S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   6757
 
                        2019-2020 Regular Sessions
 
                             I N  S E N A T E
 
                            September 30, 2019
                                ___________
 
 Introduced  by  Sens. RIVERA, KRUEGER, BRESLIN -- 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  standardized
   consolidated  itemized  general  hospital bills (Part A); to amend the
   public health law, in relation to regulation of the billing of facili-
   ty fees (Part B); to amend the  public  health  law,  in  relation  to
   standardized  patient financial liability forms (Part C); to amend the
   public health law, in relation to an all payer database (Part  D);  to
   amend the public health law, in relation to the general hospital indi-
   gent  care pool; and to repeal certain provisions of such law relating
   thereto (Part E); to amend  the  civil  practice  law  and  rules,  in
   relation  to the commencement of medical debt actions (Part F); and to
   amend the financial services law, in relation to services rendered  by
   a  non-participating  provider;  to  amend  the  public health law, in
   relation to hospital statements  of  rights  and  responsibilities  of
   patients;  to amend the financial services law, in relation to dispute
   resolution for emergency services; and to amend the financial services
   law and the insurance law, in relation to  health  insurance  benefits
   (Part G)
 
   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Short title. This act shall be known and may  be  cited  as
 the "patient medical debt protection act".
   §  2.  This  act enacts into law major components of legislation which
 relate to patient medical debt  protection.  Each  component  is  wholly
 contained  within  a Part identified as Parts A through G. The effective
 date for each particular provision contained within  such  Part  is  set
 forth  in  the  last  section of such Part. Any provision in any section
 contained within a Part, including the effective date of the Part, which
 makes reference to a section "of this act", when used in connection with
 that particular component, shall be deemed to  mean  and  refer  to  the
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD13193-05-9

 S. 6757                             2
 
 corresponding  section of the Part in which it is found. Section four of
 this act sets forth the general effective date of this act.
 
                                  PART A
 
   Section  1.  The  public health law is amended by adding a new section
 2827 to read as follows:
   § 2827. STANDARDIZED CONSOLIDATED ITEMIZED GENERAL HOSPITAL BILLS.  1.
 AFTER  A PATIENT'S DISCHARGE OR RELEASE FROM A GENERAL HOSPITAL LICENSED
 UNDER THIS ARTICLE, THE FACILITY SHALL PROVIDE TO THE PATIENT OR TO  THE
 PATIENT'S  SURVIVOR  OR  LEGAL  GUARDIAN, AS APPROPRIATE, A CONSOLIDATED
 ITEMIZED STATEMENT OR A BILL DETAILING IN PLAIN LANGUAGE, COMPREHENSIBLE
 TO AN ORDINARY LAYPERSON, THE SPECIFIC NATURE  OF  CHARGES  OR  EXPENSES
 INCURRED  BY THE PATIENT. THE CONSOLIDATED ITEMIZED STATEMENT, DEVELOPED
 BY THE COMMISSIONER IN CONSULTATION WITH THE SUPERINTENDENT OF FINANCIAL
 SERVICES, SHALL DETAIL ALL SERVICES PROVIDED TO THE PATIENT  DURING  THE
 HOSPITALIZATION,  INCLUDING  ALL  PROFESSIONAL  SERVICES ADMINISTERED. A
 PROVIDER WITH ANY FINANCIAL OR CONTRACTUAL RELATIONSHIP WITH THE FACILI-
 TY MAY NOT SEPARATELY BILL THE PATIENT  OR  THE  PATIENT'S  SURVIVOR  OR
 LEGAL  GUARDIAN. THE INITIAL STATEMENT OR BILL SHALL BE PROVIDED NO MORE
 THAN SEVEN DAYS AFTER THE PATIENT'S DISCHARGE OR  RELEASE,  OR  AFTER  A
 REQUEST  FOR  SUCH  STATEMENT OR BILL, WHICHEVER IS EARLIER. THE INITIAL
 STATEMENT OR  BILL  SHALL  CONTAIN  A  STATEMENT  OF  SPECIFIC  SERVICES
 RECEIVED  AND  EXPENSES  INCURRED BY DATE AND PROVIDER FOR SUCH ITEMS OF
 SERVICE,  ENUMERATING  IN  DETAIL  THE  CONSTITUENT  COMPONENTS  OF  THE
 SERVICES  RECEIVED  WITHIN EACH DEPARTMENT OF THE FACILITY AND INCLUDING
 UNIT PRICE DATA ON RATES CHARGED BY THE FACILITY. THE STATEMENT OR  BILL
 SHALL  IDENTIFY  EACH  ITEM AS PAID, ASSIGNED TO A THIRD PARTY PAYER, OR
 EXPECTED PAYMENT BY THE PATIENT, AND SHALL INCLUDE THE  AMOUNT  DUE,  IF
 APPLICABLE.  IF  AN  AMOUNT IS DUE FROM THE PATIENT, A DUE DATE FOR SUCH
 AMOUNT SHALL BE INCLUDED.
   2. ANY SUBSEQUENT STATEMENT OR BILL PROVIDED TO A PATIENT  OR  TO  THE
 PATIENT'S  SURVIVOR  OR  LEGAL GUARDIAN, AS APPROPRIATE, RELATING TO THE
 EPISODE OF CARE MUST INCLUDE ALL OF THE INFORMATION REQUIRED BY SUBDIVI-
 SION ONE OF THIS SECTION, WITH ANY CLEARLY DELINEATED REVISIONS.
   3. EACH CONSOLIDATED ITEMIZED STATEMENT OR BILL PROVIDED  PURSUANT  TO
 THIS SECTION SHALL:
   (A)  INCLUDE  THE  SERVICES  PROVIDED BY HOSPITAL-BASED PHYSICIANS AND
 OTHER HEALTH CARE PROVIDERS WHO MAY NOT BILL SEPARATELY.
   (B) NOT INCLUDE ANY GENERALIZED CATEGORY OF EXPENSES SUCH  AS  "OTHER"
 OR "MISCELLANEOUS" OR SIMILAR CATEGORIES.
   (C)  LIST  DRUGS  BY  BRAND OR GENERIC NAME AND NOT REFER TO DRUG CODE
 NUMBERS WHEN REFERRING TO ANY DRUGS.
   (D) SPECIFICALLY IDENTIFY PHYSICAL, REHABILITATIVE,  OCCUPATIONAL,  OR
 SPEECH  THERAPY  TREATMENT  BY  DATE, TYPE, AND LENGTH OF TREATMENT WHEN
 SUCH TREATMENT IS A PART OF THE STATEMENT OR  BILL.  PROVIDERS  OF  SUCH
 SERVICES SHALL NOT PRODUCE SEPARATE BILLS.
   (E) PROMINENTLY DISPLAY THE TELEPHONE NUMBER OF THE FACILITY'S PATIENT
 LIAISON RESPONSIBLE FOR EXPEDITING THE RESOLUTION OF ANY BILLING DISPUTE
 BETWEEN  THE  PATIENT,  OR THE PATIENT'S SURVIVOR OR LEGAL GUARDIAN, AND
 THE BILLING DEPARTMENT.
   4. EACH FACILITY SHALL ESTABLISH POLICIES AND PROCEDURES FOR REVIEWING
 AND RESPONDING TO QUESTIONS  FROM  PATIENTS  CONCERNING  SUCH  PATIENT'S
 CONSOLIDATED ITEMIZED STATEMENT OR BILL. SUCH RESPONSE SHALL BE PROVIDED
 NO  MORE THAN SEVEN BUSINESS DAYS AFTER THE DATE A QUESTION IS RECEIVED.
 IF THE PATIENT IS NOT SATISFIED WITH THE RESPONSE,  THE  FACILITY  SHALL

