), or for services provided34pursuant to title XIX of the federal social security act (medicaid). In35the event that a general hospital reviews a patient's assets in deter-36mining payment adjustments such policies and procedures shall not37consider as assets a patient's primary residence, assets held in a tax-38deferred or comparable retirement savings account, college savings39accounts, or cars used regularly by a patient or immediate family40members.41(vii)] (c) Nothing in this [paragraph] subdivision shall be construed 42 to limit a hospital's ability to establish patient eligibility for 43 payment discounts at income levels higher than those specified herein 44 and/or to provide greater payment discounts for eligible patients than 45 those required by this [paragraph] subdivision. 46 [(c)] (d) Such policies and procedures shall be clear, understandable, 47 in writing and publicly available in summary form and each general 48 hospital participating in the pool shall ensure that every patient is 49 made aware of the existence of [such] the policies and procedures and is 50 provided, in a timely manner, with a summary and a copy of [such poli-51cies and procedures] the policy and form upon request. Any summary 52 provided to patients shall, at a minimum, include specific information 53 as to income levels used to determine eligibility for assistance, a 54 description of the primary service area of the hospital and the means of 55 applying for assistance. [For general hospitals with twenty-four hour56emergency departments, such policies and procedures] A general hospitalS. 7625 4 1 shall [require the notification of patients] notify patients by provid- 2 ing written materials to patients or their authorized representatives 3 during the intake and registration process, through the conspicuous 4 posting of language-appropriate information in the general hospital, and 5 by including information on bills and statements sent to patients, that 6 financial [aid] assistance may be available to qualified patients and 7 how to obtain further information. [For specialty hospitals without8twenty-four hour emergency departments, such notification shall take9place through written materials provided to patients during the intake10and registration process prior to the provision of any health care11services or procedures, and through information on bills and statements12sent to patients, that financial aid may be available to qualified13patients and how to obtain further information. Application materials14shall include a notice to patients that upon submission of a completed15application, including any information or documentation needed to deter-16mine the patient's eligibility pursuant to the hospital's financial17assistance policy, the patient may disregard any bills until the hospi-18tal has rendered a decision on the application in accordance with this19paragraph] General hospitals shall post the financial assistance appli- 20 cation policy, procedures and form, and a summary of the policy and 21 procedures, in a conspicuous location and downloadable form on the 22 general hospital's website. 23 [(d) Such] (e) The hospital's application materials shall include a 24 notice to patients that upon submission of a completed application form, 25 the patient shall not be liable for any bills until the general hospital 26 has rendered a decision on the application in accordance with this 27 subdivision. The application materials shall include specific informa- 28 tion as the income levels used to determine eligibility for financial 29 assistance, a description of the primary service area of the hospital 30 and the means to apply for assistance. Nothing in this subdivision shall 31 be construed as precluding the use of presumptive eligibility determi- 32 nations by hospitals on behalf of patients. The policies and procedures 33 shall include clear, objective criteria for determining a patient's 34 ability to pay and for providing such adjustments to payment require- 35 ments as are necessary. In addition to adjustment mechanisms such as 36 sliding fee schedules and discounts to fixed standards, such policies 37 and procedures shall also provide for the use of installment plans for 38 the payment of outstanding balances by patients pursuant to the 39 provisions of the hospital's financial assistance policy. The monthly 40 payment under such a plan shall not exceed [ten] five percent of the 41 gross monthly income of the patient[, provided, however, that if patient42assets are considered under such a policy, then patient assets which are43not excluded assets pursuant to subparagraph (vi) of paragraph (b) of44this subdivision may be considered in addition to the limit on monthly45payments]. Installment plan payments may not be required to begin before 46 one hundred eighty days after the date of the service or discharge, 47 whichever is later. The policy shall allow the patient and the hospital 48 to mutually agree to modify the terms of an installment plan. The rate 49 of interest charged to the patient on the unpaid balance, if any, shall 50 not exceed [the rate for a ninety-day security issued by the United51States Department of Treasury, plus .5 percent] two percentum per annum 52 and no plan shall include an accelerator or similar clause under which a 53 higher rate of interest is triggered upon a missed payment. [If such] 54 The policies and procedures shall not include a requirement of a deposit 55 prior to [non-emergent,] medically-necessary care[, such deposit must be56included as part of any financial aid consideration]. The hospitalS. 