S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1366
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 11, 2023
                                ___________
 
 Introduced by Sens. RIVERA, CLEARE, GOUNARDES, HARCKHAM, JACKSON, KRUEG-
   ER,  MAY, MYRIE, PERSAUD, SALAZAR, SEPULVEDA -- 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 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:
 
   Section 1. Subdivision 9 of section 2807-k of the public  health  law,
 as amended by section 17 of part B of chapter 60 of the laws of 2014, is
 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  [implement  minimum
 collection policies and procedures approved] USE ONLY THE UNIFORM FINAN-
 CIAL ASSISTANCE POLICY AND FORM PROVIDED by the commissioner.
   §  2.   Subdivision 9-a of section 2807-k of the public health law, as
 added by section 39-a of part A of chapter 57 of the laws of 2006, para-
 graph (k) as added by section 43 of part B of chapter 58 of the laws  of
 2008, is amended to read as follows:
   9-a.  (a)  (I)  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 financial [aid]
 ASSISTANCE policies and procedures, in accordance with the provisions of
 this subdivision, for reducing HOSPITAL charges otherwise applicable  to
 low-income  individuals without THIRD-PARTY health [insurance] COVERAGE,
 or who have [exhausted their] THIRD-PARTY  health  [insurance  benefits]
 COVERAGE  THAT DOES NOT COVER OR LIMITS COVERAGE OF THE SERVICE, and who
 can demonstrate an inability to pay  full  charges,  and  also,  at  the
 hospital's  discretion,  for  reducing  or discounting the collection of
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02400-01-3
              

 S. 1366                             2
 
 co-pays and deductible payments from those individuals  who  can  demon-
 strate an inability to pay such amounts. IMMIGRATION STATUS SHALL NOT BE
 AN  ELIGIBILITY  CRITERION  FOR  THE  PURPOSE  OF  DETERMINING FINANCIAL
 ASSISTANCE UNDER THIS SECTION.
   (II)  A  GENERAL HOSPITAL MAY USE THE NEW YORK STATE OF HEALTH MARKET-
 PLACE ELIGIBILITY DETERMINATION PAGE TO ESTABLISH THE  PATIENT'S  HOUSE-
 HOLD  INCOME  AND  RESIDENCY  IN LIEU OF THE FINANCIAL APPLICATION FORM,
 PROVIDED IT HAS 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.
   (III)  UPON SUBMISSION OF A COMPLETED APPLICATION FORM, THE PATIENT IS
 NOT LIABLE FOR ANY BILLS UNTIL THE GENERAL HOSPITAL HAS RENDERED A DECI-
 SION ON THE APPLICATION IN ACCORDANCE WITH THIS SUBDIVISION.
   (b) [Such]  THE  reductions  from  charges  for  [uninsured]  patients
 DESCRIBED  IN  PARAGRAPH  (A) OF THIS SUBDIVISION with incomes below [at
 least three] SIX 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  subpara-
 graph  (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] XVIII of the federal social security
 act [(medicaid)] (MEDICARE), and provided further  that  such  [amounts]
 AMOUNT 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]  ABOVE  TWO
 hundred  [one]  percent  and [one] UP TO 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 sched-
 ule under which patients with lower incomes shall pay the lowest amount.
 [Such]  THE  schedule  shall  provide  that  the amount the hospital may
 collect for [such patients]  THE  PATIENT  increases  from  the  nominal
 amount  described  in subparagraph (i) of this paragraph in equal incre-
 ments 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]  XVIII  of
 the federal social security act [(medicaid);] (MEDICARE).
   (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
 S. 1366                             3

 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 PERCENT AND UP TO  SIX
 HUNDRED 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 hospi-
 tal 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]  XVIII  of
 the federal social security act [(medicaid)] (MEDICARE).
   [(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
 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)]  (C) Nothing in this [paragraph] SUBDIVISION 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] SUBDIVISION.
   [(c)] (D) Such policies and procedures shall be clear, understandable,
 in  writing  and  publicly  available  in  summary form and each general
 hospital participating in the pool shall ensure that  every  patient  is
 made aware of the existence of [such] THE policies and procedures and is
 provided,  in  a timely manner, with a summary AND A COPY of [such poli-
 cies and procedures] THE POLICY  AND  FORM  upon  request.  Any  summary
 provided  to  patients shall, at a minimum, 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 hospitals with twenty-four hour
 emergency departments, such policies and procedures] A GENERAL  HOSPITAL
 S. 1366                             4
 
 shall  [require the notification of patients] NOTIFY PATIENTS BY PROVID-
 ING WRITTEN MATERIALS TO PATIENTS OR  THEIR  AUTHORIZED  REPRESENTATIVES
 during  the  intake  and  registration  process, through the conspicuous
 posting of language-appropriate information in the general hospital, and
 BY  INCLUDING 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 registration 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  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 FINANCIAL ASSISTANCE  APPLI-
 CATION  POLICY,  PROCEDURES  AND  FORM,  AND A SUMMARY OF THE POLICY AND
 PROCEDURES, IN A CONSPICUOUS  LOCATION  AND  DOWNLOADABLE  FORM  ON  THE
 GENERAL HOSPITAL'S WEBSITE.
   [(d)  Such]  (E)  THE HOSPITAL'S APPLICATION MATERIALS SHALL INCLUDE A
 NOTICE TO PATIENTS THAT UPON SUBMISSION OF A COMPLETED APPLICATION FORM,
 THE PATIENT SHALL NOT BE LIABLE FOR ANY BILLS UNTIL THE GENERAL HOSPITAL
 HAS RENDERED A DECISION ON  THE  APPLICATION  IN  ACCORDANCE  WITH  THIS
 SUBDIVISION.   THE APPLICATION MATERIALS SHALL INCLUDE SPECIFIC INFORMA-
 TION 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. NOTHING IN THIS SUBDIVISION SHALL
 BE CONSTRUED AS PRECLUDING THE USE OF PRESUMPTIVE  ELIGIBILITY  DETERMI-
 NATIONS  BY HOSPITALS ON BEHALF OF PATIENTS. THE policies and procedures
 shall include clear, objective  criteria  for  determining  a  patient's
 ability  to  pay  and for providing such adjustments to payment require-
 ments 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 financial 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]. INSTALLMENT PLAN PAYMENTS MAY NOT BE REQUIRED TO BEGIN BEFORE
 ONE HUNDRED EIGHTY DAYS AFTER THE DATE  OF  THE  SERVICE  OR  DISCHARGE,
 WHICHEVER  IS LATER. THE POLICY SHALL ALLOW THE PATIENT AND THE HOSPITAL
 TO MUTUALLY AGREE TO MODIFY THE TERMS OF AN INSTALLMENT PLAN.  The  rate
 of  interest charged to the patient on the unpaid balance, if any, shall
 not exceed [the rate for a ninety-day  security  issued  by  the  United
 States  Department of Treasury, plus .5 percent] TWO PERCENTUM PER ANNUM
 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]
 THE policies and procedures 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].   THE HOSPITAL
 S. 1366                             5
 