 S. 6757                             3
 
 PROVIDE  THE PATIENT WITH THE CONTACT INFORMATION OF THE AGENCY TO WHICH
 THE ISSUE SHALL BE SENT FOR REVIEW.
   § 2. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.
 
                                  PART B
 
   Section  1.  The  public health law is amended by adding a new section
 2827-a to read as follows:
   § 2827-A. REGULATION OF THE BILLING OF FACILITY FEES. 1. FOR  PURPOSES
 OF  THIS  SECTION  "FACILITY  FEE"  MEANS ANY FEE CHARGED OR BILLED BY A
 HOSPITAL UNDER THIS ARTICLE OTHER THAN A RESIDENTIAL HEALTH CARE FACILI-
 TY, OR BY A HEALTH CARE PROFESSIONAL AUTHORIZED UNDER TITLE EIGHT OF THE
 EDUCATION LAW THAT IS: (A)  INTENDED  TO  COMPENSATE  THE  FACILITY,  OR
 HEALTH  CARE PROFESSIONAL FOR THE OPERATIONAL EXPENSES; AND (B) SEPARATE
 AND DISTINCT FROM A PROFESSIONAL FEE.
   2. NO HOSPITAL LICENSED UNDER THIS ARTICLE OTHER  THAN  A  RESIDENTIAL
 HEALTH  CARE FACILITY OR HEALTH CARE PROFESSIONAL AUTHORIZED UNDER TITLE
 EIGHT OF THE EDUCATION LAW SHALL BILL OR SEEK PAYMENT FROM A PATIENT FOR
 A FACILITY FEE RELATED TO THE PROVISION OF PREVENTIVE  CARE  SERVICE  AS
 DEFINED BY THE UNITED STATES PREVENTIVE SERVICES TASK FORCE.
   3.  NO  HOSPITAL  LICENSED UNDER THIS ARTICLE OTHER THAN A RESIDENTIAL
 HEALTH CARE FACILITY OR HEALTH CARE PROFESSIONAL AUTHORIZED UNDER  TITLE
 EIGHT OF THE EDUCATION LAW SHALL BILL OR SEEK PAYMENT FROM A PATIENT FOR
 A  FACILITY  FEE  THAT  IS NOT COVERED BY THE PATIENT'S HEALTH INSURANCE
 CARRIER.
   § 2. This act shall take effect immediately.
 
                                  PART C
 
   Section 1. The public health law is amended by adding  a  new  section
 2827-b to read as follows:
   §  2827-B.  STANDARDIZED  PATIENT  FINANCIAL  LIABILITY  FORMS. 1. ALL
 HOSPITALS LICENSED UNDER THIS  ARTICLE  AND  HEALTH  CARE  PROFESSIONALS
 AUTHORIZED  UNDER  TITLE EIGHT OF THE EDUCATION LAW SHALL BE REQUIRED TO
 USE THE UNIFORM  PATIENT  FINANCIAL  LIABILITY  FORM  DEVELOPED  BY  THE
 COMMISSIONER,  IN  CONSULTATION WITH THE COMMISSIONER OF EDUCATION.  THE
 STANDARDIZED FORM SHALL DISCLOSE TO THE PATIENT WHETHER  THEIR  CARE  IS
 IN-NETWORK  OR  OUT-OF-NETWORK,  WHETHER  THE  CARE IS A COVERED BENEFIT
 UNDER THE PATIENT INSURANCE CONTRACT, THE EXACT NATURE AND AMOUNT OF THE
 PATIENT'S PROJECTED FINANCIAL LIABILITY AND SHALL SPECIFICALLY  INDICATE
 THE EXACT AMOUNT OF PERSONAL FINANCIAL LIABILITY TO BE UNDERTAKEN BY THE
 PATIENT.  IN  NO  EVENT SHALL A PATIENT BE FINANCIALLY LIABLE FOR UNDIS-
 CLOSED BILLS OR ANY BILLS RELATED TO SERVICES PROVIDED BY A PROVIDER WHO
 FAILED TO ASCERTAIN THAT HE OR SHE WAS  IN  THE  PATIENT'S  HEALTH  PLAN
 NETWORK.  THE COMMISSIONER SHALL DEVELOP THE UNIFORM FINANCIAL LIABILITY
 FORM WITHIN SIX MONTHS OF THE EFFECTIVE DATE OF A CHAPTER OF THE LAWS OF
 TWO  THOUSAND  NINETEEN THAT ADDED THIS SECTION, AND IT SHALL BE ADOPTED
 BY ALL HOSPITALS AND HEALTH CARE PROFESSIONALS WITHIN THIRTY DAYS OF THE
 ISSUANCE OF SUCH FORM BY THE COMMISSIONER.
   § 2. This act shall take effect immediately.   Effective  immediately,
 the  addition,  amendment and/or repeal of any rule or regulation neces-
 sary for the implementation of  this  act  on  its  effective  date  are
 authorized to be made and completed on or before such effective date.

