S. 6457--C  A. 9557--B

 lower incomes shall pay the lowest amount. Such schedule shall provide
that the amount the hospital may collect for such patients increases
from the nominal amount described in subparagraph (i) of this paragraph
in equal increments as the income of the patient increases, up to a
maximum of twenty percent of the greater of the amount that would have
been paid for the same services by the "highest volume payor" for such
general hospital, as defined in subparagraph (v) of this paragraph, or
for services provided pursuant to title XVIII of the federal social
security act (medicare) or for services provided pursuant to title XIX
of the federal social security act (medicaid);

    (iii) For patients with incomes between at least one hundred fifty-one
percent and two hundred fifty percent of the federal poverty level, the
hospital shall collect no more than the amount identified after applica-
tion of a proportional sliding fee schedule under which patients with
lower income shall pay the lowest amounts. Such schedule shall provide
that the amount the hospital may collect for such patients increases
from the twenty percent figure described in subparagraph (ii) of this
paragraph in equal increments as the income of the patient increases, up
to a maximum of the greater of the amount that would have been paid for
the same services by the "highest volume payor" for such general hospi-
tal, as defined in subparagraph (v) of this paragraph, or for services
provided pursuant to title XVIII of the federal social security act
(medicare) or for services provided pursuant to title XIX of the federal
social security act (medicaid); and

                        (iv) For patients with incomes between at least two hundred fifty-one
percent and three hundred percent of the federal poverty level, the
hospital shall collect no more than the greater of the amount that would
have been paid for the same services by the "highest volume payor" for
such general hospital as defined in subparagraph (v) of this paragraph,
or for services provided pursuant to title XVIII of the federal social
security act (medicare), or for services provided pursuant to title XIX
of the federal social security act (medicaid).

                        (v) For the purposes of this paragraph, "highest volume payor" shall
mean the insurer, corporation or organization licensed, organized or
certified pursuant to article thirty-two, forty-two or forty-three of
the insurance law or article forty-four of this chapter, or other third-
party payor, which has a contract or agreement to pay claims for
services provided by the general hospital and incurred the highest
volume of claims in the previous calendar year.

                        (vi) A hospital may implement policies and procedures to permit, but
not require, consideration on a case-by-case basis of exceptions to the
requirements described in subparagraphs (i) and (ii) of this paragraph
based upon the existence of significant assets owned by the patient that
should be taken into account in determining the appropriate payment
amount for that patient's care, provided, however, that such proposed
policies and procedures shall be subject to the prior review and approval
of the commissioner and, if approved, shall be included in the
hospital's financial assistance policy established pursuant to this
section, and provided further that, if such approval is granted, the
maximum amount that may be collected shall not exceed the greater of the
amount that would have been paid for the same services by the "highest
volume payor" for such general hospital as defined in subparagraph (v)
of this paragraph, or for services provided pursuant to title XVIII of
the federal social security act (medicare) or for services provided 
pursuant to title XIX of the federal social security act (medicaid).  In
the event that a general hospital reviews a patient's assets in deter-
mining payment adjustments such policies and procedures shall not
consider as assets a patient's primary residence, assets held in a tax-
deferred or comparable retirement saving account, college savings
accounts or cars used regularly by a patient or immediate family
members 

    (vii) Nothing in this paragraph shall be construed to limit a hospi-
tal's ability to establish patient eligibility for payment discounts at
income levels higher than those specified herein and/or to provide
greater payment discounts for eligible patients than those required by
this paragraph.

 

                        (c) Such policies and procedures shall be clear, understandable, in
writing and publicly available in summary form and each general hospital
participating in the pool shall ensure that every patient is made aware
of the existence of such policies and procedures and is provided, in a
timely manner, with a summary of such policies and procedures upon
request. Any summary provided to patients shall, at a minimum, include
specific information as to income levels used to determine eligibility
for assistance, a description of the primary service area of the hospi-
tal and the means of applying for assistance. For general hospitals
with twenty-four hour emergency departments, such policies and proce-
dures shall require the notification of patients during the intake and
registration process, through the conspicuous posting of language-appro-
priate information in the general hospital, and information on bills and
statements sent to patients, that financial aid may be available to
qualified patients and how to obtain further information. For specialty
hospitals without twenty-four hour emergency departments, such notifica-
tion shall take place through written materials provided to patients
during the intake and registration process prior to the provision of any
health care services or procedures, and through information on bills and
statements sent to patients, that financial aid may be available to
qualified patients and how to obtain further information. Application
materials shall include a notice to patients that upon submission of a
completed application, including any information or documentation needed
to determine the patient's eligibility pursuant to the hospital's finan-
cial assistance policy, the patient may disregard any bills until the
hospital has rendered a decision on the application in accordance with
this paragraph.