 SHALL REFUND ANY PAYMENTS MADE BY THE PATIENT BEFORE  THE  DETERMINATION
 OF  ELIGIBILITY  FOR  FINANCIAL  ASSISTANCE  THAT  EXCEEDS THE PATIENT'S
 LIABILITY AFTER DISCOUNTS ARE  APPLIED.  Such  policies  and  procedures
 shall be applied consistently to all eligible patients.
   [(e) Such policies and procedures shall permit patients to] (F) IN ANY
 LEGAL  ACTION  BY  OR ON BEHALF OF A HOSPITAL TO COLLECT A MEDICAL DEBT,
 THE COMPLAINT SHALL BE ACCOMPANIED BY AN  AFFIDAVIT  BY  THE  HOSPITAL'S
 CHIEF  FINANCIAL  OFFICER  STATING  THAT  ON  INFORMATION AND BELIEF THE
 PATIENT DOES NOT MEET THE INCOME OR  RESIDENCY  CRITERIA  FOR  FINANCIAL
 ASSISTANCE. PATIENTS MAY apply for FINANCIAL assistance [within at least
 ninety  days  of the date of discharge or date of service and provide at
 least twenty days for patients to submit a completed application] AT ANY
 TIME DURING THE COLLECTION PROCESS, INCLUDING AFTER THE COMMENCEMENT  OF
 A  MEDICAL  DEBT  COURT ACTION OR UPON THE PLAINTIFF OBTAINING A DEFAULT
 JUDGMENT. A HOSPITAL MAY USE CREDIT SCORING SOFTWARE FOR THE PURPOSES OF
 ESTABLISHING INCOME ELIGIBILITY AND APPROVING FINANCIAL ASSISTANCE,  BUT
 ONLY  IF THE HOSPITAL MAKES CLEAR TO THE PATIENT THAT PROVIDING A SOCIAL
 SECURITY NUMBER IS NOT MANDATORY AND THE  SCORING  DOES  NOT  NEGATIVELY
 IMPACT  THE  PATIENT'S  CREDIT SCORE.   HOWEVER, CREDIT SCORING SOFTWARE
 SHALL NOT BE SOLELY RELIED UPON BY THE HOSPITAL IN DENYING  A  PATIENT'S
 APPLICATION  FOR  FINANCIAL ASSISTANCE.   [Such] THE policies and proce-
 dures [may require that] SHALL ALLOW patients seeking  [payment  adjust-
 ments]  FINANCIAL  ASSISTANCE  TO  provide  [appropriate]  THE FOLLOWING
 financial information and documentation in  support  of  their  applica-
 tion[,  provided,  however,  that  such application process shall not be
 unduly burdensome or complex]: PAY CHECKS  OR  PAY  STUBS;  UNEMPLOYMENT
 DOCUMENTATION;  SOCIAL SECURITY INCOME; 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 MAY  BE  USED.  General
 hospitals  shall,  upon  request,  assist  patients in understanding the
 hospital's APPLICATION AND FORM, policies and procedures and in applying
 for payment adjustments. Application forms shall be printed  AND  POSTED
 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 commu-
 nicate, 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 necessary  for  effective  communi-
 cation  with health care providers, or (ii) spoken by non-English speak-
 ing 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 regarding such applications shall be
 made within thirty days of receipt of a  completed  application.  [Such]
 THE  policies  and  procedures shall require that the hospital issue any
 [denial/approval] DENIAL OR APPROVAL of [such] THE application in  writ-
 ing  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
 S. 1366                             6

 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] THE HOSPITAL SHALL INFORM
 PATIENTS  ON  HOW  TO  FILE  A  COMPLAINT AGAINST THE HOSPITAL OR A DEBT
 COLLECTOR THAT IS CONTRACTED ON BEHALF OF  THE  HOSPITAL  REGARDING  THE
 PATIENT'S BILL.
   [(f) Such] (G) THE policies and procedures shall provide that patients
 with  incomes  below  [three] SIX 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
 subdivision, provided, however, that nothing in this  subdivision  shall
 be  interpreted  as  precluding  hospitals  from  extending such payment
 adjustments to other patients, either generally  or  on  a  case-by-case
 basis.  [Such] THE policies and procedures 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] THE criteria,  the
 commissioner  shall  consult with representatives of the hospital indus-
 try, health care consumer advocates and local public  health  officials.
 [Such]  THE  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)] (H) Nothing in this subdivision shall be interpreted as preclud-
 ing 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  financial  [aid]
 ASSISTANCE policy, [such] THE policies and procedures shall prohibit any
 limitations  on  financial  [aid]  ASSISTANCE  for 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 forced]  (I)  A
 HOSPITAL  OR  ITS  AGENT  SHALL NOT ISSUE, AUTHORIZE OR PERMIT AN INCOME
 EXECUTION OF A PATIENT'S WAGES, SECURE A LIEN OR FORCE A sale  or  fore-
 closure  of  a  patient's  primary  residence  in  order  to  collect an
 outstanding medical bill and shall [require the hospital to refrain from
 sending] NOT SEND an account to collection if the patient has  submitted
 a  completed  application  for  financial  [aid,  including any required
 supporting documentation] ASSISTANCE, while the hospital determines  the
 patient's  eligibility  for [such aid] FINANCIAL ASSISTANCE.  [Such] THE
 policies and procedures shall provide for  written  notification,  which
 shall include notification on a patient bill, to a patient not less than
 S. 1366                             7
 
 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] THE policies  and  procedures
 shall  require  all general hospital staff who interact with patients or
 have responsibility for billing and collections to be trained in  [such]
 THE  policies  and procedures, and require the implementation of a mech-
 anism for the general hospital to measure its compliance with [such] THE
 policies and procedures.   [Such]  THE  policies  and  procedures  shall
 require that any collection agency, LAWYER OR FIRM under contract with a
 general  hospital  for  the  collection  of  debts follow the hospital's
 financial assistance policy, including providing information to patients
 on how to apply for financial assistance where appropriate.  [Such]  THE
 policies and procedures 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] UNDER TITLE ELEVEN OF  ARTICLE  FIVE
 OF  THE  SOCIAL  SERVICES LAW at the time services were rendered and for
 which services medicaid payment is available.
   [(i)] (J) 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,]   SHALL
 CONTAIN:  (I)  a  certification  from  an  independent  certified public
 accountant or independent licensed public accountant or  an  attestation
 from  a  senior official of the hospital that the hospital is in compli-
 ance with conditions of participation in the pools[, shall also contain,
 for reporting periods on and after January first, two thousand seven:];
   [(i)] (II) 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)]  (III)  hospital  costs  incurred  and  uncollected amounts for
 deductibles and coinsurance for  eligible  patients  with  insurance  or
 other third-party payor coverage;
   [(iii)]  (IV)  the  number  of patients, organized according to United
 States postal service zip code, RACE, ETHNICITY AND GENDER, who  applied
 for  financial  assistance  [pursuant to] UNDER the hospital's financial
 assistance policy, and the number, organized according to United  States
 postal  service zip code, RACE, ETHNICITY AND GENDER, whose applications
 were approved and whose applications were denied;
   [(iv)] (V) the reimbursement received for indigent care from the  pool
 established [pursuant to] UNDER this section;
   [(v)]  (VI)  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]  THE
 bequests or trusts;
   [(vi)]  (VII)  for  hospitals  located in social services districts in
 which the district allows hospitals to assist patients with such  appli-
 cations,  the  number of applications for eligibility FOR MEDICAID under
 title [XIX of the social security act (medicaid)] ELEVEN OF ARTICLE FIVE
 OF THE SOCIAL SERVICES  LAW  that  the  hospital  assisted  patients  in
 completing and the number denied and approved;
   [(vii)] (VIII) the hospital's financial losses resulting from services
 provided under medicaid; and
   [(viii)]  (IX)  the  number  of  REFERRALS  TO  COLLECTION  AGENTS  OR
 CONTRACTED EXTERNAL COLLECTION VENDORS, COURT CASES AND liens placed  on
 S. 1366                             8
 