                                  PART D

 S. 6757                             4
 
   Section 1. Subdivision 18-a of section 206 of the public health law is
 amended by adding a new paragraph (e) to read as follows:
   (E)(I) THE COMMISSIONER SHALL ENSURE THAT THE NEW YORK STATE ALL PAYER
 DATABASE SHALL SERVE THE INTERESTS OF NEW YORK'S HEALTH CARE CONSUMERS.
   (II) ALL HOSPITALS LICENSED UNDER ARTICLE TWENTY-EIGHT OF THIS CHAPTER
 AND HEALTH CARE PROFESSIONALS AUTHORIZED UNDER TITLE EIGHT OF THE EDUCA-
 TION  LAW  SHALL  BE  REQUIRED  TO PARTICIPATE IN THE ALL PAYER DATABASE
 THROUGH THEIR INSURANCE CARRIER CONTRACTS, WHICH IN NO  EVENT  SHALL  BE
 DEEMED  PROPRIETARY  INFORMATION  FOR THE PURPOSES OF SUBMITTING DATA TO
 THE ALL PAYER DATABASE.
   § 2. This act shall take effect immediately.
 
                                  PART E
 
   Section 1. Subdivisions 9 and 9-a of  section  2807-k  of  the  public
 health  law, subdivision 9 as amended by section 17 of part B of chapter
 60 of the laws of 2014, subdivision 9-a as added by section 39-a of part
 A of chapter 57 of the laws of 2006 and paragraph (k) of subdivision 9-a
 as added by section 43 of part B of chapter 58 of the laws of 2008,  are
 amended to read as follows:
   9.  In order for a general hospital to participate in the distribution
 of funds from the pool, the general hospital must ONLY implement minimum
 collection policies and procedures [approved] PROVIDED  by  the  commis-
 sioner.
   9-a.  (a)  As  a  condition  for  participation  in pool distributions
 authorized pursuant to this section  and  section  twenty-eight  hundred
 seven-w  of  this  article  for  periods on and after January first, two
 thousand nine, general hospitals shall, effective  for  periods  on  and
 after  January  first, two thousand [seven, establish] TWENTY-ONE, ADOPT
 AND IMPLEMENT THE UNIFORM financial [aid  policies  and  procedures,  in
 accordance  with  the  provisions  of  this subdivision] ASSISTANCE FORM
 POLICY, TO BE DEVELOPED AND ISSUED BY THE COMMISSIONER NO LATER THAN ONE
 HUNDRED EIGHTY DAYS AFTER THE EFFECTIVE DATE OF A CHAPTER OF THE LAWS OF
 TWO THOUSAND NINETEEN THAT AMENDED THIS SUBDIVISION. NO LATER THAN THIR-
 TY DAYS OF THE ISSUANCE OF THE UNIFORM  FINANCIAL  ASSISTANCE  FORM  AND
 POLICY,  GENERAL  HOSPITALS  SHALL  IMPLEMENT  SUCH FORM AND POLICY, for
 reducing HOSPITAL charges AND CHARGES FOR PHYSICIANS  WHO  WORK  IN  THE
 HOSPITAL  otherwise  applicable to low-income individuals without health
 insurance, or who have [exhausted  their]  health  insurance  [benefits]
 THAT  DOES  NOT  COVER  OR  LIMITS  COVERAGE OF THE SERVICE, and who can
 demonstrate an inability to pay full charges, and also,  at  the  hospi-
 tal's  discretion, for reducing or discounting the collection of co-pays
 and deductible payments from those individuals who  can  demonstrate  an
 inability to pay such amounts. IMMIGRATION STATUS SHALL NOT BE AN ELIGI-
 BILITY  CRITERION.  GENERAL  HOSPITALS  SHALL  USE THE NEW YORK STATE OF
 HEALTH MARKETPLACE  ELIGIBILITY  DETERMINATION  PAGE  TO  ESTABLISH  THE
 PATIENT'S HOUSEHOLD INCOME AND RESIDENCY IN LIEU OF THE FINANCIAL APPLI-
 CATION  FORM,  PROVIDED  THEY HAVE SECURED THE CONSENT OF THE PATIENT. A
 GENERAL HOSPITAL SHALL NOT REQUIRE  A  PATIENT  TO  APPLY  FOR  COVERAGE
 THROUGH  THE  NEW  YORK  STATE OF HEALTH MARKETPLACE IN ORDER TO RECEIVE
 CARE OR FINANCIAL ASSISTANCE.
   (b) Such reductions from charges for uninsured patients  with  incomes
 below at least [three] FOUR hundred percent of the federal poverty level
 shall  result  in a charge to such individuals that does not exceed [the
 greater of] the amount that would have been paid for the  same  services
 [by  the  "highest volume payor" for such general hospital as defined in