7625 5 1 shall refund any payments made by the patient before the determination 2 of eligibility for financial assistance that exceeds the patient's 3 liability after discounts are applied. Such policies and procedures 4 shall be applied consistently to all eligible patients. 5 [(e) Such policies and procedures shall permit patients to] (f) In any 6 legal action by or on behalf of a hospital to collect a medical debt, 7 the complaint shall be accompanied by an affidavit by the hospital's 8 chief financial officer stating that on information and belief the 9 patient does not meet the income or residency criteria for financial 10 assistance. Patients may apply for financial assistance [within at least11ninety days of the date of discharge or date of service and provide at12least twenty days for patients to submit a completed application] at any 13 time during the collection process, including after the commencement of 14 a medical debt court action or upon the plaintiff obtaining a default 15 judgment. A hospital may use credit scoring software for the purposes of 16 establishing income eligibility and approving financial assistance, but 17 only if the hospital makes clear to the patient that providing a social 18 security number is not mandatory and the scoring does not negatively 19 impact the patient's credit score. However, credit scoring software 20 shall not be solely relied upon by the hospital in denying a patient's 21 application for financial assistance. [Such] The policies and proce- 22 dures [may require that] shall allow patients seeking [payment adjust-23ments] financial assistance to provide [appropriate] the following 24 financial information and documentation in support of their applica- 25 tion[, provided, however, that such application process shall not be26unduly burdensome or complex]: pay checks or pay stubs; unemployment 27 documentation; social security income; rent receipts; a letter from the 28 patient's employer attesting to the patient's gross income; or, if none 29 of the aforementioned information and documentation are available, a 30 written self-attestation of the patient's income may be used. General 31 hospitals shall, upon request, assist patients in understanding the 32 hospital's application and form, policies and procedures and in applying 33 for payment adjustments. Application forms shall be printed and posted 34 to its website in the "primary languages" of patients served by the 35 general hospital. For the purposes of this paragraph, "primary 36 languages" shall include any language that is either (i) used to commu- 37 nicate, during at least five percent of patient visits in a year, by 38 patients who cannot speak, read, write or understand the English 39 language at the level of proficiency necessary for effective communi- 40 cation with health care providers, or (ii) spoken by non-English speak- 41 ing individuals comprising more than one percent of the primary hospital 42 service area population, as calculated using demographic information 43 available from the United States Bureau of the Census, supplemented by 44 data from school systems. Decisions regarding such applications shall be 45 made within thirty days of receipt of a completed application. [Such] 46 The policies and procedures shall require that the hospital issue any 47 [denial/approval] denial or approval of [such] the application in writ- 48 ing with information on how to appeal the denial and shall require the 49 hospital to establish an appeals process under which it will evaluate 50 the denial of an application. [Nothing in this subdivision shall be51interpreted as prohibiting a hospital from making the availability of52financial assistance contingent upon the patient first applying for53coverage under title XIX of the social security act (medicaid) or anoth-54er insurance program if, in the judgment of the hospital, the patient55may be eligible for medicaid or another insurance program, and upon the56patient's cooperation in following the hospital's financial assistanceS. 7625 6 1application requirements, including the provision of information needed2to make a determination on the patient's application in accordance with3the hospital's financial assistance policy] The hospital shall inform 4 patients on how to file a complaint against the hospital or a debt 5 collector that is contracted on behalf of the hospital regarding the 6 patient's bill. 7 [(f) Such] (g) The policies and procedures shall provide that patients 8 with incomes below [three] six hundred percent of the federal poverty 9 level are deemed [presumptively] eligible for payment adjustments and 10 shall conform to the requirements set forth in paragraph (b) of this 11 subdivision, provided, however, that nothing in this subdivision shall 12 be interpreted as precluding hospitals from extending such payment 13 adjustments to other patients, either generally or on a case-by-case 14 basis. [Such] The policies and procedures shall provide financial [aid] 15 assistance for emergency hospital services, including emergency trans- 16 fers pursuant to the federal emergency medical treatment and active 17 labor act (42 USC 1395dd), to patients who reside in New York state and 18 for medically necessary hospital services for patients who reside in the 19 hospital's primary service area as determined according to criteria 20 established by the commissioner. In developing [such] the criteria, the 21 commissioner shall consult with representatives of the hospital indus- 22 try, health care consumer advocates and local public health officials. 