What's happening
This bill amends the public health law to define "clean claims" from home care agencies and imposes penalties and interest for delayed payments.
Why it matters
Clarifies what constitutes a "clean claim". for home care agencies, making it harder for payors to delay payments due to vague or incomplete claims requirements. This specificity can help agencies get paid faster and reduce administrative disputes over claim validity.
Establishes financial penalties and interest for late payments,. which creates a financial incentive for insurance companies and managed care organizations to pay home care providers promptly. This could improve cash flow and financial stability for home care agencies, which often operate on tight margins.
Applies these rules to a broad range of home care providers. including licensed and certified home care agencies, long-term care programs, and fiscal intermediaries—potentially benefiting a large segment of New York's home care workforce and the patients who rely on them.
Standardizes claims processing expectations. across the home care sector, which could reduce administrative burden and legal ambiguity for providers, fostering a more predictable and transparent payment environment.
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Who cares
Headline styles
Speed Up Health Agency Payments
Plain English, a few words. Used as the page title.
Sponsors
2 Multi-sponsors
History
- Referred to ways and means
- Reported referred to ways and means
- Reported referred to codes
- Referred to health
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
564
2017-2018 Regular Sessions
IN ASSEMBLY
January 9, 2017
Introduced by M. of A. ABINANTI, SKOUFIS, MOSLEY, CURRAN, RAIA -- Multi-Sponsored by -- M. of A. McDONOUGH, RA -- read once and referred to the Committee on Health
AN ACT to amend the public health law, in relation to payment of claims submitted by healthcare agencies
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 3621 of the public health law, as added by section 57-a of part A of chapter 56 of the laws of 2013, is amended to read as follows:
§ 3621. Payment of claims. 1. Notwithstanding any law to the contrary, the provisions of section thirty-two hundred twenty-four-a of the insurance law, and regulations thereunder, shall apply to claims for payment submitted by a licensed home care services agency, certified home health agency, long term home health care program, or fiscal intermediary operating under section three hundred sixty-five-f of the social services law, pursuant to a contract with a payor under section forty-four hundred three-f of this chapter or section three hundred sixty-four-j of the social services law, and such claims shall be subject to and settled in compliance with the standards set forth in such section.
2. For the purposes of this section, a "clean claim" shall:
(a) identify the licensed home care services program, certified home health agency, long term home health care program or fiscal intermediary operating pursuant to section three hundred sixty-five-f of the social services law;
(b) sufficiently identify the eligible covered person;
(c) list the date and place of service;
(d) substantiate the appropriateness of the service provided;
(e) state if prior authorization is required for such eligible covered person and service; and
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03331-01-7
A. 564 2
(f) state any documentation as reasonably required by any entity referenced in this section.
3. Each clean claim or payment for services processed in violation of this section shall constitute a separate violation. In addition to the penalties provided in this chapter, any organization or corporation that fails to adhere to the standards contained in this section shall be obligated to pay to certified home health agencies, long term home health care programs, licensed home health care programs or fiscal intermediaries operating pursuant to section three hundred sixty-five-f of the social services law in full settlement of the bill, claim or payment plus interest on the amount of such bill, claim or payment of the greater of the rate equal to the rate set by the commissioner of taxation and finance for corporate taxes pursuant to paragraph one of subsection (e) of section one thousand ninety-six of the tax law or twelve percent per annum, to be computed from the date the bill, claim or payment was required to be made.
§ 2. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.