 S. 6757                             5

 subparagraph (v) of this paragraph, or for services provided pursuant to
 title XVIII of the  federal  social  security  act  (medicare),  or  for
 services]  provided pursuant to title XIX of the federal social security
 act (medicaid), and provided further that such amounts shall be adjusted
 according to income level as follows:
   (i)  For  patients with incomes at or below at least [one] TWO hundred
 percent of the federal poverty level, the hospital shall collect no more
 than a nominal payment amount, consistent with guidelines established by
 the commissioner;
   (ii) For patients with incomes between at least [one] TWO hundred  one
 percent  and  [one]  FOUR hundred [fifty] percent of the federal poverty
 level, the hospital shall collect no more  than  the  amount  identified
 after  application  of  a  proportional sliding fee schedule under which
 patients with lower incomes shall pay the lowest amount.  Such  schedule
 shall provide that the amount the hospital may collect for such patients
 increases  from the nominal amount described in subparagraph (i) of this
 paragraph in equal increments as the income of the patient increases, up
 to a maximum of twenty percent of the greater of the amount  that  would
 have  been paid for the same services [by the "highest volume payor" for
 such general hospital, as defined in subparagraph (v) of this paragraph,
 or for services provided pursuant to title XVIII of the  federal  social
 security  act (medicare) or for services] provided pursuant to title XIX
 of the federal social security act (medicaid);
   (iii) [For patients with incomes between at least one  hundred  fifty-
 one  percent and two hundred fifty percent of the federal poverty level,
 the hospital shall collect no more  than  the  amount  identified  after
 application  of a proportional sliding fee schedule under which patients
 with lower income shall pay the  lowest  amounts.  Such  schedule  shall
 provide  that  the  amount  the  hospital  may collect for such patients
 increases from the twenty percent figure described in subparagraph  (ii)
 of  this  paragraph  in  equal  increments  as the income of the patient
 increases, up to a maximum of the greater of the amount that would  have
 been  paid  for the same services by the "highest volume payor" for such
 general hospital, as defined in subparagraph (v) of this  paragraph,  or
 for  services  provided  pursuant  to  title XVIII of the federal social
 security act (medicare) or for services provided pursuant to  title  XIX
 of the federal social security act (medicaid); and
   (iv)]  For  patients with incomes [between at least two hundred fifty-
 one percent and three hundred] ABOVE FOUR HUNDRED  ONE  percent  of  the
 federal  poverty  level,  the  hospital  shall  collect no more than the
 greater of the amount that would have been paid for  the  same  services
 [by  the  "highest volume payor" for such general hospital as defined in
 subparagraph (v) of this paragraph, or for services provided pursuant to
 title XVIII of the  federal  social  security  act  (medicare),  or  for
 services]  provided pursuant to title XIX of the federal social security
 act (medicaid)[.]; AND
   [(v) For the purposes of this paragraph, "highest volume payor"  shall
 mean  the  insurer,  corporation  or organization licensed, organized or
 certified pursuant to article thirty-two, forty-two  or  forty-three  of
 the insurance law or article forty-four of this chapter, or other third-
 party  payor,  which  has  a  contract  or  agreement  to pay claims for
 services provided by the  general  hospital  and  incurred  the  highest
 volume of claims in the previous calendar year.
   (vi)  A  hospital may implement policies and procedures to permit, but
 not require, consideration on a case-by-case basis of exceptions to  the
 requirements  described  in subparagraphs (i) and (ii) of this paragraph

 S. 6757                             6

 based upon the existence of significant assets owned by the patient that
 should be taken into account  in  determining  the  appropriate  payment
 amount  for  that  patient's care, provided, however, that such proposed
 policies  and  procedures  shall  be  subject  to  the  prior review and
 approval of the commissioner and, if approved, shall be included in  the
 hospital's  financial  assistance  policy  established  pursuant to this
 section, and provided further that, if such  approval  is  granted,  the
 maximum amount that may be collected shall not exceed the greater of the
 amount  that  would have been paid for the same services by the "highest
 volume payor" for such general hospital as defined in  subparagraph  (v)
 of  this  paragraph, or for services provided pursuant to title XVIII of
 the federal social security act (medicare),  or  for  services  provided
 pursuant  to title XIX of the federal social security act (medicaid). In
 the event that a general hospital reviews a patient's assets  in  deter-
 mining  payment  adjustments  such  policies  and  procedures  shall not
 consider as assets a patient's primary residence, assets held in a  tax-
 deferred  or  comparable  retirement  savings  account,  college savings
 accounts, or cars used  regularly  by  a  patient  or  immediate  family
 members.
   (vii)]  (IV)  Nothing  in this paragraph shall be construed to limit a
 hospital's  ability  to  establish  patient  eligibility   for   payment
 discounts  at income levels higher than those specified herein and/or to
 provide greater payment  discounts  for  eligible  patients  than  those
 required by this paragraph.
   (c)  [Such  policies and procedures shall be clear, understandable, in
 writing and publicly available in summary form and  each]  EACH  general
 hospital  participating  in  the pool shall ensure that every patient is
 made aware of the existence of such [policies  and  procedures]  UNIFORM
 FINANCIAL  ASSISTANCE  FORM  AND  POLICY  and  is  provided, in a timely
 manner, with a [summary] COPY of such [policies and procedures] FORM AND
 POLICY upon request. [Any summary provided to patients shall, at a mini-
 mum, include specific information as to income levels used to  determine
 eligibility for assistance, a description of the primary service area of
 the  hospital  and  the  means  of applying for assistance. For general]
 GENERAL hospitals with twenty-four  hour  emergency  departments,  [such
 policies  and  procedures]  shall  require  the notification of patients
 during the intake and  registration  process,  through  the  conspicuous
 posting of language-appropriate information in the general hospital, and
 information  on  bills  and  statements sent to patients, that financial
 [aid] ASSISTANCE may be available  to  qualified  patients  and  how  to
 obtain  further information. For specialty hospitals without twenty-four
 hour emergency departments, such notification shall take  place  through
 written  materials  provided to patients during the intake and registra-
 tion process prior to the provision  of  any  health  care  services  or
 procedures,  and  through  information  on  bills and statements sent to
 patients, that financial [aid] ASSISTANCE may be available to  qualified
 patients  and  how to obtain further information. [Application materials
 shall include a notice to patients that upon submission of  a  completed
 application, including any information or documentation needed to deter-
 mine  the  patient's  eligibility  pursuant  to the hospital's financial
 assistance policy, the patient may disregard any bills until the  hospi-
 tal  has  rendered a decision on the application in accordance with this
 paragraph] GENERAL HOSPITALS SHALL POST THE UNIFORM FINANCIAL ASSISTANCE
 APPLICATION FORM AND POLICY IN A CONSPICUOUS  LOCATION  ON  THE  GENERAL
 HOSPITAL'S  WEBSITE.  THE  COMMISSIONER  SHALL LIKEWISE POST THE UNIFORM

