S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  2864--A
 
                        2019-2020 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 28, 2019
                                ___________
 
 Introduced by M. of A. ABINANTI -- read once and referred to the Commit-
   tee on Health -- committee discharged, bill amended, ordered reprinted
   as amended and recommitted to said committee
 
 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:
 
   Section 1.  Section 3621 of the public health law, as added by section
 57-a  of part A of chapter 56 of the laws of 2013, is amended to read as
 follows:
   § 3621. Payment of claims. 1. Notwithstanding any law to the contrary,
 the provisions of section thirty-two hundred twenty-four-a of the insur-
 ance law, and regulations thereunder, shall apply to claims for  payment
 submitted by a licensed home care services agency, certified home health
 agency, long term home health care program, or fiscal intermediary oper-
 ating  under  section  three hundred sixty-five-f of the social services
 law, pursuant to a  contract  with  a  payor  under  section  forty-four
 hundred three-f of this chapter or section three hundred sixty-four-j of
 the social services law, and such claims shall be subject to and settled
 in compliance with the standards set forth in such section.
   2. THE PAYOR SHALL PAY A CLEAN CLAIM (A) WITHIN THIRTY DAYS OF RECEIPT
 OF  A  CLAIM THAT IS TRANSMITTED VIA THE INTERNET OR ELECTRONIC MAIL, OR
 (B) WITHIN FORTY-FIVE DAYS OF RECEIPT OF A CLAIM THAT  IS  SUBMITTED  BY
 OTHER MEANS, SUCH AS PAPER OR FACSIMILE.
   3.  THE  PAYOR  SHALL PAY ANY UNDISPUTED PORTION OF A CLAIM AS A CLEAN
 CLAIM AS SET FORTH IN SUBDIVISION TWO OF THIS SECTION. THE  PAYOR  SHALL
 NOTIFY  A PROVIDER UNDER THIS ARTICLE IN WRITING WITHIN FIFTEEN CALENDAR
 DAYS OF THE RECEIPT OF AN INITIAL  CLAIM  OF  ALL  SPECIFIC  DEFECTS  OR
 DISPUTES  OF  SUCH  CLAIM  AND SPECIFICALLY REQUEST IN WRITING THE ADDI-
 TIONAL INFORMATION OR REMEDY NEEDED TO PROCESS ANY DISPUTED PORTIONS  OF
 THE  CLAIM. NO FURTHER DEFECT OR DISPUTE OF THE CLAIM MAY BE ASSERTED BY
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD04404-02-9

 A. 2864--A                          2
 
 THE PAYOR, UNLESS IT IS ASSERTED ON THE BASIS OF NEW INFORMATION  RELAT-
 ING  TO  THE  CLAIM THAT THE PAYOR DID NOT KNOW AND COULD NOT REASONABLY
 HAVE KNOWN PRIOR TO THE NOTIFICATION.
   4.  ANY  DISPUTED  CLAIM REMEDIED SHALL BE PAID AS A CLEAN CLAIM UNDER
 SUBDIVISION TWO OF THIS SECTION.
   5. FOR THE PURPOSES OF THIS SECTION, A "CLEAN CLAIM" MEANS A CLAIM FOR
 PAYMENT FOR SERVICES UNDER THIS ARTICLE FOR WHICH THE PAYOR IS OBLIGATED
 TO PROVIDE PAYMENT AND THAT SHALL:
   (A) IDENTIFY THE LICENSED HOME CARE SERVICES PROGRAM,  CERTIFIED  HOME
 HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM OR FISCAL INTERMEDIARY
 OPERATING  PURSUANT  TO SECTION THREE HUNDRED SIXTY-FIVE-F OF THE SOCIAL
 SERVICES LAW;
   (B) SUFFICIENTLY IDENTIFY THE ELIGIBLE COVERED PERSON, THE  NATURE  OF
 THE SERVICES AND LIST THE DATE AND PLACE OF SERVICE;
   (C) SUBSTANTIATE THE APPROPRIATENESS OF THE SERVICE PROVIDED;
   (D)  IF  PRIOR  AUTHORIZATION  IS  REQUIRED  FOR SUCH ELIGIBLE COVERED
 PERSON AND SERVICE, STATE THAT SUCH PRIOR  AUTHORIZATION  WAS  OBTAINED;
 AND
   (E)  INCLUDE  ANY  DOCUMENTATION  AS REASONABLY REQUIRED BY ANY ENTITY
 REFERENCED IN THIS SECTION.
   6. EACH CLEAN CLAIM OR PAYMENT FOR SERVICES PROCESSED IN VIOLATION  OF
 THIS  SECTION  SHALL CONSTITUTE A SEPARATE VIOLATION. IN ADDITION TO THE
 PENALTIES PROVIDED IN THIS CHAPTER, ANY ORGANIZATION OR CORPORATION THAT
 FAILS TO ADHERE TO THE STANDARDS CONTAINED  IN  THIS  SECTION  SHALL  BE
 OBLIGATED  TO  PAY  TO  CERTIFIED  HOME  HEALTH AGENCIES, LONG TERM HOME
 HEALTH CARE PROGRAMS, LICENSED  HOME  HEALTH  CARE  PROGRAMS  OR  FISCAL
 INTERMEDIARIES  OPERATING PURSUANT TO SECTION THREE HUNDRED SIXTY-FIVE-F
 OF THE SOCIAL SERVICES LAW IN FULL SETTLEMENT  OF  THE  BILL,  CLAIM  OR
 PAYMENT  PLUS  INTEREST  ON THE AMOUNT OF SUCH BILL, CLAIM OR PAYMENT OF
 THE GREATER OF THE RATE EQUAL TO THE RATE SET  BY  THE  COMMISSIONER  OF
 TAXATION  AND  FINANCE  FOR CORPORATE TAXES PURSUANT TO PARAGRAPH ONE OF
 SUBSECTION (E) OF SECTION ONE THOUSAND NINETY-SIX  OF  THE  TAX  LAW  OR
 TWELVE  PERCENT  PER ANNUM, TO BE COMPUTED FROM THE DATE THE BILL, CLAIM
 OR PAYMENT WAS REQUIRED TO BE MADE.
   § 2. This act shall take effect immediately.