 [the  primary] ANY residences of patients through the collection process
 used by a hospital.
   [(j)]  (K)  Within ninety days of the effective date of THE CHAPTER OF
 THE LAWS OF TWO THOUSAND TWENTY-THREE  WHICH  AMENDED  this  subdivision
 each  hospital  shall submit to the commissioner a written report on its
 policies and procedures for financial assistance to patients  which  are
 used  by the hospital [on the] AS OF SUCH effective date [of this subdi-
 vision]. Such report shall include copies of  its  policies  and  proce-
 dures,  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 financial aid eligible  patients  receive  and
 the means of calculating such aid, and the service area, if any, used by
 the hospital to determine eligibility.
   [(k)]  (L)  THE  COMMISSIONER  SHALL  INCLUDE THE DATA COLLECTED UNDER
 PARAGRAPH (J) OF THIS SUBDIVISION IN REGULAR AUDITS OF THE ANNUAL GENER-
 AL HOSPITAL INSTITUTIONAL COST REPORT.
   (M) In the event [it is determined by the commissioner that] the state
 [will be] IS  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  subdivi-
 sion  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]. NOTWITHSTANDING section twelve of  this
 chapter,  failure to comply with [the provisions of] this subdivision by
 a GENERAL hospital [on and after the date of such  determination]  shall
 make  [such]  THE  hospital liable for a civil penalty not to exceed ten
 thousand dollars for each [such] violation. The imposition of [such] THE
 civil penalties shall be subject to [the provisions of] section twelve-a
 of this chapter.
   (N) A HOSPITAL OR ITS  COLLECTION  AGENTS  SHALL  NOT  REPORT  ADVERSE
 INFORMATION ABOUT A PATIENT TO A CONSUMER OR FINANCIAL REPORTING ENTITY,
 OR  COMMENCE  CIVIL  ACTION  AGAINST  A PATIENT OR DELEGATE A COLLECTION
 ACTIVITY TO A DEBT COLLECTOR FOR NONPAYMENT FOR ONE HUNDRED EIGHTY  DAYS
 AFTER  THE  FIRST  POST-SERVICE BILL IS ISSUED; AND A HOSPITAL SHALL NOT
 REPORT ADVERSE INFORMATION TO A CONSUMER REPORTING AGENCY, OR COMMENCE A
 CIVIL ACTION AGAINST A PATIENT OR DELEGATE A COLLECTION  ACTIVITY  TO  A
 DEBT COLLECTOR, IF: THE HOSPITAL WAS NOTIFIED THAT AN APPEAL OR A REVIEW
 OF A HEALTH INSURANCE DECISION IS PENDING WITHIN THE IMMEDIATELY PRECED-
 ING  SIXTY  DAYS; OR THE PATIENT HAS A PENDING APPLICATION FOR OR QUALI-
 FIED FOR FINANCIAL ASSISTANCE.  A HOSPITAL SHALL REPORT THE  FULFILLMENT
 OF  A  PATIENT'S  PAYMENT  OBLIGATION WITHIN THIRTY DAYS AFTER THE OBLI-
 GATION IS FULFILLED TO A CONSUMER OR FINANCIAL REPORTING ENTITY TO WHICH
 THE HOSPITAL HAD REPORTED ADVERSE INFORMATION ABOUT THE PATIENT.
   § 3. Subdivision 9-a of section 2807-k of the  public  health  law  as
 amended by section two of this act, is amended to read as follows:
   9-a.  (a)  (i)  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-FIVE, ADOPT
 AND IMPLEMENT THE UNIFORM financial assistance [policies and procedures,
 in accordance with the provisions of this subdivision,] FORM AND POLICY,
 TO BE DEVELOPED AND ISSUED BY THE COMMISSIONER. GENERAL HOSPITALS  SHALL
 S. 1366                             9
 
 IMPLEMENT  THE UNIFORM POLICY AND FORM for reducing hospital charges AND
 CHARGES FOR AFFILIATED  PROVIDERS  otherwise  applicable  to  low-income
 individuals without third-party health coverage, or who have third-party
 health  coverage  that does not cover or limits coverage of the service,
 and who can demonstrate an inability to pay full charges, and  also,  at
 the hospital's discretion, for reducing or discounting the collection of
 co-pays  and  deductible  payments from those individuals who can demon-
 strate an inability to pay such amounts. Immigration status shall not be
 an eligibility  criterion  for  the  purpose  of  determining  financial
 assistance  under  this  section.  AS  USED IN THIS SECTION, "AFFILIATED
 PROVIDER" MEANS A PROVIDER THAT IS: (A) EMPLOYED BY  THE  HOSPITAL;  (B)
 UNDER  A  PROFESSIONAL  SERVICES  AGREEMENT  WITH THE HOSPITAL; OR (C) A
 CLINICAL FACULTY MEMBER OF A MEDICAL SCHOOL OR OTHER SCHOOL THAT  TRAINS
 INDIVIDUALS  TO BE PROVIDERS AND THAT IS AFFILIATED WITH THE HOSPITAL OR
 HEALTH SYSTEM.
   (ii) A general hospital may use the New York state of  health  market-
 place  eligibility  determination page to establish the patient's house-
 hold income and residency in lieu of  the  financial  application  form,
 provided  it  has 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.
   (iii) Upon submission of a completed application form, the patient  is
 not liable for any bills until the general hospital has rendered a deci-
 sion on the application in accordance with this subdivision.
   (b)  The  reductions  from charges for patients described in paragraph
 (a) of this subdivision with incomes below six hundred  percent  of  the
 federal  poverty level shall result in a charge to such individuals that
 does not exceed the amount that  would  have  been  paid  for  the  same
 services provided pursuant to title XVIII of the federal social security
 act  (medicare), and provided further that such amount shall be adjusted
 according to income level as follows:
   (i) For patients with incomes at or below 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 commis-
 sioner.
   (ii) For patients with incomes above two hundred  percent  and  up  to
 four  hundred  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. The schedule shall provide that the
 amount the hospital may collect for the patient increases from the nomi-
 nal 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 amount that would have  been  paid  for  the  same
 services provided pursuant to title XVIII of the federal social security
 act (medicare).
   (iii)  For  patients with incomes above four hundred percent and up to
 six hundred percent of the federal poverty  level,  the  hospital  shall
 collect  no  more than the amount that would have been paid for the same
 services provided pursuant to title XVIII of the federal social security
 act (medicare).
   (c) Nothing in this subdivision shall be construed to limit  a  hospi-
 tal's  ability to establish patient eligibility for payment discounts at
 income levels higher than  those  specified  herein  and/or  to  provide
 S. 1366                            10
 