 S. 6757                             7
 
 FINANCIAL ASSISTANCE  FORM  AND  POLICY  ON  THE  DEPARTMENT'S  HOSPITAL
 PROFILE PAGE RELATED TO THE GENERAL HOSPITAL'S OR ANY SUCCESSOR WEBSITE.
   (d)  THE  COMMISSIONER  SHALL PROVIDE APPLICATION MATERIALS TO GENERAL
 HOSPITALS, INCLUDING THE UNIFORM FINANCIAL ASSISTANCE  APPLICATION  FORM
 AND  POLICY.  THESE  APPLICATION  MATERIALS  SHALL  INCLUDE  A NOTICE TO
 PATIENTS THAT UPON SUBMISSION  OF  A  COMPLETED  APPLICATION  FORM,  THE
 PATIENT  MAY DISREGARD ANY BILLS UNTIL THE GENERAL HOSPITAL HAS RENDERED
 A DECISION ON THE APPLICATION IN ACCORDANCE  WITH  THIS  PARAGRAPH.  THE
 APPLICATION  MATERIALS  SHALL INCLUDE SPECIFIC INFORMATION AS THE INCOME
 LEVELS  USED  TO  DETERMINE  ELIGIBILITY  FOR  FINANCIAL  ASSISTANCE,  A
 DESCRIPTION OF THE PRIMARY SERVICE AREA OF THE HOSPITAL AND THE MEANS TO
 APPLY  FOR ASSISTANCE. Such policies and procedures shall include clear,
 objective criteria for determining a patient's ability to  pay  and  for
 providing  such adjustments to payment requirements as are necessary. In
 addition to adjustment mechanisms such  as  sliding  fee  schedules  and
 discounts  to  fixed  standards, such policies and procedures shall also
 provide for the use of installment plans for the payment of  outstanding
 balances by patients pursuant to the provisions of the hospital's finan-
 cial  assistance policy. The monthly payment under such a plan shall not
 exceed [ten] FIVE percent of the gross monthly income of  the  patient[,
 provided,  however,  that  if patient assets are considered under such a
 policy, then patient assets which are not excluded  assets  pursuant  to
 subparagraph (vi) of paragraph (b) of this subdivision may be considered
 in  addition  to  the  limit  on monthly payments.] The rate of interest
 charged to the patient on the unpaid balance, if any, shall  not  exceed
 the  [rate  for  a ninety-day security] FEDERAL FUNDS RATE issued by the
 United States Department of Treasury[, plus  .5  percent]  and  no  plan
 shall include an accelerator or similar clause under which a higher rate
 of  interest  is  triggered upon a missed payment. [If such policies and
 procedures] THE POLICY SHALL NOT include  a  requirement  of  a  deposit
 prior  to  non-emergent, medically-necessary care[, such deposit must be
 included as part of any financial aid consideration]. Such policies  and
 procedures shall be applied consistently to all eligible patients.
   (e)  Such  policies  and procedures shall permit patients to apply for
 assistance within at least [ninety] TWO HUNDRED FORTY days of  the  date
 of discharge or date of service and provide at least [twenty] SIXTY days
 for patients to submit a completed application. Such policies and proce-
 dures  may  require  that  patients  seeking payment adjustments provide
 [appropriate] THE FOLLOWING financial information and  documentation  in
 support  of their application[, provided, however, that such application
 process shall not be unduly burdensome or complex] THAT ARE USED BY  THE
 NEW  YORK  STATE  OF  HEALTH  MARKETPLACE: PAY CHECKS OR PAY STUBS; RENT
 RECEIPTS;  A  LETTER  FROM  THE  PATIENT'S  EMPLOYER  ATTESTING  TO  THE
 PATIENT'S  GROSS  INCOME;  OR, IF NONE OF THE AFOREMENTIONED INFORMATION
 AND DOCUMENTATION ARE  AVAILABLE,  A  WRITTEN  SELF-ATTESTATION  OF  THE
 PATIENT'S INCOME. General hospitals shall, upon request, assist patients
 in  understanding the hospital's policies and procedures and in applying
 for payment  adjustments.  [Application  forms  shall  be  printed]  THE
 COMMISSIONER  SHALL  TRANSLATE THE FINANCIAL ASSISTANCE APPLICATION FORM
 AND POLICY INTO THE "PRIMARY LANGUAGES" OF EACH GENERAL  HOSPITAL.  EACH
 GENERAL  HOSPITAL SHALL PRINT AND POST THESE MATERIALS TO ITS WEBSITE in
 the "primary languages" of patients served by the general hospital.  For
 the  purposes  of  this paragraph, "primary languages" shall include any
 language that is either (i) used to communicate, during  at  least  five
 percent of patient visits in a year, by patients who cannot speak, read,
 write  or  understand  the  English language at the level of proficiency