23 [Such] The criteria shall be made available to the public no less than 24 thirty days prior to the date of implementation and shall, at a minimum: 25 (i) prohibit a hospital from developing or altering its primary 26 service area in a manner designed to avoid medically underserved commu- 27 nities or communities with high percentages of uninsured residents; 28 (ii) ensure that every geographic area of the state is included in at 29 least one general hospital's primary service area so that eligible 30 patients may access care and financial assistance; and 31 (iii) require the hospital to notify the commissioner upon making any 32 change to its primary service area, and to include a description of its 33 primary service area in the hospital's annual implementation report 34 filed pursuant to subdivision three of section twenty-eight hundred 35 three-l of this article. 36 [(g)] (h) Nothing in this subdivision shall be interpreted as preclud- 37 ing hospitals from extending payment adjustments for medically necessary 38 non-emergency hospital services to patients outside of the hospital's 39 primary service area. For patients determined to be eligible for finan- 40 cial [aid] assistance under the terms of a hospital's financial [aid] 41 assistance policy, [such] the policies and procedures shall prohibit any 42 limitations on financial [aid] assistance for services based on the 43 medical condition of the applicant, other than typical limitations or 44 exclusions based on medical necessity or the clinical or therapeutic 45 benefit of a procedure or treatment. 46 [(h) Such policies and procedures shall not permit the forced] (i) A 47 hospital or its agent shall not issue, authorize or permit an income 48 execution of a patient's wages, secure a lien or force a sale or fore- 49 closure of a patient's primary residence in order to collect an 50 outstanding medical bill and shall [require the hospital to refrain from51sending] not send an account to collection if the patient has submitted 52 a completed application for financial [aid, including any required53supporting documentation] assistance, while the hospital determines the 54 patient's eligibility for [such aid] financial assistance. [Such] The 55 policies and procedures shall provide for written notification, which 56 shall include notification on a patient bill, to a patient not less thanS. 7625 7 1 thirty days prior to the referral of debts for collection and shall 2 require that the collection agency obtain the hospital's written consent 3 prior to commencing a legal action. [Such] The policies and procedures 4 shall require all general hospital staff who interact with patients or 5 have responsibility for billing and collections to be trained in [such] 6 the policies and procedures, and require the implementation of a mech- 7 anism for the general hospital to measure its compliance with [such] the 8 policies and procedures. [Such] The policies and procedures shall 9 require that any collection agency, lawyer or firm under contract with a 10 general hospital for the collection of debts follow the hospital's 11 financial assistance policy, including providing information to patients 12 on how to apply for financial assistance where appropriate. [Such] The 13 policies and procedures shall prohibit collections from a patient who is 14 determined to be eligible for medical assistance [pursuant to title XIX15of the federal social security act] under title eleven of article five 16 of the social services law at the time services were rendered and for 17 which services medicaid payment is available. 18 [(i)] (j) Reports required to be submitted to the department by each 19 general hospital as a condition for participation in the pools[, and20which contain, in accordance with applicable regulations,] shall 21 contain: (i) a certification from an independent certified public 22 accountant or independent licensed public accountant or an attestation 23 from a senior official of the hospital that the hospital is in compli- 24 ance with conditions of participation in the pools[, shall also contain,25for reporting periods on and after January first, two thousand seven:]; 26 [(i)] (ii) a report on hospital costs incurred and uncollected amounts 27 in providing services to [eligible] patients [without insurance] found 28 eligible for financial assistance, including the amount of care provided 29 for a nominal payment amount, during the period covered by the report; 30 [(ii)] (iii) hospital costs incurred and uncollected amounts for 31 deductibles and coinsurance for eligible patients with insurance or 32 other third-party payor coverage; 33 [(iii)] (iv) the number of patients, organized according to United 34 States postal service zip code, race, ethnicity and gender, who applied 35 for financial assistance [pursuant to] under the hospital's financial 36 assistance policy, and