BILL NUMBER: S6123
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the public health law, in relation to the submission of
claims for services provided by home care agencies
 
PURPOSE OR GENERAL IDEA OF BILL:
To improve the process for claiming and billing for home and community-
based providers.
 
SUMMARY OF SPECIFIC PROVISIONS:
The bill amends Public Health Law Article 36, to provide that home and
community providers shall use federally approved forms for the claiming
to insurance companies. It also provides that insurers shall not require
the utilization by contract or action any specific billing entity nor
impede the timely processing and payment of claims. These provisions
include Medicaid managed care plans as well managed long-term care
plans.
 
JUSTIFICATION:
Many homes and community based providers are having large account
balance issues with certain insurers related to the introduction of a
new billing and processing software system. This system has caused
claims to be pended, denied or to be deemed untimely. Having a good
cashflow is vital to the survival of many home care providers. This
legislation would not limit the insurer's ability to review or audit
claims for fraud, waste and abuse. However, a software issue should not
be a barrier to payment on clean claims.
 
PRIOR LEGISLATIVE HISTORY:
New bill
 
FISCAL IMPLICATIONS:
None
 
EFFECTIVE DATE:
Thirty days after enactment

Statutes affected:
S6123: 3614-e public health law