 S. 6757                             8
 
 necessary for effective communication with  health  care  providers,  or
 (ii) spoken by non-English speaking individuals comprising more than one
 percent  of  the primary hospital service area population, as calculated
 using demographic information available from the United States Bureau of
 the  Census, supplemented by data from school systems. Decisions regard-
 ing such applications shall be made within thirty days of receipt  of  a
 completed  application.  Such policies and procedures shall require that
 the hospital issue any denial/approval of such  application  in  writing
 with  information  on  how  to  appeal  the denial and shall require the
 hospital to establish an appeals process under which  it  will  evaluate
 the  denial  of  an  application.  [Nothing in this subdivision shall be
 interpreted as prohibiting a hospital from making  the  availability  of
 financial  assistance  contingent  upon  the  patient first applying for
 coverage under title XIX of the social security act (medicaid) or anoth-
 er insurance program if, in the judgment of the  hospital,  the  patient
 may  be eligible for medicaid or another insurance program, and upon the
 patient's cooperation in following the hospital's  financial  assistance
 application  requirements, including the provision of information needed
 to make a determination on the patient's application in accordance  with
 the hospital's financial assistance policy.]
   (f)  Such  policies  and  procedures  shall provide that patients with
 incomes below [three] FOUR hundred percent of the federal poverty  level
 are  deemed  presumptively  eligible  for  payment adjustments and shall
 conform to the requirements set forth in paragraph (b) of this  subdivi-
 sion,  provided,  however,  that  nothing  in  this subdivision shall be
 interpreted as precluding hospitals from extending such payment  adjust-
 ments  to  other  patients, either generally or on a case-by-case basis.
 Such [policies and procedures]  POLICY  shall  provide  financial  [aid]
 ASSISTANCE  for  emergency hospital services, including emergency trans-
 fers pursuant to the federal  emergency  medical  treatment  and  active
 labor  act (42 USC 1395dd), to patients who reside in New York state and
 for medically necessary hospital services for patients who reside in the
 hospital's primary service area  as  determined  according  to  criteria
 established  by  the  commissioner.  In  developing  such  criteria, the
 commissioner shall consult with representatives of the  hospital  indus-
 try,  health  care consumer advocates and local public health officials.
 Such criteria shall be made available to the public no less than  thirty
 days prior to the date of implementation and shall, at a minimum:
   (i)  prohibit  a  hospital  from  developing  or  altering its primary
 service area in a manner designed to avoid medically underserved  commu-
 nities or communities with high percentages of uninsured residents;
   (ii)  ensure that every geographic area of the state is included in at
 least one general hospital's  primary  service  area  so  that  eligible
 patients may access care and financial assistance; and
   (iii)  require the hospital to notify the commissioner upon making any
 change to its primary service area, and to include a description of  its
 primary  service  area  in  the  hospital's annual implementation report
 filed pursuant to subdivision  three  of  section  twenty-eight  hundred
 three-l of this article.
   (g)  Nothing  in  this  subdivision shall be interpreted as precluding
 hospitals from extending payment  adjustments  for  medically  necessary
 non-emergency  hospital  services  to patients outside of the hospital's
 primary service area. For patients determined to be eligible for  finan-
 cial  [aid]  ASSISTANCE  under  the  terms of [a hospital's] THE UNIFORM
 financial [aid] ASSISTANCE policy, such [policies and procedures] POLICY
 shall  prohibit  any  limitations  on  financial  [aid]  ASSISTANCE  for

 S. 6757                             9
 
 services  based  on  the  medical condition of the applicant, other than
 typical limitations or exclusions based  on  medical  necessity  or  the
 clinical or therapeutic benefit of a procedure or treatment.
   (h)  Such  policies and procedures shall not permit the SECURANCE OF A
 LIEN OR forced sale or foreclosure of a patient's primary  residence  in
 order  to  collect  an  outstanding  medical  bill and shall require the
 hospital to refrain from sending an account to collection if the patient
 has submitted a completed application for financial [aid, including  any
 required supporting documentation] ASSISTANCE, while the hospital deter-
 mines  the patient's eligibility for such [aid] ASSISTANCE.  Such [poli-
 cies and procedures] POLICY  shall  provide  for  written  notification,
 which  shall  include  notification  on a patient bill, to a patient not
 less than thirty days prior to the referral of debts for collection  and
 shall  require  that the collection agency obtain the hospital's written
 consent prior to commencing a legal action. Such  [policies  and  proce-
 dures] POLICY shall require all general hospital staff who interact with
 patients  or  have  responsibility  for  billing  and  collections to be
 trained in such [policies and procedures] POLICY, and require the imple-
 mentation of a mechanism for the general hospital to measure its compli-
 ance with [such policies and procedures] THE POLICY. Such [policies  and
 procedures]  POLICY  shall  require  that  any  collection  agency under
 contract with a general hospital for the collection of debts follow  the
 [hospital's]  UNIFORM  financial  assistance policy, including providing
 information to patients on how to apply for financial  assistance  where
 appropriate.  Such  [policies  and  procedures]  POLICY  shall  prohibit
 collections from a patient who is determined to be eligible for  medical
 assistance  pursuant  to title XIX of the federal social security act at
 the time services were rendered and for which services medicaid  payment
 is available.
   (i) Reports required to be submitted to the department by each general
 hospital  as  a  condition  for  participation  in  the pools, and which
 contain, in accordance with applicable regulations, a certification from
 an independent  certified  public  accountant  or  independent  licensed
 public accountant or an attestation from a senior official of the hospi-
 tal  that the hospital is in compliance with conditions of participation
 in the pools, shall also contain, for reporting  periods  on  and  after
 January first, two thousand seven:
   (i)  a  report  on  hospital costs incurred and uncollected amounts in
 providing services to  [eligible]  patients  [without  insurance]  FOUND
 ELIGIBLE FOR FINANCIAL ASSISTANCE, including the amount of care provided
 for a nominal payment amount, during the period covered by the report;
   (ii)  hospital  costs incurred and uncollected amounts for deductibles
 and coinsurance for eligible patients with insurance or other third-par-
 ty payor coverage;
   (iii) the number of patients, organized  according  to  United  States
 postal  service  zip code, who applied for financial assistance pursuant
 to the [hospital's] UNIFORM financial assistance policy, and the number,
 organized according to United States  postal  service  zip  code,  whose
 applications were approved and whose applications were denied;
   (iv) the reimbursement received for indigent care from the pool estab-
 lished pursuant to this section;
   (v)  the  amount  of  funds  that have been expended on [charity care]
 FINANCIAL ASSISTANCE from charitable bequests made or trusts established
 for the purpose of providing financial assistance to  patients  who  are
 eligible in accordance with the terms of such bequests or trusts;