the number, organized according to United States 37 postal service zip code, race, ethnicity and gender, whose applications 38 were approved and whose applications were denied; 39 [(iv)] (v) the reimbursement received for indigent care from the pool 40 established [pursuant to] under this section; 41 [(v)] (vi) the amount of funds that have been expended on [charity42care] financial assistance from charitable bequests made or trusts 43 established for the purpose of providing financial assistance to 44 patients who are eligible in accordance with the terms of [such] the 45 bequests or trusts; 46 [(vi)] (vii) for hospitals located in social services districts in 47 which the district allows hospitals to assist patients with such appli- 48 cations, the number of applications for eligibility for medicaid under 49 title [XIX of the social security act (medicaid)] eleven of article five 50 of the social services law that the hospital assisted patients in 51 completing and the number denied and approved; 52 [(vii)] (viii) the hospital's financial losses resulting from services 53 provided under medicaid; and 54 [(viii)] (ix) the number of referrals to collection agents or 55 contracted external collection vendors, court cases and liens placed onS. 7625 8 1 [the primary] any residences of patients through the collection process 2 used by a hospital. 3 [(j)] (k) Within ninety days of the effective date of the chapter of 4 the laws of two thousand twenty-two which amended this subdivision each 5 hospital shall submit to the commissioner a written report on its poli- 6 cies and procedures for financial assistance to patients which are used 7 by the hospital [on the] as of such effective date [of this subdivi-8sion]. Such report shall include copies of its policies and procedures, 9 including material which is distributed to patients, and a description 10 of the hospital's financial aid policies and procedures. Such 11 description shall include the income levels of patients on which eligi- 12 bility is based, the financial aid eligible patients receive and the 13 means of calculating such aid, and the service area, if any, used by the 14 hospital to determine eligibility. 15 [(k)] (l) The commissioner shall include the data collected under 16 paragraph (j) of this subdivision in regular audits of the annual gener- 17 al hospital institutional cost report. 18 (m) In the event [it is determined by the commissioner that] the state 19 [will be] is unable to secure all necessary federal approvals to 20 include, as part of the state's approved state plan under title nineteen 21 of the federal social security act, a requirement[, as set forth in22paragraph one of this subdivision,] that compliance with this subdivi- 23 sion is a condition of participation in pool distributions authorized 24 pursuant to this section and section twenty-eight hundred seven-w of 25 this article, then such condition of participation shall be deemed null 26 and void [and, notwithstanding]. Notwithstanding section twelve of this 27 chapter, failure to comply with [the provisions of] this subdivision by 28 a general hospital [on and after the date of such determination] shall 29 make [such] the hospital liable for a civil penalty not to exceed ten 30 thousand dollars for each [such] violation. The imposition of [such] the 31 civil penalties shall be subject to [the provisions of] section twelve-a 32 of this chapter. 33 (n) A hospital or its collection agents shall not report adverse 34 information about a patient to a consumer or financial reporting entity, 35 or commence civil action against a patient or delegate a collection 36 activity to a debt collector for nonpayment for one hundred eighty days 37 after the first post-service bill is issued; and a hospital shall not 38 report adverse information to a consumer reporting agency, or commence a 39 civil action against a patient or delegate a collection activity to a 40 debt collector, if: the hospital was notified that an appeal or a review 41 of a health insurance decision is pending within the immediately preced- 42 ing sixty days; or the patient has a pending application for or quali- 43 fied for financial assistance. A hospital shall report the fulfillment 44 of a patient's payment obligation within thirty days after the obli- 45 gation is fulfilled to a consumer or financial reporting entity to which 46 the hospital had reported adverse information about the patient. 47 § 3. Subdivision 9-a of section 2807-k of the public health law as 48 amended by section two of this act, is amended to read as follows: 49 9-a. (a) (i) As a condition for participation in pool distributions 50 authorized pursuant to this section and section twenty-eight hundred 51 seven-w of this article for periods on and after January first, two 52 thousand nine, general hospitals shall, effective for periods on and 53 after January first, two thousand [seven, establish] twenty-four, adopt 54 and implement the uniform financial assistance [policies and procedures,55in accordance with the provisions of this subdivision,] form and policy, 56 to be developed and issued by the commissioner. General hospitals shallS. 