S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   5646
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                                May 9, 2019
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed to the Committee 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:
 
   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
 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.
              

                                                            LBD04404-03-9

 S. 5646                             2
 
 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.