 S. 6757                            10
 
   (vi)  for  hospitals located in social services districts in which the
 district allows hospitals to assist patients with such applications, the
 number of applications for eligibility under title  XIX  of  the  social
 security  act (medicaid) that the hospital assisted patients in complet-
 ing and the number denied and approved;
   (vii) the hospital's financial losses resulting from services provided
 under medicaid; and
   (viii)  the number of REFERRALS TO COLLECTION AGENTS OR OUTSIDE VENDOR
 COURT CASES AND liens placed on [the primary] ANY residences of patients
 through the collection process used by a hospital.
   (j) [Within ninety days of the effective date of this subdivision each
 hospital shall submit to the commissioner a written report on its  poli-
 cies  and procedures for financial assistance to patients which are used
 by the hospital on the effective date of this subdivision.  Such  report
 shall  include copies of its policies and procedures, including material
 which is distributed to patients, and a description  of  the  hospital's
 financial  aid  policies  and procedures. Such description shall include
 the income levels of patients on which eligibility is based, the  finan-
 cial  aid  eligible  patients  receive and the means of calculating such
 aid, and the service area, if any, used by  the  hospital  to  determine
 eligibility]  THE  COMMISSIONER  SHALL  INCLUDE THE DATA COLLECTED UNDER
 PARAGRAPH (I) OF THIS SUBDIVISION IN REGULAR AUDITS OF THE ANNUAL GENER-
 AL HOSPITAL INSTITUTIONAL COST REPORT.
   (k) In the event it is determined by the commissioner that  the  state
 will  be unable to secure all necessary federal approvals to include, as
 part of the state's approved state plan  under  title  nineteen  of  the
 federal  social  security act, a requirement[, as set forth in paragraph
 one of this subdivision,] that compliance with  this  subdivision  is  a
 condition  of participation in pool distributions authorized pursuant to
 this section and section twenty-eight hundred seven-w of  this  article,
 then  such condition of participation shall be deemed null and void and,
 notwithstanding section twelve of this chapter, failure to  comply  with
 the  provisions  of this subdivision by a hospital on and after the date
 of such determination shall make such hospital liable for a civil penal-
 ty not to exceed ten thousand dollars for each such violation. The impo-
 sition of such civil penalties shall be subject  to  the  provisions  of
 section twelve-a of this chapter.
   §  2.  Subdivision  14  of  section 2807-k of the public health law is
 REPEALED and subdivisions 15, 16 and 17 are renumbered subdivisions  14,
 15 and 16.
   § 3. This act shall take effect immediately.
 
                                  PART F
 
   Section 1. The civil practice law and rules is amended by adding a new
 section 213-d to read as follows:
   §  213-D.  ACTIONS TO BE COMMENCED WITHIN TWO YEARS; MEDICAL DEBT.  AN
 ACTION ON A MEDICAL DEBT BY A HOSPITAL LICENSED  UNDER  ARTICLE  TWENTY-
 EIGHT  OF THE PUBLIC HEALTH LAW OR A HEALTH CARE PROFESSIONAL AUTHORIZED
 UNDER TITLE EIGHT OF THE EDUCATION LAW SHALL  BE  COMMENCED  WITHIN  TWO
 YEARS  OF  TREATMENT AND NO DETERMINATION OF A DEBT OR AWARD OF DEBT MAY
 BE BASED UPON A SERVICE HAVING OCCURRED MORE THAN TWO YEARS  BEFORE  THE
 ACTION IS COMMENCED.
   §  2.  Section 5004 of the civil practice law and rules, as amended by
 chapter 258 of the laws of 1981, is amended to read as follows:

 S. 6757                            11
 
   § 5004. Rate of interest. Interest shall be at the rate  of  nine  per
 centum  per  annum, except where otherwise provided by statute, PROVIDED
 THAT IN MEDICAL DEBT ACTIONS BY A HOSPITAL LICENSED UNDER ARTICLE  TWEN-
 TY-EIGHT  OF THE PUBLIC HEALTH LAW OR A HEALTH CARE PROFESSIONAL AUTHOR-
 IZED   UNDER TITLE EIGHT OF THE EDUCATION LAW THE INTEREST RATE SHALL BE
 THREE PER CENTUM PER ANNUM.
   § 3. This act shall take effect immediately.
 
                                  PART G
 
   Section 1. Subsection (h) of section 603  of  the  financial  services
 law, as added by section 26 of part H of chapter 60 of the laws of 2014,
 is amended to read as follows:
   (h)  "Surprise bill" means a bill for health care services, other than
 emergency services, received by:
   (1) an insured for services rendered by a non-participating  physician
 at  a  participating  hospital  or  ambulatory  surgical center, where a
 participating physician is unavailable or a non-participating  physician
 renders  services without the insured's knowledge, or unforeseen medical
 services arise at the  time  the  health  care  services  are  rendered;
 provided,  however,  that a surprise bill shall not mean a bill received
 for health care services when a participating physician is available and
 the insured has elected to  obtain  services  from  a  non-participating
 physician;
   (2)  an insured for services rendered by a non-participating provider,
 where the services were referred by a participating physician to a  non-
 participating  provider  without explicit written consent of the insured
 acknowledging that the participating physician is referring the  insured
 to  a  non-participating  provider  and  that the referral may result in
 costs not covered by the health care plan; [or]
   (3) AN INSURED FOR SERVICES RENDERED BY A  NON-PARTICIPATING  PROVIDER
 WHEN  THE  INSURED  REASONABLY  RELIED UPON AN ORAL OR WRITTEN STATEMENT
 THAT THE NON-PARTICIPATING PROVIDER WAS A PARTICIPATING PROVIDER MADE BY
 A HEALTH CARE PLAN, OR AGENT OR REPRESENTATIVE OF A HEALTH CARE PLAN, OR
 AS SPECIFIED IN THE HEALTH CARE PLAN PROVIDER LISTING OR  DIRECTORY,  OR
 PROVIDER INFORMATION ON THE HEALTH PLAN'S WEBSITE;
   (4)  AN  INSURED FOR SERVICES RENDERED BY A NON-PARTICIPATING PROVIDER
 WHEN THE INSURED REASONABLY RELIED UPON A STATEMENT THAT THE  NON-PARTI-
 CIPATING  PROVIDER WAS A PARTICIPATING PROVIDER MADE BY THE NON-PARTICI-
 PATING PROVIDER, OR AGENT OR  REPRESENTATIVE  OF  THE  NON-PARTICIPATING
 PROVIDER,  OR  AS SPECIFIED ON THE NON-PARTICIPATING PROVIDER'S WEBSITE;
 OR
   (5) a patient who is not an insured for services rendered by a  physi-
 cian  at a hospital or ambulatory surgical center, where the patient has
 not timely received all of the disclosures required pursuant to  section
 twenty-four of the public health law.
   §  2.  Paragraph  (k)  of  subdivision 1 of section 2803 of the public
 health law, as added by chapter 241 of the laws of 2016, is  amended  to
 read as follows:
   (k)  The  statement  regarding  patient  rights  and responsibilities,
 required pursuant to paragraph (g) of this  subdivision,  shall  include
 provisions informing the patient of his or her right to [choose] BE HELD
 HARMLESS  FROM  CERTAIN BILLS FOR EMERGENCY SERVICES AND SURPRISE BILLS,
 AND to submit surprise bills or bills  for  emergency  services  to  the
 independent  dispute process established in article six of the financial
 services law, and informing the patient of his or her right  to  view  a