 greater  payment  discounts for eligible patients than those required by
 this subdivision.
   (d)  [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 [the policies and procedures] THE UNIFORM
 FINANCIAL ASSISTANCE FORM AND  POLICY  and  is  provided,  in  a  timely
 manner, with [a summary and] a copy of the policy and form upon request.
 [Any  summary provided to patients shall, at a minimum, 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.]  A  general  hospital  shall
 notify  patients  by  providing  written  materials to patients or their
 authorized representatives during the intake and  registration  process,
 through  the  conspicuous posting of language-appropriate information in
 the general hospital, and by including information on bills  and  state-
 ments  sent  to  patients, that financial assistance may be available to
 qualified patients and how to obtain further information. General hospi-
 tals shall post the UNIFORM financial  assistance  application  policy[,
 procedures] and form, and a summary of the policy [and procedures], in a
 conspicuous  location  and  downloadable  form on the general hospital's
 website. THE COMMISSIONER SHALL POST THE  UNIFORM  FINANCIAL  ASSISTANCE
 FORM  AND  POLICY  IN  DOWNLOADABLE  FORM  ON  THE DEPARTMENT'S HOSPITAL
 PROFILE PAGE OR ANY SUCCESSOR WEBSITE.
   (e) The [hospital's] COMMISSIONER SHALL PROVIDE APPLICATION  MATERIALS
 TO  GENERAL HOSPITALS, INCLUDING THE UNIFORM FINANCIAL ASSISTANCE APPLI-
 CATION FORM AND POLICY. THESE  application  materials  shall  include  a
 notice to patients that upon submission of a completed application form,
 the patient shall not be liable for any bills until the general hospital
 has  rendered  a  decision  on  the  application in accordance with this
 subdivision.  The application materials shall include specific  informa-
 tion  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. Nothing in this subdivision shall
 be  construed  as precluding the use of presumptive eligibility determi-
 nations by hospitals on behalf of patients.  The  [policies  and  proce-
 dures]  UNIFORM  APPLICATION FORM AND POLICY shall include clear, objec-
 tive 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] THE UNIFORM
 POLICY  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  financial  assistance  policy]. The monthly payment
 under such a plan shall not exceed five percent  of  the  gross  monthly
 income  of the patient. Installment plan payments may not be required to
 begin before one hundred eighty days after the date of  the  service  or
 discharge,  whichever  is  later. The policy shall allow the patient and
 the hospital to mutually agree to modify the  terms  of  an  installment
 plan.    The  rate  of  interest  charged  to  the patient on the unpaid
 balance, if any, shall not exceed two percentum per annum  and  no  plan
 shall include an accelerator or similar clause under which a higher rate
 of interest is triggered upon a missed payment. The [policies and proce-
 dures] UNIFORM POLICY shall not include a requirement of a deposit prior
 to medically-necessary care. The hospital shall refund any payments made
 by  the  patient  before  the determination of eligibility for financial
 S. 1366                            11
 
 assistance that exceeds the  patient's  liability  after  discounts  are
 applied.   Such policies and procedures shall be applied consistently to
 all eligible patients.
   (f)  In  any  legal  action by or on behalf of a hospital to collect a
 medical debt, the complaint shall be accompanied by an affidavit by  the
 hospital's  chief  financial  officer  stating  that  on information and
 belief the patient does not meet the income or  residency  criteria  for
 financial assistance. Patients may apply for financial assistance at any
 time  during the collection process, including after the commencement of
 a medical debt court action or upon the plaintiff  obtaining  a  default
 judgment. A hospital may use credit scoring software for the purposes of
 establishing  income eligibility and approving financial assistance, but
 only if the hospital makes clear to the patient that providing a  social
 security  number  is  not  mandatory and the scoring does not negatively
 impact the patient's credit score.   However,  credit  scoring  software
 shall  not  be solely relied upon by the hospital in denying a patient's
 application for financial  assistance.  The  [policies  and  procedures]
 UNIFORM  POLICY  AND FORM shall allow patients seeking financial assist-
 ance to provide the following financial information and documentation in
 support of their application:   pay checks or  pay  stubs;  unemployment
 documentation;  social security income; 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 may  be  used.  General
 hospitals  shall,  upon  request,  assist  patients in understanding the
 [hospital's application  and  form,  policies  and  procedures]  UNIFORM
 FINANCIAL  ASSISTANCE  APPLICATION  FORM  AND POLICY and in applying for
 payment adjustments. [Application forms shall be printed and posted] THE
 COMMISSIONER SHALL TRANSLATE THE UNIFORM FINANCIAL  ASSISTANCE  APPLICA-
 TION FORM AND POLICY INTO THE "PRIMARY LANGUAGES" OF EACH GENERAL HOSPI-
 TAL.  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  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  regarding  such applications shall be made within thirty days
 of receipt of a completed application.  The  [policies  and  procedures]
 UNIFORM  FINANCIAL  ASSISTANCE  POLICY  shall  require that the hospital
 issue any denial or approval of the application in writing with informa-
 tion 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. The hospital shall inform patients  on  how  to  file  a
 complaint against the hospital or a debt collector that is contracted on
 behalf of the hospital regarding the patient's bill.
   (g)  The [policies and procedures] UNIFORM FINANCIAL ASSISTANCE POLICY
 shall provide that patients with incomes below six  hundred  percent  of
 the  federal  poverty  level are deemed eligible for payment adjustments
 and shall conform to the requirements set forth in paragraph (b) of this
 subdivision, provided, however, that nothing in this  subdivision  shall
 be  interpreted  as  precluding  hospitals  from  extending such payment
 S. 1366                            12
 
 adjustments to other patients, either generally  or  on  a  case-by-case
 basis. The [policies and procedures] UNIFORM POLICY shall provide finan-
 cial  assistance  for  emergency  hospital services, including emergency
 transfers 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 the criteria, the commis-
 sioner  shall  consult  with  representatives  of the hospital industry,
 health care consumer advocates and local public  health  officials.  The
 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.
   (h) 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 assistance under the terms of [a hospital's] THE UNIFORM  financial
 assistance  policy,  the  [policies and procedures] FINANCIAL ASSISTANCE
 POLICY shall  prohibit  any  limitations  on  financial  assistance  for
 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.
   (i)  A  hospital  or its agent shall not issue, authorize or permit an
 income execution of a patient's wages, secure a lien or force a sale  or
 foreclosure  of  a  patient's  primary  residence in order to collect an
 outstanding medical bill and shall not send an account to collection  if
 the  patient has submitted a completed application for financial assist-
 ance, while the hospital determines the patient's eligibility for finan-
 cial assistance.   The [policies and procedures]  UNIFORM  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 refer-
 ral of debts for collection and shall require that the collection agency
 obtain the hospital's  written  consent  prior  to  commencing  a  legal
 action.   The [policies and procedures] UNIFORM POLICY shall require all
 general hospital staff who interact with patients or have responsibility
 for billing and collections to be trained in the  [policies  and  proce-
 dures]  POLICY,  and  require  the implementation of a mechanism for the
 general hospital to measure its compliance with the [policies and proce-
 dures] POLICY.  The  [policies  and  procedures]  UNIFORM  POLICY  shall
 require that any collection agency, lawyer or firm 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.
 The [policies and procedures] UNIFORM POLICY shall prohibit  collections
 from  a  patient who is determined to be eligible for medical assistance
 S. 1366                            13
 