7625 9 1 implement the uniform policy and form for reducing hospital charges and 2 charges for affiliated providers otherwise applicable to low-income 3 individuals without third-party health coverage, or who have third-party 4 health coverage that does not cover or limits coverage of the service, 5 and who can demonstrate an inability to pay full charges, and also, at 6 the hospital's discretion, for reducing or discounting the collection of 7 co-pays and deductible payments from those individuals who can demon- 8 strate an inability to pay such amounts. Immigration status shall not be 9 an eligibility criterion for the purpose of determining financial 10 assistance under this section. As used in this section, "affiliated 11 provider" means a provider that is: (A) employed by the hospital; (B) 12 under a professional services agreement with the hospital; or (C) a 13 clinical faculty member of a medical school or other school that trains 14 individuals to be providers and that is affiliated with the hospital or 15 health system. 16 (ii) A general hospital may use the New York state of health market- 17 place eligibility determination page to establish the patient's house- 18 hold income and residency in lieu of the financial application form, 19 provided it has secured the consent of the patient. A general hospital 20 shall not require a patient to apply for coverage through the New York 21 state of health marketplace in order to receive care or financial 22 assistance. 23 (iii) Upon submission of a completed application form, the patient is 24 not liable for any bills until the general hospital has rendered a deci- 25 sion on the application in accordance with this subdivision. 26 (b) The reductions from charges for patients described in paragraph 27 (a) of this subdivision with incomes below six hundred percent of the 28 federal poverty level shall result in a charge to such individuals that 29 does not exceed the amount that would have been paid for the same 30 services provided pursuant to title XVIII of the federal social security 31 act (medicare), and provided further that such amount shall be adjusted 32 according to income level as follows: 33 (i) For patients with incomes at or below two hundred percent of the 34 federal poverty level, the hospital shall collect no more than a nominal 35 payment amount, consistent with guidelines established by the commis- 36 sioner. 37 (ii) For patients with incomes above two hundred percent and up to 38 four hundred percent of the federal poverty level, the hospital shall 39 collect no more than the amount identified after application of a 40 proportional sliding fee schedule under which patients with lower 41 incomes shall pay the lowest amount. The schedule shall provide that the 42 amount the hospital may collect for the patient increases from the nomi- 43 nal amount described in subparagraph (i) of this paragraph in equal 44 increments as the income of the patient increases, up to a maximum of 45 twenty percent of the amount that would have been paid for the same 46 services provided pursuant to title XVIII of the federal social security 47 act (medicare). 48 (iii) For patients with incomes above four hundred percent and up to 49 six hundred percent of the federal poverty level, the hospital shall 50 collect no more than the amount that would have been paid for the same 51 services provided pursuant to title XVIII of the federal social security 52 act (medicare). 53 (c) Nothing in this subdivision shall be construed to limit a hospi- 54 tal's ability to establish patient eligibility for payment discounts at 55 income levels higher than those specified herein and/or to provideS. 7625 10 1 greater payment discounts for eligible patients than those required by 2 this subdivision. 3 (d) [Such policies and procedures shall be clear, understandable, in4writing and publicly available in summary form and each] Each general 5 hospital participating in the pool shall ensure that every patient is 6 made aware of the existence of [the policies and procedures] the uniform 7 financial assistance form and policy and is provided, in a timely 8 manner, with [a summary and] a copy of the policy and form upon request. 9 [Any summary provided to patients shall, at a minimum, include specific10information as to income levels used to determine eligibility for11assistance, a description of the primary service area of the hospital12and the means of applying for assistance.] A general hospital shall 13 notify patients by providing written materials to patients or their 14 authorized representatives during the intake and registration process, 15 through the conspicuous posting of language-appropriate information in 16 the general hospital, and by including information on bills and state- 17 ments sent to patients, that financial assistance may be available to 18 qualified patients and how to obtain further information. General hospi- 19 tals shall post the uniform financial assistance application policy[,20procedures] and form, and a summary of the policy [and procedures], in a 21 conspicuous location and downloadable form on the general hospital's 22 website. The commissioner shall post the uniform financial assistance 23 form and policy in downloadable form on the department's hospital 24 profile page or any successor website. 