 S. 6757                            12
 
 list  of the hospital's standard charges and the health plans the hospi-
 tal participates with consistent with section twenty-four of this  chap-
 ter.
   § 3. Paragraph 1 of subsection (a) of section 605 and sections 606 and
 608  of  the financial services law, as added by section 26 of part H of
 chapter 60 of the laws of 2014, are amended to read as follows:
   (1) When a health care plan receives a  bill  for  emergency  services
 from  a  non-participating  physician, the health care plan shall pay an
 amount that it determines  is  reasonable  for  the  emergency  services
 rendered  by the non-participating physician, in accordance with section
 three thousand two hundred twenty-four-a of the  insurance  law,  except
 for  the  insured's  co-payment,  coinsurance or deductible, if any, and
 shall ensure that the insured shall incur no greater out-of-pocket costs
 for the emergency services than the insured would have incurred  with  a
 participating  physician  pursuant  to  subsection  (c) of section three
 thousand two hundred forty-one of  the  insurance  law.  IF  AN  INSURED
 ASSIGNS BENEFITS TO A NON-PARTICIPATING PHYSICIAN OR AMBULANCE PROVIDER,
 SUCH PAYMENT SHALL BE MADE DIRECTLY TO THE ASSIGNEE.
   § 606. Hold harmless and assignment of benefits for EMERGENCY SERVICES
 AND surprise bills for insureds. When an insured assigns benefits for AN
 EMERGENCY  SERVICE  OR a surprise bill in writing to a non-participating
 physician OR HOSPITAL that knows the insured is insured under  a  health
 care  plan,  the  non-participating physician OR HOSPITAL shall not bill
 the insured except for any applicable copayment, coinsurance or  deduct-
 ible  that  would be owed if the insured utilized a participating physi-
 cian OR HOSPITAL.
   § 608. Payment for independent  dispute  resolution  entity.  (a)  For
 disputes  involving  an insured, when the independent dispute resolution
 entity determines the health care plan's payment is reasonable,  payment
 for  the  dispute  resolution process shall be the responsibility of the
 non-participating physician.   When the independent  dispute  resolution
 entity  determines  the non-participating physician's fee is reasonable,
 payment for the dispute resolution process shall be  the  responsibility
 of  the  health care plan. When a good faith negotiation directed by the
 independent dispute resolution entity  pursuant  to  paragraph  four  of
 subsection (a) of section six hundred five of this article, or paragraph
 six  of  subsection  (a)  of  section  six hundred seven of this article
 results in a settlement between the health care plan and non-participat-
 ing physician, the health care plan and the non-participating  physician
 shall evenly divide and share the prorated cost for dispute resolution.
   (b)  For disputes involving a patient that is not an insured, when the
 independent dispute resolution  entity  determines  the  physician's  OR
 HOSPITAL'S fee is reasonable, payment for the dispute resolution process
 shall  be  the  responsibility  of  the  patient  unless payment for the
 dispute resolution process would pose a hardship  to  the  patient.  The
 superintendent  shall  promulgate  a regulation to determine payment for
 the dispute resolution process in cases of hardship. When the  independ-
 ent  dispute  resolution entity determines the physician's OR HOSPITAL'S
 fee is unreasonable, payment for the dispute resolution process shall be
 the responsibility of the physician OR HOSPITAL.
   § 6. Subsection (c) of section 3241 of the insurance law, as added  by
 section  6  of  part  H of chapter 60 of the laws of 2014, is amended to
 read as follows:
   (c) When an insured or  enrollee  under  a  contract  or  policy  that
 provides  coverage  for  emergency services receives the services from a
 health care provider that does not participate in the  provider  network

 S. 6757                            13
 
 of  an  insurer, a corporation organized pursuant to article forty-three
 of this chapter, a municipal cooperative health benefit  plan  certified
 pursuant  to  article  forty-seven of this chapter, a health maintenance
 organization  certified  pursuant  to  article  forty-four of the public
 health law, or a student health plan established or maintained  pursuant
 to section one thousand one hundred twenty-four of this chapter ("health
 care  plan"),  the  health  care  plan  shall ensure that the insured or
 enrollee shall incur no greater out-of-pocket costs  for  the  emergency
 services  than the insured or enrollee would have incurred with a health
 care provider that participates  in  the  health  care  plan's  provider
 network.
   For  the  purpose of this section, "emergency services" shall have the
 meaning set forth in [subparagraph (D) of paragraph nine  of  subsection
 (i)  of  section  three  thousand  two  hundred sixteen of this article,
 subparagraph (D) of paragraph four of subsection (k)  of  section  three
 thousand two hundred twenty-one of this article, and subparagraph (D) of
 paragraph  two  of subsection (a) of section four thousand three hundred
 three of this chapter] SUBSECTION (B) OF SECTION SIX  HUNDRED  THREE  OF
 THE FINANCIAL SERVICES LAW.
   § 7. This act shall take effect immediately.
   § 3. Severability clause. If any clause, sentence, paragraph, subdivi-
 sion,  section  or  part  of  this act shall be adjudged by any court of
 competent jurisdiction to be invalid, such judgment  shall  not  affect,
 impair,  or invalidate   the remainder thereof, but shall be confined in
 its operation to the clause, sentence, paragraph,  subdivision,  section
 or part thereof directly involved in the controversy in which such judg-
 ment shall have been rendered. It is hereby declared to be the intent of
 the  legislature  that  this  act  would  have been enacted even if such
 invalid provisions had not been included herein.
   § 4. This act shall take effect immediately  provided,  however,  that
 the  applicable effective date of Parts A through G of this act shall be
 as specifically set forth in the last section of such Parts.