 under title eleven of article five of the social  services  law  at  the
 time  services  were rendered and for which services medicaid payment is
 available.
   (j) Reports required to be submitted to the department by each general
 hospital as a condition for participation in the pools shall contain:
   (i) a certification from an independent certified public accountant or
 independent  licensed  public accountant or an attestation from a senior
 official of the hospital that the hospital is in compliance with  condi-
 tions of participation in the pools;
   (ii)  a  report  on hospital costs incurred and uncollected amounts in
 providing services to patients found eligible for financial  assistance,
 including  the  amount  of  care  provided for a nominal payment amount,
 during the period covered by the report;
   (iii) hospital costs incurred and uncollected amounts for  deductibles
 and coinsurance for eligible patients with insurance or other third-par-
 ty payor coverage;
   (iv)  the  number  of  patients,  organized according to United States
 postal service zip code, race, ethnicity and  gender,  who  applied  for
 financial assistance under the [hospital's] UNIFORM financial assistance
 policy,  and  the  number,  organized  according to United States postal
 service zip code, race, ethnicity and gender,  whose  applications  were
 approved and whose applications were denied;
   (v)  the reimbursement received for indigent care from the pool estab-
 lished under this section;
   (vi) the amount of funds that have been expended on financial  assist-
 ance 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 the bequests or trusts;
   (vii) 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 for medicaid under title eleven
 of article five of the social services law that  the  hospital  assisted
 patients in completing and the number denied and approved;
   (viii)   the  hospital's  financial  losses  resulting  from  services
 provided under medicaid; and
   (ix) the number  of  referrals  to  collection  agents  or  contracted
 external  collection  vendors, court cases and liens placed on any resi-
 dences of patients through the collection process used by a hospital.
   (k) [Within ninety days of the effective date of the  chapter  of  the
 laws  of  two  thousand twenty-three which amended 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 as of such effective date.  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  financial  aid
 eligible patients receive and the means of calculating such aid, and the
 service area, if any, used by the hospital to determine eligibility.
   (l)] The commissioner shall include the data collected under paragraph
 (j) of this subdivision in regular audits of the annual general hospital
 institutional cost report.
   [(m)]  (L)  In  the  event the state is 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
 that compliance with this subdivision is a condition of participation in
 S. 1366                            14
 
 pool distributions authorized pursuant to this section and section twen-
 ty-eight hundred seven-w of this article, then such condition of partic-
 ipation shall be deemed null and void. Notwithstanding section twelve of
 this  chapter,  failure  to  comply  with  this subdivision by a general
 hospital shall make the hospital liable  for  a  civil  penalty  not  to
 exceed  ten  thousand  dollars for each violation. The imposition of the
 civil penalties shall be subject to section twelve-a of this chapter.
   [(n)] (M) A hospital or its collection agents shall not report adverse
 information about a patient to a consumer or financial reporting entity,
 or commence civil action against a  patient  or  delegate  a  collection
 activity  to a debt collector for nonpayment for one hundred eighty days
 after the first post-service bill is issued; and a  hospital  shall  not
 report adverse information to a consumer reporting agency, or commence a
 civil  action  against  a patient or delegate a collection activity to a
 debt collector, if: the hospital was notified that an appeal or a review
 of a health insurance decision is pending within the immediately preced-
 ing sixty days; or the patient has a pending application for  or  quali-
 fied  for financial assistance.  A hospital shall report the fulfillment
 of a patient's payment obligation within thirty  days  after  the  obli-
 gation is fulfilled to a consumer or financial reporting entity to which
 the hospital had reported adverse information about the patient.
   §  4.  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.
   §  5.  This  act  shall  take  effect immediately; provided   that (a)
 section two of this act shall take effect on the one  hundred  twentieth
 day  after it shall have become a law; and (b) sections one and three of
 this act shall take effect October 1, 2024 and apply to funding distrib-
 utions made on or after January 1, 2025.    Effective  immediately,  the
 commissioner  of  health  may  make  regulations  and take other actions
 reasonably necessary to implement sections one, two and  three  of  this
 act on their respective effective dates.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1366--B
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             January 11, 2023
                                ___________
 
 Introduced  by  Sens. RIVERA, ASHBY, BRESLIN, CLEARE, COMRIE, FERNANDEZ,
   GALLIVAN,  GIANARIS,  GONZALEZ,  GOUNARDES,  HARCKHAM,  HOYLMAN-SIGAL,
   JACKSON,  KRUEGER,  LIU,  MAY,  MAYER, MYRIE, PERSAUD, RAMOS, SALAZAR,
   SANDERS, SEPULVEDA, SERRANO, WEBB -- read twice and  ordered  printed,
   and  when  printed  to  be  committed  to  the  Committee on Health --
   reported favorably from said committee, ordered to  first  and  second
   report,  ordered  to  a  third reading, amended and ordered reprinted,
   retaining its place in the order of third reading  --  recommitted  to
   the  Committee  on  Health in accordance with Senate Rule 6, sec. 8 --
   committee discharged, bill amended, ordered reprinted as  amended  and
   recommitted to said committee
 
 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:
 
   Section  1.  Subdivision 9 of section 2807-k of the public health law,
 as amended by section 1 of subpart C of part Y of chapter 57 of the laws
 of 2023, is 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 [implement minimum
 collection policies and procedures approved by the commissioner, utiliz-
 ing] UTILIZE only a uniform financial assistance POLICY AND form  devel-
 oped  and  provided by the department. ALL GENERAL HOSPITALS THAT DO NOT
 PARTICIPATE IN THE INDIGENT  CARE  POOL  SHALL  ALSO  UTILIZE  ONLY  THE
 UNIFORM  FINANCIAL  ASSISTANCE POLICY AND FORM AND OTHERWISE COMPLY WITH
 SUBDIVISION NINE-A OF THIS SECTION GOVERNING THE PROVISION OF  FINANCIAL
 ASSISTANCE AND HOSPITAL COLLECTION PROCEDURES.
   §  2.   Subdivision 9-a of section 2807-k of the public health law, as
 added by section 39-a of part A of chapter 57 of the laws of 2006, para-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02400-06-4
 S. 1366--B                          2
              