 

                        (d) Such policies and procedures shall include clear, objective crite-
ria for determining a patient's ability to pay and for providing such
adjustments to payment requirements as are necessary. In addition to
adjustment mechanisms such as sliding fee schedules and discounts to
fixed standards, such policies and procedures shall also provide for the
use of installment plans for the payment of outstanding balances by
patients pursuant to the provisions of the hospital's financial assist-
ance policy. The monthly payment under such a plan shall not exceed ten
percent of the gross monthly income of the patient, provided, however,
that if patient assets are considered under such a policy, then patient
assets which are not excluded assets pursuant to subparagraph (vi) of
paragraph (b) of this subdivision may be considered in addition to the
limit on monthly payments.  The rate of interest charged to the patient
on the unpaid balance, if any, shall not exceed the rate for a ninety
day security issued by the United States Department of Treasury, plus .5
percent and no plan shall include an accelerator or similar clause under
which a higher rate of interest is triggered upon a missed payment. If
such policies and procedures include a requirement of a deposit prior to
non-emergent, medically-necessary care, such deposit must be included as
part of any financial aid consideration. Such policies and procedures
shall be applied consistently to all eligible patients.

 

                        (e) Such policies and procedures shall permit patients to apply for
assistance within at least ninety days of the date of discharge or date
of service and provide at least twenty days for patients to submit a
completed application. Such policies and procedures may require that
patients seeking payment adjustments provide appropriate financial
information and documentation in support of their application, provided,
however, that such application process shall not be unduly burdensome or
complex. General hospitals shall, upon request, assist patients in
understanding the hospital's policies and procedures and in applying for
payment adjustments. Application forms shall be printed in the "primary
languages" of patients served by the general hospital. For the purposes
of this paragraph, "primary languages" shall include any language that
is either (i) used to communicate, during at least five percent of
patient visits in a year, by patients who cannot speak, read, write or
understand the English language at the level of proficiency necessary
for effective communication with health care providers, or (ii) spoken
by non-English speaking individuals comprising more than one percent of
the primary hospital service area population, as calculated using demo-
graphic information available from the United States Bureau of the
Census, supplemented by data from school systems. Decisions regarding
such applications shall be made within thirty days of receipt of a
completed application. Such policies and procedures shall require that
the hospital issue any denial/approval of such application in writing
with information on how to appeal the denial and shall require the
hospital to establish an appeals process under which it will evaluate
the denial of an application. Nothing in this subdivision shall be
interpreted as prohibiting a hospital from making the availability of
financial assistance contingent upon the patient first applying for
coverage under title XIX of the social security act (medicaid) or anoth-
er insurance program if, in the judgment of the hospital, the patient
may be eligible for medicaid or another insurance program, and upon the
patient's cooperation in following the hospital's financial assistance
application requirements, including the provision of information needed
to make a determination on the patient's application in accordance with
the hospital's financial assistance policy.

 

                        (f) Such policies and procedures shall provide that patients with
incomes below three hundred percent of the federal poverty level are
deemed presumptively eligible for payment adjustments and shall conform
to the requirements set forth in paragraph (b) of this subdivision,
provided, however, that nothing in this subdivision shall be interpreted
as precluding hospitals from extending such payment adjustments to other
patients, either generally or on a case-by-case basis. Such policies and
procedures shall provide financial aid for emergency hospital services,
including emergency transfers pursuant to the federal emergency medical 
treatment and active labor act (42 USC 1395dd),to patients who reside
in New York state and for medically necessary hospital services for
patients who reside in the hospital's primary service area as determined
according to criteria established by the commissioner. In developing
such criteria, the commissioner shall consult with representatives of
the hospital industry, health care consumer advocates and local public
health officials.  Such criteria shall be made available to the public no
less that thirty days prior to the date of implementation and shall, at
a minimum:                    

                        (i) prohibit a hospital from developing or altering its primary
service area in a manner designed to avoid medically underserved commu-
nities or communities with high percentages of uninsured residents;

                        (ii) ensure that every geographic area of the state is included in at
least one general hospital's primary service area so that eligible
patients may access care and financial assistance; and 

      (iii) require the hospital to notify the commissioner upon making any
change to its primary service area, and to include a description of its
primary service area in the hospital's annual implementation report
filed pursuant to subdivision three of section twenty-eight hundred
three-l of this article.

