What's happening
This bill requires prompt payment of clean claims to home health agencies, sets deadlines, defines clean claims, and imposes penalties for late payments.
Why it matters
Directly impacts cash flow for home health providers. By requiring prompt payment of clean claims, the bill helps home care agencies, long-term home health care programs, and fiscal intermediaries receive reliable and timely revenue, reducing financial uncertainty and potential service disruptions.
Establishes clear timelines for payors. The legislation sets strict deadlines (30 days for electronic, 45 days for paper) and requires payors to promptly notify providers of any claim issues within 15 days, creating greater accountability and predictability in payment processes.
Defines and limits disputes. The bill clearly defines what constitutes a “clean claim” and restricts payors from raising new disputes after the initial 15-day window, unless new information emerges. This limits administrative delays and prevents payors from stalling payments due to repeated or changing objections.
Penalizes late payments to encourage compliance. The inclusion of mandatory interest penalties (at least 12% per year or the state tax rate, whichever is higher) for delayed payments gives providers recourse and provides a significant financial incentive for payors to comply, potentially reducing chronic late payment issues in the industry.
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Who cares
Headline styles
Speed Up Healthcare Payments
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Referred to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Faster Pay for Health Claims
In Assembly Committee · Ways And Means · Sponsor Thomas Abinanti
Full text
2 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
5646
2019-2020 Regular Sessions
IN SENATE
May 9, 2019
Introduced by Sen. RIVERA -- 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 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. The payor shall pay a clean claim (a) within thirty days of receipt of a claim that is transmitted via the internet or electronic mail, or (b) within forty-five days of receipt of a claim that is submitted by other means, such as paper or facsimile.
3. The payor shall pay any undisputed portion of a claim as a clean claim as set forth in subdivision two of this section. The payor shall notify a provider under this article in writing within fifteen calendar days of the receipt of an initial claim of all specific defects or disputes of such claim and specifically request in writing the additional information or remedy needed to process any disputed portions of the claim. No further defect or dispute of the claim may be asserted by the payor, unless it is asserted on the basis of new information relat-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04404-03-9
S. 5646 2
ing to the claim that the payor did not know and could not reasonably have known prior to the notification.
4. Any disputed claim remedied shall be paid as a clean claim under subdivision two of this section.
5. For the purposes of this section, a "clean claim" means a claim for payment for services under this article for which the payor is obligated to provide payment and that 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, the nature of the services and list the date and place of service;
(c) substantiate the appropriateness of the service provided;
(d) if prior authorization is required for such eligible covered person and service, state that such prior authorization was obtained; and
(e) include any documentation as reasonably required by any entity referenced in this section.
6. 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.
Sponsor's memo
Title of bill
An act to amend the public health law, in relation to payment of claims submitted by healthcare agencies
Purpose
This act will help address the home care fiscal crisis by providing standards for and prompt payment of clean claims for personal care, home health care services or other long term services.
Summary of provisions
Section one of the bill sets forth the standards for clean claims for payment of personal care, home health care services, consumer directed personal assistance services or other long term care services and requires these claims to be processed and paid in accordance with section 3224-a of the insurance law.
This section further provides that each clean claim or payment for services processed in violation of this section shall constitute a sepa- rate violation and sets forth penalties for such violations.
Section two is the effective date.
Justification
This legislation will help stabilize the home health care system in New York which has been impacted by hundreds of millions dollars in cuts, unfunded wage mandates, the transition to managed long term care, and rate recoupments in 2012 of $250 million.
Providers, workers and patients are transitioning to a new system of managed long term care with fewer resources while striving to maintain the high quality of home care they provide.
Agencies are reporting unusually large accounts receivables due to the lag in the payment of claims under managed care and the frequent rejection of claims. This, together with the State's Medicaid rate recoupment efforts has resulted in a financial crisis for many agencies impacting workers and the patients they serve.
This legislation attempts to assist patients, workers and providers in keeping the promise to people facing illness or disability - maintaining their independence in the comfort, security and privacy of their homes by requiring managed long term care plans pay clean claims promptly.
Legislative history
2013-2014: S3966 (Hannon) 2015: S2902
Fiscal implications
None.
Effective date
This act shall take effect immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.