 
 graph (k) as added by section 43 of part B of chapter 58 of the laws  of
 2008, is amended to read as follows:
   9-a.  (a)  (I)  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-FIVE, ADOPT
 AND IMPLEMENT THE UNIFORM financial [aid  policies  and  procedures,  in
 accordance with the provisions of this subdivision,] ASSISTANCE FORM AND
 POLICY,  TO  BE  DEVELOPED  AND ISSUED BY THE COMMISSIONER. THIS SECTION
 SHALL APPLY TO ANY GENERAL HOSPITAL INCLUDING ANY  AFFILIATED  PROVIDERS
 OR  ENTITY  ACTING  ON  THE  GENERAL HOSPITAL'S OR AFFILIATED PROVIDER'S
 BEHALF, AND SHALL INCLUDE ANY THIRD PARTY OR AGENT THEREOF IF  THE  DEBT
 IS  TRANSFERRED OR SOLD.  AS USED IN THIS SECTION, "AFFILIATED PROVIDER"
 MEANS A PROVIDER THAT IS BILLING FOR MEDICAL GOODS OR SERVICES THAT WERE
 DELIVERED AT A GENERAL HOSPITAL THAT IS: (A) EMPLOYED BY  THE  HOSPITAL;
 (B)  UNDER A PROFESSIONAL SERVICES AGREEMENT WITH THE HOSPITAL; OR (C) A
 CLINICAL FACULTY MEMBER OF A MEDICAL SCHOOL OR OTHER SCHOOL THAT  TRAINS
 INDIVIDUALS  TO BE PROVIDERS AND THAT IS AFFILIATED WITH THE HOSPITAL OR
 HEALTH SYSTEM. GENERAL HOSPITALS, SHALL IMPLEMENT THE UNIFORM POLICY AND
 FORM for reducing GENERAL HOSPITAL charges otherwise applicable to  low-
 income  individuals  [without  health  insurance,  or who have exhausted
 their health insurance benefits, and] who can demonstrate  an  inability
 to  pay full charges, and also, at the hospital's discretion, for reduc-
 ing 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  ELIGIBILITY  CRITERION  FOR
 THE PURPOSE OF DETERMINING FINANCIAL ASSISTANCE UNDER THIS SECTION.
   (II)  A  GENERAL HOSPITAL MAY USE THE NEW YORK STATE OF HEALTH MARKET-
 PLACE ELIGIBILITY DETERMINATION PAGE TO ESTABLISH THE  PATIENT'S  HOUSE-
 HOLD  INCOME  AND  RESIDENCY  IN LIEU OF THE FINANCIAL APPLICATION FORM,
 PROVIDED IT HAS 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.
   (III)  UPON SUBMISSION OF A COMPLETED APPLICATION FORM, THE PATIENT IS
 NOT LIABLE FOR ANY BILLS AND NO INTEREST MAY ACCRUE  UNTIL  THE  GENERAL
 HOSPITAL  HAS  RENDERED A DECISION ON THE APPLICATION IN ACCORDANCE WITH
 THIS SUBDIVISION.
   (b) [Such]  THE  reductions  from  charges  for  [uninsured]  patients
 DESCRIBED  IN  PARAGRAPH  (A) OF THIS SUBDIVISION with incomes below [at
 least three] SIX 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  subpara-
 graph  (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] XVIII of the federal social security
 act (medicaid), and provided further that such [amounts] AMOUNT 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  estab-
 lished  by the commissioner] WAIVE ALL CHARGES. NO NOMINAL PAYMENT SHALL
 BE COLLECTED;
 S. 1366--B                          3
 
   (ii) For patients with  incomes  [between  at  least  one]  ABOVE  TWO
 hundred  [one]  percent  and [one] UP TO 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 sched-
 ule under which patients with lower incomes shall pay the lowest amount.
 [Such]  THE  schedule  shall  provide  that  the amount the hospital may
 collect for [such patients]  THE  PATIENT  increases  from  the  nominal
 amount  described  in subparagraph (i) of this paragraph in equal incre-
 ments 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]  XVIII  of
 the  federal social security act (medicaid). AFTER RECEIPT OF THIRTY-SIX
 MONTHS OF PAYMENT AT THE AGREED UPON AMOUNT, THE PATIENT'S BILL SHALL BE
 CONSIDERED PAID IN FULL AND ANY AND ALL  COLLECTION  ACTIVITIES  ON  ANY
 BALANCE THAT REMAINS UNPAID SHALL BE PROHIBITED;
   (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 PERCENT AND UP TO SIX
 HUNDRED 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 hospi-
 tal  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] XVIII of
 the federal social security  act  (medicaid).  AFTER  RECEIPT  OF  SIXTY
 MONTHS OF PAYMENT AT THE AGREED UPON AMOUNT, THE PATIENT'S BILL SHALL BE
 CONSIDERED  PAID  IN  FULL  AND ANY AND ALL COLLECTION ACTIVITIES ON ANY
 BALANCE THAT REMAINS UNPAID SHALL BE PROHIBITED.
   [(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
 based upon the existence of significant assets owned by the patient that
 should be taken into account  in  determining  the  appropriate  payment
 S. 1366--B                          4

 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)]  (C) Nothing in this [paragraph] SUBDIVISION 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] SUBDIVISION.
   [(c)  Such  policies and procedures shall be clear, understandable, in
 writing and publicly available in summary form and each] (D) EACH gener-
 al hospital participating in the pool shall ensure that every patient is
 made aware of the  existence  of  [such  policies  and  procedures]  THE
 UNIFORM FINANCIAL ASSISTANCE FORM AND POLICY and is provided, in a time-
 ly  manner,  with a [summary] COPY of [such policies and procedures upon
 request] THE POLICY AND FORM AT INTAKE, ADMISSION, AND DISCHARGE.   [Any
 summary  provided  to  patients  shall,  at  a minimum, 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  hospitals  with
 twenty-four  hour emergency departments, such policies and procedures] A
 PLAIN LANGUAGE SUMMARY OF THE COLLECTIONS  PROCESS  MUST  ALSO  BE  MADE
 AVAILABLE.  A  GENERAL  HOSPITAL  shall  [require  the  notification  of
 patients] NOTIFY PATIENTS BY PROVIDING WRITTEN MATERIALS TO PATIENTS  OR
 THEIR  AUTHORIZED  REPRESENTATIVES  during  the  intake and registration
 process, BY MAKING MATERIALS AVAILABLE IN CONSPICUOUS LOCATIONS  IN  THE
 HOSPITAL INCLUDING EMERGENCY DEPARTMENTS, WAITING AREAS AND OTHER PLACES
 PATIENTS  CONGREGATE, through the conspicuous posting of language-appro-
 priate information in the general hospital, and BY INCLUDING information
 on bills and statements sent to patients, that financial  [aid]  ASSIST-
 ANCE  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  materi-
 als  provided  to  patients  during  the intake and registration 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 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 determine the patient's eligibil-
 ity  pursuant to the hospital's financial assistance policy, the patient
 may disregard any bills until the hospital has rendered  a  decision  on
 the  application  in  accordance  with this paragraph] GENERAL HOSPITALS
 S. 1366--B                          5
 