25 (e) The [hospital's] commissioner shall provide application materials 26 to general hospitals, including the uniform financial assistance appli- 27 cation form and policy. These application materials shall include a 28 notice to patients that upon submission of a completed application form, 29 the patient shall not be liable for any bills until the general hospital 30 has rendered a decision on the application in accordance with this 31 subdivision. The application materials shall include specific informa- 32 tion as the income levels used to determine eligibility for financial 33 assistance, a description of the primary service area of the hospital 34 and the means to apply for assistance. Nothing in this subdivision shall 35 be construed as precluding the use of presumptive eligibility determi- 36 nations by hospitals on behalf of patients. The [policies and proce-37dures] uniform application form and policy shall include clear, objec- 38 tive criteria for determining a patient's ability to pay and for 39 providing such adjustments to payment requirements as are necessary. In 40 addition to adjustment mechanisms such as sliding fee schedules and 41 discounts to fixed standards, [such policies and procedures] the uniform 42 policy shall also provide for the use of installment plans for the 43 payment of outstanding balances by patients [pursuant to the provisions44of the hospital's financial assistance policy]. The monthly payment 45 under such a plan shall not exceed five percent of the gross monthly 46 income of the patient. Installment plan payments may not be required to 47 begin before one hundred eighty days after the date of the service or 48 discharge, whichever is later. The policy shall allow the patient and 49 the hospital to mutually agree to modify the terms of an installment 50 plan. The rate of interest charged to the patient on the unpaid 51 balance, if any, shall not exceed two percentum per annum and no plan 52 shall include an accelerator or similar clause under which a higher rate 53 of interest is triggered upon a missed payment. The [policies and proce-54dures] uniform policy shall not include a requirement of a deposit prior 55 to medically-necessary care. The hospital shall refund any payments made 56 by the patient before the determination of eligibility for financialS. 7625 11 1 assistance that exceeds the patient's liability after discounts are 2 applied. Such policies and procedures shall be applied consistently to 3 all eligible patients. 4 (f) In any legal action by or on behalf of a hospital to collect a 5 medical debt, the complaint shall be accompanied by an affidavit by the 6 hospital's chief financial officer stating that on information and 7 belief the patient does not meet the income or residency criteria for 8 financial assistance. Patients may apply for financial assistance at any 9 time during the collection process, including after the commencement of 10 a medical debt court action or upon the plaintiff obtaining a default 11 judgment. A hospital may use credit scoring software for the purposes of 12 establishing income eligibility and approving financial assistance, but 13 only if the hospital makes clear to the patient that providing a social 14 security number is not mandatory and the scoring does not negatively 15 impact the patient's credit score. However, credit scoring software 16 shall not be solely relied upon by the hospital in denying a patient's 17 application for financial assistance. The [policies and procedures] 18 uniform policy and form shall allow patients seeking financial assist- 19 ance to provide the following financial information and documentation in 20 support of their application: pay checks or pay stubs; unemployment 21 documentation; social security income; rent receipts; a letter from the 22 patient's employer attesting to the patient's gross income; or, if none 23 of the aforementioned information and documentation are available, a 24 written self-attestation of the patient's income may be used. General 25 hospitals shall, upon request, assist patients in understanding the 26 [hospital's application and form, policies and procedures] uniform 27 financial assistance application form and policy and in applying for 28 payment adjustments. [Application forms shall be printed and posted] The 29 commissioner shall translate the uniform financial assistance applica- 30 tion form and policy into the "primary languages" of each general hospi- 31 tal. Each general hospital shall print and post these materials to its 32 website in the "primary languages" of patients served by the general 33 hospital. For the purposes of this paragraph, "primary languages" shall 34 include any language that is either (i) used to communicate, during at 35 least five percent of patient visits in a year, by patients who cannot 36 speak, read, write or understand the English language at the level of 37 proficiency necessary for effective communication with health care 38 providers, or (ii) spoken by non-English speaking individuals comprising 39 more than one percent of the primary hospital service area population, 40 as calculated using demographic information available from the United 41 States Bureau of the Census, supplemented by data from school systems. 