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History
- Referred to insurance
Full text
The text isn't available here yet. Check nysenate.gov.
Sponsor's memo
Title of bill
An act directing the superintendent of financial services to conduct an analysis of standards and enforcement provisions for prompt and equitable settlement of claims for payment of home care services
Purpose
To review current practices in the authorization and payment of claims for home care services under the state's prompt, fair and equitable settlement of claims law, and to determine the need for change in or enforcement of such standards.
Summary of provisions
Section 1 directs the Superintendent of the State Department of Financial Services, in conjunction with the State Commissioner of Health, to conduct an analysis of the standards for prompt, fair and equitable settlement of claims and payments for home care services as required under section 3224-a of the insurance law, New York's prompt, fair and equitable claims settlement law.
Section 2 is the effective date.
Justification
Priority state health care reform policies are requiring a major shift in services from hospitals and other institutional settings into community based care. Most notably, state policies and models are specifically seeking a 25% reduction in avoidable hospital admissions and readmissions and emergency room use over the next several years, and billions in federal funding to the state is contingent on achieving this goal. These policies, along with policies requiring provision of long term care in "least restrictive and most integrated settings for individuals," are directly dependent on a viable, accessible and well-operating home care system.
Concurrent with the shift in settings, has been the state's and other payors' shift of coverage models into managed care and other payor arrangements distinct from the prior longstanding fee-for-service system.
Data from studies of the home care field, along with steady and statewide anecdotal reports, indicate significant impacts from delayed, denied or "settled" payments of home care services claims. Such payment issues jeopardize services as well as state policies.
While New York State has a broad statute intended to ensure prompt, fair and equitable settlement of claims, indications and reports of compliance concerns or other gaps continue, and necessitate examination and resolution, particularly with the growing population need for, and emphasis on, home care services and the dependence of the state's policies on these services.
To further, and more precisely, narrow and determine the exact nature, root causes and solutions in terms of either a revision in standards or in enforcement of such, this legislation would require the State Department of Financial Services and State Department of Health jointly conduct an analysis and report on authorization, claims and settlement practices between payors and providers for home care services, with the participation and input of the relevant service coverage and provider representatives.
Legislative history
New bill.
Fiscal implications
None.
Effective date
Immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.