 

                        (g) Nothing in this subdivision shall be interpreted as precluding
hospitals from extending payment adjustments for medically necessary
non-emergency hospital services to patients outside of the hospital's
primary service area. For patients determined to be eligible for finan-
cial aid under the terms of a hospital's financial aid policy, such
policies and procedures shall prohibit any limitations on financial aid
for services based on the medical condition of the applicant, other than
typical limitations or exclusions based on medical necessity or the
clinical or therapeutic benefit of a procedure or treatment.

 

                        (h) Such policies and procedures shall not permit the forced sale or
foreclosure of a patient's primary residence in order to collect an
outstanding medical bill and shall require the hospital to refrain from
sending an account to collection if the patient has submitted a
completed application for financial aid, including any required support-
ing documentation, while the hospital determines the patient's eligibil-
ity for such aid. Such policies and procedures shall provide for written
notification, which shall include notification on a patient bill, to a
patient not less than thirty days prior to the referral of debts for
collection and shall require that the collection agency obtain the
hospital's written consent prior to commencing a legal action. Such
policies and procedures shall require all general hospital staff who
interact with patients or have responsibility for billing and
collections to be trained in such policies and procedures, and require
the implementation of a mechanism for the general hospital to measure
its compliance with such policies and procedures. Such policies and
procedures shall require that any collection agency under contract with
a general hospital for the collection of debts follow the hospital's
financial assistance policy, including providing information to patients
on how to apply for financial assistance where appropriate. Such poli-
cies and procedures shall prohibit collections from a patient who is
determined to be eligible for medical assistance pursuant to title XIX
of the federal social security act at the time services were rendered
and for which services medicaid payment is available.

                        (i) Reports required to be submitted to the department by each general
hospital as a condition for participation in the pools, and which
contain, in accordance with applicable regulations, a certification from
an independent certified public accountant or independent licensed
public accountant or an attestation from a senior official of the hospi­
al that the hospital is in compliance with conditions of participation
in the pools, shall also contain, for reporting periods on and after
January first, two thousand seven:

                        (ii) hospital costs incurred and uncollected amounts for deductibles
and coinsurance for eligible patients with insurance or other third-party-
 payor coverage;  

     (iii) the number of patients, organized according to United States
postal service zip code, who applied for financial assistance pursuant
to the hospital's financial assistance policy, and the number, organized
according to United States postal service zip code, whose applications
were approved and whose applications were denied;

                        (iv) the reimbursement received for indigent care from the pool estab-
lished pursuant to this section;

                        (v) the amount of funds that have been expended on charity care from
charitable bequests made or trusts established for the purpose of
providing financial assistance to patients who are eligible in accord-
ance with the terms of such bequests or trusts;

                        (vi) for hospitals located in social services districts in which the
district allows hospitals to assist patients with such applications, the
number of applications for eligibility under title XIX of the social
security act (medicaid) that the hospital assisted patients in complet-
ing and the number denied and approved; 

      (vii) the hospital's financial losses resulting from services provided
under medicaid; and

    (viii) the number of liens placed on the primary residences of
patients through the collection process used by a hospital.

 

(j) Within ninety days of the effective date of this subdivision each
hospital shall submit to the commissioner a written report on its poli-
cies and procedures for financial assistance to patients which are used
by the hospital on the effective date of this subdivision. Such report
shall include copies of its policies and procedures, including material
which is distributed to patients, and a description of the hospital's
financial aid policies and procedures. Such description shall include
the income levels of patients on which eligibility is based, the finan-
cial aid eligible patients receive and the means of calculating such
aid, and the service area, if any, used by the hospital to determine
eligibility.