42 Decisions regarding such applications shall be made within thirty days 43 of receipt of a completed application. The [policies and procedures] 44 uniform financial assistance policy shall require that the hospital 45 issue any denial or approval of the application in writing with informa- 46 tion on how to appeal the denial and shall require the hospital to 47 establish an appeals process under which it will evaluate the denial of 48 an application. The hospital shall inform patients on how to file a 49 complaint against the hospital or a debt collector that is contracted on 50 behalf of the hospital regarding the patient's bill. 51 (g) The [policies and procedures] uniform financial assistance policy 52 shall provide that patients with incomes below six hundred percent of 53 the federal poverty level are deemed eligible for payment adjustments 54 and shall conform to the requirements set forth in paragraph (b) of this 55 subdivision, provided, however, that nothing in this subdivision shall 56 be interpreted as precluding hospitals from extending such paymentS. 7625 12 1 adjustments to other patients, either generally or on a case-by-case 2 basis. The [policies and procedures] uniform policy shall provide finan- 3 cial assistance for emergency hospital services, including emergency 4 transfers pursuant to the federal emergency medical treatment and active 5 labor act (42 USC 1395dd), to patients who reside in New York state and 6 for medically necessary hospital services for patients who reside in the 7 hospital's primary service area as determined according to criteria 8 established by the commissioner. In developing the criteria, the commis- 9 sioner shall consult with representatives of the hospital industry, 10 health care consumer advocates and local public health officials. The 11 criteria shall be made available to the public no less than thirty days 12 prior to the date of implementation and shall, at a minimum: 13 (i) prohibit a hospital from developing or altering its primary 14 service area in a manner designed to avoid medically underserved commu- 15 nities or communities with high percentages of uninsured residents; 16 (ii) ensure that every geographic area of the state is included in at 17 least one general hospital's primary service area so that eligible 18 patients may access care and financial assistance; and 19 (iii) require the hospital to notify the commissioner upon making any 20 change to its primary service area, and to include a description of its 21 primary service area in the hospital's annual implementation report 22 filed pursuant to subdivision three of section twenty-eight hundred 23 three-l of this article. 24 (h) Nothing in this subdivision shall be interpreted as precluding 25 hospitals from extending payment adjustments for medically necessary 26 non-emergency hospital services to patients outside of the hospital's 27 primary service area. For patients determined to be eligible for finan- 28 cial assistance under the terms of [a hospital's] the uniform financial 29 assistance policy, the [policies and procedures] financial assistance 30 policy shall prohibit any limitations on financial assistance for 31 services based on the medical condition of the applicant, other than 32 typical limitations or exclusions based on medical necessity or the 33 clinical or therapeutic benefit of a procedure or treatment. 34 (i) A hospital or its agent shall not issue, authorize or permit an 35 income execution of a patient's wages, secure a lien or force a sale or 36 foreclosure of a patient's primary residence in order to collect an 37 outstanding medical bill and shall not send an account to collection if 38 the patient has submitted a completed application for financial assist- 39 ance, while the hospital determines the patient's eligibility for finan- 40 cial assistance. The [policies and procedures] uniform policy shall 41 provide for written notification, which shall include notification on a 42 patient bill, to a patient not less than thirty days prior to the refer- 43 ral of debts for collection and shall require that the collection agency 44 obtain the hospital's written consent prior to commencing a legal 45 action. The [policies and procedures] uniform policy shall require all 46 general hospital staff who interact with patients or have responsibility 47 for billing and collections to be trained in the [policies and proce-48dures] policy, and require the implementation of a mechanism for the 49 general hospital to measure its compliance with the [policies and proce-50dures] policy. The [policies and procedures] uniform policy shall 51 require that any collection agency, lawyer or firm under contract with a 52 general hospital for the collection of debts follow the [hospital's] 53 uniform financial assistance policy, including providing information to 54 patients on how to apply for financial assistance where appropriate. 55 The [policies and procedures] uniform policy shall prohibit collections 56 from a patient who is determined to be eligible for medical assistanceS. 7625 13 1 under title eleven of article five of the social services law at the 2 time services were rendered and for which services medicaid payment is 3 available. 