Protect Patients From Medical Debt

Section 1. Short title. This act shall be known and may be cited as the "patient medical debt protection act".

§ 2. This act enacts into law major components of legislation which relate to patient medical debt protection. Each component is wholly

EXPLANATION--Matter in italics (underscored) is new; matter in brackets

[ ] is old law to be omitted.

LBD13193-10-0

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contained within a Part identified as Parts A through I. The effective date for each particular provision contained within such Part is set forth in the last section of such Part. Any provision in any section contained within a Part, including the effective date of the Part, which makes reference to a section "of this act", when used in connection with that particular component, shall be deemed to mean and refer to the corresponding section of the Part in which it is found. Section four of this act sets forth the general effective date of this act.

PART A

Section 1. Sections 2800 through 2827 of article 28 of the public health law are designated title 1, and a new title 2 is added to article 28, to read as follows:

TITLE 2

MEDICAL BILLING AND DEBT

§ 2. This act shall take effect immediately.

PART B

Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2830 to read as follows:

§ 2830. Definitions. As used in this title, the following terms shall have the following meanings, unless the context clearly requires otherwise:

1. "Affiliated provider" means a provider that is: (a) employed by a hospital or health system, (b) under a professional services agreement with a hospital or health system, or (c) a clinical faculty member of a medical school or other school that trains individuals to be providers that is affiliated with a hospital or health system.

2. "Campus" means: (a) the physical area immediately adjacent to a hospital's main buildings and other areas and structures that are not strictly contiguous to the main buildings but are located within two hundred fifty yards of the main buildings, or (b) any other area that has been determined on an individual case basis by the Centers for Medicare and Medicaid Services to be part of a hospital's campus.

3. "Facility fee" means any fee charged or billed by a hospital or health system for inpatient or outpatient hospital services provided in a hospital-based facility that is: (a) intended to compensate the hospital or health system for the operational expenses of the hospital or health system, and (b) separate and distinct from a fee for patient-specific services, supplies and drugs; "facility fee" shall not include any fee charged or billed by a residential health care facility.

4. "Health system" means a group of one or more hospitals and providers affiliated through ownership, governance, membership or other means.

5. "Hospital-based facility" means a facility that is owned or operated, in whole or in part, by a hospital or health system where hospital or professional health care services, supplies or drugs are provided.

6. "Fee" means any fee charged or billed by a provider for professional health care services provided in a hospital-based facility.

7. "Provider" means an individual or entity, whether for profit or nonprofit, whose primary purpose is to provide professional health care services.

§ 2. This act shall take effect immediately.

PART C

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Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2831 to read as follows:

§ 2831. Standardized consolidated itemized general hospital bills. 1. After a patient's discharge or release from a general hospital, or completion of a discrete course of treatment by a hospital-based facility, the facility shall provide to the patient or to the patient's survivor or legal guardian, as appropriate, a consolidated itemized bill. The initial consolidated itemized bill shall be provided no more than seven days after the patient's discharge, or release or completion of the episode or course of treatment, or after a request for such bill, whichever is earlier.

2. The consolidated itemized bill shall:

(a) detail in plain language, comprehensible to an ordinary layperson (consistent with accuracy), the specific nature of charges or expenses incurred by the patient during the hospitalization or episode or course of treatment and the date of each service;

(b) detail all services provided to the patient during the hospitalization or episode or course of treatment, including all professional services administered and supplies and drugs, contain a statement of specific services received and expenses incurred by date and provider for such items of service, enumerating in detail the constituent components of the services received within each department of the facility and including unit price data on rates charged;

(c) identify each item as paid, assigned to a third-party payer, or expected payment by the patient;

(d) include the amount due, if any from the patient, including a due date;

(e) for any amount paid or to be paid by the patient, indicate to which person or entity an amount is due;

(f) not include any generalized category of expenses such as "other" or "miscellaneous" or similar categories;

(g) list drugs by brand or generic name, even where drug code numbers are used;

(h) specifically identify physical, rehabilitative, occupational, or speech therapy treatment by date, type, and length of treatment when such treatment is a part of the statement or bill; and

(i) prominently display the telephone number of the facility's patient liaison responsible for expediting the resolution of any billing dispute between the patient, or the patient's survivor or legal guardian, and the billing department or departments.

