BILL NUMBER: S3358
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:
Section 1 amends section 3614-e of the Public Health Law, as it relates
to electronic payment of claims, to provide that home and community
providers would use federally approved forms for the claiming to insur-
ance companies. It also provides that insurers would not require the
utilization by contract or action of any specific billing entity nor
impede the timely processing and payment of claims. These provisions
include Medicaid-managed care plans as well as managed long-term care
plans.
Section 2 provides an effective date.
 
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
cash flow is vital to the survival of many home care providers. This
bill would maintain electronic visit verification (EW) data integrity,
expedite claims processing and payment, and prevent ongoing increases in
providers' account receivables from unpaid claims. It 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:
2023-2024: S6123/A5750 Paulin
 
FISCAL IMPLICATIONS:
None.
 
EFFECTIVE DATE:
Effective on the thirtieth day after it shall have become law.

Statutes affected:
S3358: 3614-e public health law