 SHALL POST THE UNIFORM FINANCIAL ASSISTANCE APPLICATION POLICY AND FORM,
 AND THE SUMMARY OF THE COLLECTION PROCESS, IN A CONSPICUOUS LOCATION AND
 DOWNLOADABLE FORM ON THE GENERAL HOSPITAL'S  WEBSITE.  THE  COMMISSIONER
 SHALL POST THE UNIFORM FINANCIAL ASSISTANCE FORM AND POLICY IN DOWNLOAD-
 ABLE  FORM  ON  THE  DEPARTMENT'S HOSPITAL PROFILE PAGE OR ANY SUCCESSOR
 WEBSITE.
   [(d) Such polices and procedures] (E) THE COMMISSIONER  SHALL  PROVIDE
 APPLICATION MATERIALS TO GENERAL HOSPITALS, INCLUDING THE UNIFORM FINAN-
 CIAL  ASSISTANCE APPLICATION FORM AND POLICY.  THESE APPLICATION MATERI-
 ALS SHALL INCLUDE A  NOTICE  TO  PATIENTS  THAT  UPON  SUBMISSION  OF  A
 COMPLETED  APPLICATION  FORM,  THE  PATIENT  SHALL NOT BE LIABLE FOR ANY
 BILLS UNTIL THE GENERAL HOSPITAL HAS RENDERED A DECISION ON THE APPLICA-
 TION IN ACCORDANCE WITH  THIS  SUBDIVISION.  THE  APPLICATION  MATERIALS
 SHALL  INCLUDE  SPECIFIC INFORMATION AS THE INCOME LEVELS USED TO DETER-
 MINE ELIGIBILITY FOR FINANCIAL ASSISTANCE AND THE  MEANS  TO  APPLY  FOR
 ASSISTANCE. NOTHING IN THIS SUBDIVISION SHALL BE CONSTRUED AS PRECLUDING
 THE USE OF PRESUMPTIVE ELIGIBILITY DETERMINATIONS BY HOSPITALS ON BEHALF
 OF  PATIENTS.  THE  UNIFORM  APPLICATION  FORM  AND POLICY 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] THE UNIFORM
 POLICY  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  financial  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]. INSTALLMENT PLAN PAYMENTS MAY NOT BE REQUIRED TO BEGIN BEFORE
 ONE HUNDRED EIGHTY DAYS AFTER THE DATE  OF  THE  SERVICE  OR  DISCHARGE,
 WHICHEVER  IS LATER. THE POLICY SHALL ALLOW THE PATIENT AND THE HOSPITAL
 TO MUTUALLY AGREE TO MODIFY THE TERMS OF AN INSTALLMENT PLAN.  The  rate
 of  interest charged to the patient on the unpaid balance, if any, shall
 not exceed [the rate for a ninety-day  security  issued  by  the  United
 States  Department of Treasury, plus .5 percent] TWO PERCENTUM PER ANNUM
 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 UNIFORM POLICY SHALL NOT include a require-
 ment  of  a  deposit prior to [non-emergent,] medically-necessary care[,
 such deposit must be included as part of  any  financial  aid  consider-
 ation].    THE  HOSPITAL  SHALL  REFUND ANY PAYMENTS MADE BY THE PATIENT
 BEFORE THE DETERMINATION OF ELIGIBILITY FOR  FINANCIAL  ASSISTANCE  THAT
 EXCEEDS  THE PATIENT'S LIABILITY AFTER DISCOUNTS ARE APPLIED. Such poli-
 cies and procedures  shall  be  applied  consistently  to  all  eligible
 patients.
   [(e) Such policies and procedures shall permit patients to] (F) IN ANY
 LEGAL  ACTION  BY  OR ON BEHALF OF A HOSPITAL TO COLLECT A MEDICAL DEBT,
 THE COMPLAINT SHALL BE ACCOMPANIED BY AN  AFFIDAVIT  BY  THE  HOSPITAL'S
 CHIEF  FINANCIAL  OFFICER STATING THAT THE HOSPITAL HAS TAKEN REASONABLE
 STEPS TO DETERMINE WHETHER THE PATIENT QUALIFIES FOR  FINANCIAL  ASSIST-
 ANCE  AND  UPON  INFORMATION  AND  BELIEF  THE PATIENT DOES NOT MEET THE
 INCOME OR RESIDENCY CRITERIA  FOR  FINANCIAL  ASSISTANCE.  PATIENTS  MAY
 apply  for FINANCIAL assistance [within at least ninety days of the date
 of discharge or date of service and provide at  least  twenty  days  for
 S. 1366--B                          6

 patients  to  submit  a  completed  application]  AT ANY TIME DURING THE
 COLLECTION PROCESS, INCLUDING AFTER THE COMMENCEMENT OF A  MEDICAL  DEBT
 COURT  ACTION  OR  UPON  THE  PLAINTIFF OBTAINING A DEFAULT JUDGMENT.  A
 DETERMINATION  THAT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE SHALL
 BE VALID FOR A MINIMUM OF TWELVE MONTHS AND WILL APPLY TO ALL  OUTSTAND-
 ING  MEDICAL  BILLS.  A HOSPITAL MAY USE CREDIT SCORING SOFTWARE FOR THE
 PURPOSES OF ESTABLISHING  INCOME  ELIGIBILITY  AND  APPROVING  FINANCIAL
 ASSISTANCE,  BUT  ONLY  IF  THE HOSPITAL MAKES CLEAR TO THE PATIENT THAT
 PROVIDING A SOCIAL SECURITY NUMBER IS NOT MANDATORY AND THE SCORING DOES
 NOT NEGATIVELY IMPACT THE PATIENT'S CREDIT SCORE.  HOWEVER, CREDIT SCOR-
 ING SOFTWARE SHALL NOT BE SOLELY RELIED UPON BY THE HOSPITAL IN  DENYING
 A PATIENT'S APPLICATION FOR FINANCIAL ASSISTANCE. FURTHER, PROPENSITY TO
 PAY  SCORES MAY NOT DISQUALIFY PATIENTS WHO OTHERWISE QUALIFY FOR ELIGI-
 BILITY FROM RECEIVING FINANCIAL ASSISTANCE. [Such  policies  and  proce-
 dures may require that] THE UNIFORM POLICY AND FORM SHALL ALLOW patients
 seeking [payment adjustments] FINANCIAL ASSISTANCE TO provide [appropri-
 ate] THE FOLLOWING financial information and documentation in support of
 their  application[,  provided,  however,  that such application process
 shall not be unduly burdensome or complex]: PAY  CHECKS  OR  PAY  STUBS;
 UNEMPLOYMENT  DOCUMENTATION;  SOCIAL  SECURITY  INCOME; RENT RECEIPTS; A
 LETTER FROM THE PATIENT'S EMPLOYER  ATTESTING  TO  THE  PATIENT'S  GROSS
 INCOME;  DOCUMENTATION  OF ELIGIBILITY FOR OTHER MEANS-TESTED GOVERNMENT
 BENEFITS; OR, IF NONE OF THE AFOREMENTIONED INFORMATION  AND  DOCUMENTA-
 TION  ARE  AVAILABLE, A WRITTEN SELF-ATTESTATION OF THE PATIENT'S INCOME
 MAY BE USED. General hospitals shall[, upon  request,]  TAKE  REASONABLE
 STEPS  TO assist patients in understanding the [hospital's, policies and
 procedures] UNIFORM POLICY AND FORM, and in applying for payment adjust-
 ments. [Application forms  shall  be  printed]  THE  COMMISSIONER  SHALL
 TRANSLATE  THE  UNIFORM 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
 necessary for effective communication with  health  care  providers,  or
 (ii)   spoken  by  [non-English]  LIMITED-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 regarding such  applications  shall  be  made  within
 thirty  days  of  receipt of a completed application. [Such policies and
 procedures] THE UNIFORM FINANCIAL ASSISTANCE POLICY shall  require  that
 the  hospital  issue  any [denial/approval] DENIAL OR APPROVAL of [such]
 THE application in writing WHICH  CLEARLY  COMMUNICATES  THE  AMOUNT  OF
 ASSISTANCE  GRANTED,  ANY  AMOUNTS STILL OWED with information on how to
 appeal the [denial] DECISION and shall require the hospital to establish
 an appeals process under which it will evaluate the [denial of] DECISION
 ABOUT 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  another  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 coop-
 eration in following the  hospital's  financial  assistance  application
 S. 1366--B                          7