3. A provider with any financial or contractual relationship with the facility may not separately bill the patient or the patient's survivor or legal guardian for such services, supplies or drugs.

4. Any subsequent bill provided to a patient or to the patient's survivor or legal guardian, as appropriate, relating to the hospitalization or episode or course of treatment must include all of the information required under this section, in or enclosed with the bill or by reference to a previous consolidated itemized bill, with any clearly delineated revisions.

5. The consolidated itemized bill, shall be in a form developed by the commissioner, in consultation with the superintendent of financial services.

6. Each facility shall establish policies and procedures for reviewing and responding to questions from patients concerning the patient's consolidated itemized bill. The response shall be provided no more than seven business days after the date a question is received. If the

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patient is not satisfied with the response, the facility shall provide the patient with the contact information of the hospital department or collection entity to which the issue shall be sent for review.

§ 2. This act shall take effect one year after it shall have become a law.

PART D

Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2832 to read as follows:

§ 2832. Regulation of the billing of facility fees. No hospital or health system shall bill or seek payment from a patient for a facility fee: 1. related to the provision of preventive care service as defined by the United States Preventive Services Task Force; or

2. where the facility fee is not covered for the patient by a thirdparty payer.

§ 2. This act shall take effect on the one hundred eightieth day after it shall have become a law.

PART E

Section 1. Title 2 of article 28 of the public health law is amended by adding a new section 2833 to read as follows:

§ 2833. Standardized patient financial liability forms. Every hospital, health system, hospital-based facility, affiliated provider or other provider shall use the uniform patient financial liability form which shall be developed by the commissioner. The form shall disclose to the patient whether services, supplies and drugs provided to the patient are in-network or out-of-network, whether the care is a covered benefit by a third-party payer of the patient, and the nature and amount of the patient's projected financial liability. A patient shall not be financially liable for any service, supplies or drugs subject to this title that is not charged or billed in accordance with this title. The commissioner shall develop and issue the uniform financial liability form within six months of the effective date of this section. The form shall be adopted and used under this section by each hospital, health system, hospital-based facility, affiliated provider and other provider not later than sixty days after the commissioner issues the form.

§ 2. This act shall take effect immediately.

PART F

Section 1. Subdivision 18-a of section 206 of the public health law is amended by adding a new paragraph (e) to read as follows:

(e)(i) The commissioner shall ensure that the New York state all payer database shall serve the interests of New York's health care consumers.

(ii) Every hospital licensed under article twenty-eight of this chapter and health care professionals authorized under title eight of the education law shall participate in the all payer database through their insurance carrier contracts, and may participate in the all payer database through any other of the hospital's third-party payer contracts.

(iii) Data that is required to be submitted to the all payer database shall not be considered proprietary information for the purposes of submission to or inclusion in the all payer database.

§ 2. This act shall take effect on the one hundred eightieth day after it shall have become a law.

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PART G

Section 1. Subdivisions 9 and 9-a of section 2807-k of the public health law, subdivision 9 as amended by section 17 of part B of chapter 60 of the laws of 2014, subdivision 9-a as added by section 39-a of part A of chapter 57 of the laws of 2006 and paragraph (k) of subdivision 9-a as added by section 43 of part B of chapter 58 of the laws of 2008, are amended to read as follows:

9. In order for a general hospital to participate in the distribution of funds from the pool, the general hospital must [implement minimum collection policies and procedures approved] use only the uniform financial assistance form provided by the commissioner. The definitions in section twenty-eight hundred thirty of this article shall apply to this subdivision and subdivision nine-a of this section.

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-one, adopt and implement the uniform financial [aid policies and procedures, in accordance with the provisions of this subdivision] assistance form policy, to be developed and issued by the commissioner no later than one hundred eighty days after the effective date of a chapter of the laws of two thousand twenty that amended this subdivision. No later than thirty days after the issuance of the uniform financial assistance form and policy, general hospitals shall implement such form and policy, for reducing hospital charges and charges for affiliated providers 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 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.

(ii) A general hospital may use the New York state of health marketplace eligibility determination page to establish the patient's household income and residency in lieu of the financial 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 may disregard any bills until the general hospital has rendered a decision on the application in accordance with this paragraph.