4 (j) Reports required to be submitted to the department by each general 5 hospital as a condition for participation in the pools shall contain: 6 (i) a certification from an independent certified public accountant or 7 independent licensed public accountant or an attestation from a senior 8 official of the hospital that the hospital is in compliance with condi- 9 tions of participation in the pools; 10 (ii) a report on hospital costs incurred and uncollected amounts in 11 providing services to patients found eligible for financial assistance, 12 including the amount of care provided for a nominal payment amount, 13 during the period covered by the report; 14 (iii) hospital costs incurred and uncollected amounts for deductibles 15 and coinsurance for eligible patients with insurance or other third-par- 16 ty payor coverage; 17 (iv) the number of patients, organized according to United States 18 postal service zip code, race, ethnicity and gender, who applied for 19 financial assistance under the [hospital's] uniform financial assistance 20 policy, and the number, organized according to United States postal 21 service zip code, race, ethnicity and gender, whose applications were 22 approved and whose applications were denied; 23 (v) the reimbursement received for indigent care from the pool estab- 24 lished under this section; 25 (vi) the amount of funds that have been expended on financial assist- 26 ance from charitable bequests made or trusts established for the purpose 27 of providing financial assistance to patients who are eligible in 28 accordance with the terms of the bequests or trusts; 29 (vii) for hospitals located in social services districts in which the 30 district allows hospitals to assist patients with such applications, the 31 number of applications for eligibility for medicaid under title eleven 32 of article five of the social services law that the hospital assisted 33 patients in completing and the number denied and approved; 34 (viii) the hospital's financial losses resulting from services 35 provided under medicaid; and 36 (ix) the number of referrals to collection agents or contracted 37 external collection vendors, court cases and liens placed on any resi- 38 dences of patients through the collection process used by a hospital. 39 (k) [Within ninety days of the effective date of the chapter of the40laws of two thousand twenty-two which amended this subdivision each41hospital shall submit to the commissioner a written report on its poli-42cies and procedures for financial assistance to patients which are used43by the hospital as of such effective date. Such report shall include44copies of its policies and procedures, including material which is45distributed to patients, and a description of the hospital's financial46aid policies and procedures. Such description shall include the income47levels of patients on which eligibility is based, the financial aid48eligible patients receive and the means of calculating such aid, and the49service area, if any, used by the hospital to determine eligibility.50(l)] The commissioner shall include the data collected under paragraph 51 (j) of this subdivision in regular audits of the annual general hospital 52 institutional cost report. 53 [(m)] (l) In the event the state is unable to secure all necessary 54 federal approvals to include, as part of the state's approved state plan 55 under title nineteen of the federal social security act, a requirement 56 that compliance with this subdivision is a condition of participation inS. 7625 14 1 pool distributions authorized pursuant to this section and section twen- 2 ty-eight hundred seven-w of this article, then such condition of partic- 3 ipation shall be deemed null and void. Notwithstanding section twelve of 4 this chapter, failure to comply with this subdivision by a general 5 hospital shall make the hospital liable for a civil penalty not to 6 exceed ten thousand dollars for each violation. The imposition of the 7 civil penalties shall be subject to section twelve-a of this chapter. 8 [(n)] (m) A hospital or its collection agents shall not report adverse 9 information about a patient to a consumer or financial reporting entity, 10 or commence civil action against a patient or delegate a collection 11 activity to a debt collector for nonpayment for one hundred eighty days 12 after the first post-service bill is issued; and a hospital shall not 13 report adverse information to a consumer reporting agency, or commence a 14 civil action against a patient or delegate a collection activity to a 15 debt collector, if: the hospital was notified that an appeal or a review 16 of a health insurance decision is pending within the immediately preced- 17 ing sixty days; or the patient has a pending application for or quali- 18 fied for financial assistance. A hospital shall report the fulfillment 19 of a patient's payment obligation within thirty days after the obli- 20 gation is fulfilled to a consumer or financial reporting entity to which 21 the hospital had reported adverse information about the patient. 22 § 4. Subdivision 14 of section 2807-k of the public health law is 23 REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions 14, 24 15 and 16. 25 § 5. This act shall take effect immediately; provided that (a) 26 section two of this act shall take effect on the one hundred twentieth 27 day after it shall have become a law; and (b) sections one and three of 28 this act shall take effect October 1, 2023 and apply to funding distrib- 29 utions made on or after January 1, 2024. Effective immediately, the 30 commissioner of health may make regulations and take other actions 31 reasonably necessary to implement sections one, two and three of this 32 act on their respective effective dates.