 requirements,  including  the  provision of information needed to make a
 determination on the patient's application in accordance with the hospi-
 tal's financial assistance policy] PREVENT A HOSPITAL FROM INFORMING AND
 ASSISTING  A  PATIENT  WITH AN APPLICATION FOR HEALTH INSURANCE COVERAGE
 WITH A LOCAL SERVICES DISTRICT OR THE MARKETPLACE. A HOSPITAL SHALL  NOT
 MAKE  THE  AVAILABILITY  OF  FINANCIAL  ASSISTANCE  CONTINGENT  UPON THE
 PATIENT'S APPLICATION FOR HEALTH INSURANCE COVERAGE.  THE HOSPITAL SHALL
 INFORM PATIENTS ON HOW TO FILE A COMPLAINT AGAINST  THE  HOSPITAL  OR  A
 DEBT  COLLECTOR  THAT  IS CONTRACTED ON BEHALF OF THE HOSPITAL REGARDING
 THE PATIENT'S BILL.  GENERAL HOSPITALS ARE REQUIRED TO  TAKE  REASONABLE
 MEASURES  TO DETERMINE IF A PATIENT  IS  ELIGIBLE  FOR FINANCIAL ASSIST-
 ANCE INCLUDING PRIOR TO MAKING A REFERRAL TO A THIRD-PARTY DEBT  COLLEC-
 TOR OR  OTHER EXTRAORDINARY COLLECTIONS MEASURES.
   [(f)  Such  policies and procedures] (G) THE UNIFORM FINANCIAL ASSIST-
 ANCE POLICY shall provide that patients with incomes below  [three]  SIX
 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 subdivision, provided, however, that
 nothing in this subdivision shall be interpreted as precluding hospitals
 from extending such payment adjustments to other patients, either gener-
 ally or on a case-by-case basis. [Such  policies  and  procedures  shall
 provide  financial  aid for emergency hospital services, including emer-
 gency transfers 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
 industry,  health  care consumer advocates and local public health offi-
 cials. 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)] (H) Nothing in this subdivision shall be interpreted as preclud-
 ing 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] THE
 UNIFORM FINANCIAL ASSISTANCE POLICY shall prohibit  any  limitations  on
 financial  [aid]  ASSISTANCE for 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 forced]  (I)  A
 HOSPITAL  OR ITS AGENT SHALL NOT COMMENCE A LEGAL ACTION OR FORCE A sale
 or foreclosure of a patient's primary residence in order to  collect  an
 S. 1366--B                          8
 
 outstanding medical bill and shall [require the hospital to refrain from
 sending] NOT SEND an account to collection [if the patient has submitted
 a  completed  application  for  financial  aid,  including  any required
 supporting  documentation,  while  the hospital determines the patient's
 eligibility for such aid] UNTIL THE HOSPITAL  HAS  DETERMINED  THAT  THE
 PATIENT  IS  NOT  ELIGIBLE FOR FINANCIAL ASSISTANCE.  [Such policies and
 procedures] THE UNIFORM 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]  THE  UNIFORM 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] THE UNIFORM
 POLICY, and require the implementation of a mechanism  for  the  general
 hospital  to  measure its compliance with [such policies and procedures]
 THE UNIFORM POLICY. [Such policies and procedures]  THE  UNIFORM  POLICY
 shall  require that any collection agency, LAWYER OR FIRM under contract
 with a general hospital for the collection of debts follow  the  [hospi-
 tal's] UNIFORM financial assistance policy, including providing informa-
 tion  to  patients on how to apply for financial assistance where appro-
 priate. [Such policies and procedures] THE UNIFORM 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]
 UNDER TITLE ELEVEN OF ARTICLE FIVE OF THE SOCIAL  SERVICES  LAW  at  the
 time  services  were rendered and for which services medicaid payment is
 available.
   [(i)] (J) 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,]   SHALL
 CONTAIN:  (I)  a  certification  from  an  independent  certified public
 accountant or independent licensed public accountant or  an  attestation
 from  a  senior official of the hospital that the hospital is in compli-
 ance with conditions of participation in the pools[, shall also contain,
 for reporting periods on and after January first, two thousand seven:];
   [(i)] (II) 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] PATIENTS UNDER TWO HUNDRED PERCENT POVER-
 TY, during the period covered by the report;
   [(ii)]  (III)  hospital  costs  incurred  and  uncollected amounts for
 deductibles and coinsurance for  eligible  patients  with  insurance  or
 other third-party payor coverage;
   [(iii)]  (IV)  the  number  of patients, organized according to United
 States postal service zip code, RACE, ETHNICITY AND GENDER, who  applied
 for  financial  assistance  [pursuant to] UNDER the [hospital's] UNIFORM
 financial assistance policy, and  the  number,  organized  according  to
 United States postal service zip code, RACE, ETHNICITY AND GENDER, whose
 applications were approved and whose applications were denied;
   [(iv)]  (V) the reimbursement received for indigent care from the pool
 established [pursuant to] UNDER this section;
   [(v)] (VI) 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] THE
 bequests or trusts;
 S. 1366--B                          9
 
   [(vi)] (VII) for hospitals located in  social  services  districts  in
 which  the district allows hospitals to assist patients with such appli-
 cations, the number of applications for eligibility FOR  MEDICAID  under
 title [XIX of the social security act (medicaid)] ELEVEN OF ARTICLE FIVE
 OF  THE  SOCIAL  SERVICES  LAW  that  the  hospital assisted patients in
 completing and the number denied and approved;
   [(vii)] (VIII) the hospital's financial losses resulting from services
 provided under medicaid; and
   [(viii)]  (IX)  the  number  of  REFERRALS  TO  COLLECTION  AGENTS  OR
 CONTRACTED  EXTERNAL COLLECTION VENDORS, 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.]
   (k) THE COMMISSIONER SHALL INCLUDE THE DATA COLLECTED UNDER  PARAGRAPH
 (I) OF THIS SUBDIVISION IN REGULAR AUDITS OF THE ANNUAL GENERAL HOSPITAL
 INSTITUTIONAL COST REPORT.
   (1) In the event [it is determined by the commissioner that] the state
 [will  be]  IS  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 subdivi-
 sion 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]. NOTWITHSTANDING section twelve of this
 chapter, failure to comply with [the provisions of] this subdivision  by
 a  GENERAL  hospital [on and after the date of such determination] shall
 make [such] THE hospital liable for a civil penalty not  to  exceed  ten
 thousand dollars for each [such] violation. The imposition of [such] THE
 civil penalties shall be subject to [the provisions of] section twelve-a
 of this chapter.
   (M)  A  HOSPITAL  OR  ITS  COLLECTION AGENT SHALL NOT COMMENCE A CIVIL
 ACTION AGAINST A PATIENT OR DELEGATE A COLLECTION  ACTIVITY  TO  A  DEBT
 COLLECTOR  FOR  NONPAYMENT  FOR  ONE HUNDRED EIGHTY DAYS AFTER THE FIRST
 POST-SERVICE BILL IS ISSUED AND UNTIL A  HOSPITAL  HAS  MADE  REASONABLE
 EFFORTS  TO  DETERMINE WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSIST-
 ANCE. A HOSPITAL OR ITS COLLECTION AGENCY,  LAWYER  OR  FIRM  SHALL  NOT
 COMMENCE  A  CIVIL  ACTION  AGAINST  A  PATIENT OR DELEGATE A COLLECTION
 ACTIVITY TO A DEBT COLLECTOR, IF: THE  HOSPITAL  WAS  NOTIFIED  THAT  AN
 APPEAL  OR A REVIEW OF A HEALTH INSURANCE DECISION IS PENDING WITHIN THE
 IMMEDIATELY PRECEDING SIXTY DAYS; OR THE PATIENT HAS A PENDING  APPLICA-
 TION FOR OR QUALIFIES FOR FINANCIAL ASSISTANCE.
   §  3.  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.
   § 4. This act shall take effect January 1, 2025.