BILL NUMBER: S1366B
SPONSOR: RIVERA
 
TITLE OF BILL:
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
 
PURPOSE OR GENERAL IDEA OF BILL:
To require hospitals to use a uniform financial assistance policy and
form and to expand the eligibility and protections available through
financial assistance.
 
SUMMARY OF SPECIFIC PROVISIONS:
This bill would:
Require general hospitals and their affiliated providers, including any
agents of these parties, to utilize a uniform financial assistance poli-
cy and form, that will be developed and provided by the Department of
Health, as a condition to participate in indigent care pool distrib-
utions and as compliance to the public health law regarding financial
assistance and hospital collection procedures. This would also apply to
any third party if the debt is transferred or sold.
Allow low income individuals and those who can demonstrate their inabil-
ity to pay the charges to be eligible for financial aid. Patients would
not be responsible for paying any bills and no interest would accrue on
said bills until the hospital makes a decision on the financial aid
application.
Modify the maximum charges to patients receiving financial assistance as
follows:
All charges shall be waived and no nominal payments shall be made for
patients with incomes at or below 200% of FPL.
Patients above 200% and up to 400% of FPL would have charges reduced at
a sliding scale, and capped at 20% of the Medicaid payment rate. Addi-
tionally, patients above 200% and up to 400% of FPL would have their
outstanding bills discharged after 36 monthly payments at the agreed
upon amount.
Patients with incomes above 400% and up to 600% of the federal poverty
level are eligible to have charges capped at Medicaid payment levels for
the same service. Furthermore, patients with incomes above 400% and up
to 600% of FPL would have their outstanding bills discharged after
making 60 monthly payments at the agreed upon amount.
Require the Commissioner of Health (COH) and general hospitals to post
the policy and and form on their respective websites. It would also
require hospitals to make patients aware of the financial assistance in
plain language during the intake, admission, and discharge process. A
summary of the collections process must also be made available.
Allow payment installment plans to be offered with payments capped at 5%
of the patient's gross monthly income with the first payment due no
sooner than 180 days after the date of service or discharge, whichever
is later.
Cap interest on medical debt at 2% per year.
Require patients to be refunded any overpayments made after financial
assistance is determined.
Require the hospital's chief financial officer to provide an affidavit
stating that the hospital has taken reasonable steps to determine if the
patient qualified for financial assistance. The patient's financial aid
eligibility shall be valid for a minimum of 12 months and will apply to
all outstanding medical bills.
Modify hospital collection actions to allow a patient to apply for
financial assistance if their financial circumstance has changed, even
if a collection action has commenced.
Establish that a hospital may use credit scoring software to help deter-
mine income eligibility, but a credit score may not be the sole determi-
nant of eligibility.
Prohibit hospitals from reporting to financial reporting entities or
commencing a civil action if the hospital was notified that an appeal of
a health insurance determination is pending within the last 60 days or
if the patient has a pending financial assistance application.
Require that legal action by a hospital to collect medical debt must
include an affidavit attesting that the patient is not eligible for
financial assistance based on information and belief.
Establish additional consumer protections relating to notifications,
language access, appeals, and complaints of abuse.
Authorize hospitals to inform and assist patients with applications for
health insurance coverage with local services districts or the market-
place. Prohibits decisions on financial assistance applications from
being contingent upon health insurance applications.
 
JUSTIFICATION:
Currently, the Department of Health (DOH) distributes over $1 billion
annually in Indigent Care Pool (ICP) funding to public and voluntary
hospitals throughout the state. As a condition of receiving ICP funding,
the law requires hospitals to offer free or discounted care to uninsured
low- and moderate-income patients. Recent studies and news stories have
documented that some hospitals are pursuing extraordinary collection
actions and lawsuits against patients who often live in neighborhoods
that are disproportionately low-income or have a high percentage of
people of color, furthering systemic economic and racial inequality.
The law currently allows hospitals to develop their own hospital finan-
cial assistance application forms and policies, as long as they meet
guidelines provided by DOH. However, the state's audits repeatedly have
found that hospitals are not complying with the law, as have studies by
consumer advocates. In fact, recent DOH audits show that hospitals have
become less compliant with the law over time. The lack of standardi-
zation in how hospitals implement financial assistance policies results
in patients who should receive assistance going without that assistance
and even going without care.
This bill requires all hospitals to use one simplified form and policy
developed by DOH and it strengthens the guardrails for when and how
hospitals can pursue extraordinary medical debt collection activities,
such as suing patients.
In addition, the current eligibility requirements have not kept up with
developments in public coverage eligibility. Medicaid enrollees in the
MAGI Medicaid program are no longer subject to an asset test. The
income eligibility rules for premium subsidies under the State's Chil-
dren Health Insurance Program extend up to 400% of the Federal Poverty
Level (FPL). Recognizing that even 400% is too low, the federal American
Rescue Plan has extended Affordable Care Act subsidies up to 600% of the
FPL. Accordingly, this bill eliminates asset tests and increases income
eligibility for financial assistance from 300% to 600% of the FPL.
The changes in this legislation will make it easier for DOH to ensure
hospital compliance and simplify the experience for both patients and
providers. New Yorkers deserve accountability for critical tax dollars
going towards health care and compliance with laws assisting and
protecting patients. Patients deserve the care they need without incur-
ring financial disaster.
 
PRIOR LEGISLATIVE HISTORY:
2023 - S1366A (Rivera) - Advanced to 3rd Reading
2022 - S7625 (Rivera) - Advanced to 3rd Reading
2021 - S7625 (Rivera) - Referred to Rules
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
The bill would take effect on January 1, 2025.

Statutes affected:
S1366: 2807-k public health law, 2807-k(9-a) public health law
S1366A: 2807-k public health law, 2807-k(9) public health law, 2807-k(9-a) public health law
S1366B: 2807-k public health law, 2807-k(9) public health law