Bill Text: NY S08366 | 2019-2020 | General Assembly | Introduced
Bill Title: Provides extensions for certain medical debt and insurance premiums related to the COVID-19 pandemic and requires certain information to be included in adverse determination notices to Medicaid recipients, and temporarily expands eligibility for the basic health program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-05-19 - REFERRED TO HEALTH [S08366 Detail]
Download: New_York-2019-S08366-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 8366 IN SENATE May 19, 2020 ___________ 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, the debtor and creditor law, the civil practice law and rules and the insurance law, in relation to COVID-19 pandemic medical debt requirements; to amend the social services law and the public health law, in relation to adverse deter- mination notices to Medicaid recipients; to amend the social services law, in relation to eligibility for the basic health program; and providing for the repeal of certain provisions upon the expiration thereof The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. The public health law is amended by adding a new section 2 2828 to read as follows: 3 § 2828. COVID-19 pandemic medical debt requirements. 1. Definitions. 4 The following words or phrases, as used in this section, shall have the 5 following meanings: 6 (a) "Collection action" means any of the following: 7 (i) Selling an individual's debt to another party, except if, prior to 8 the sale, the medical creditor has entered into a legally binding writ- 9 ten agreement with the medical debt buyer of the debt pursuant to which: 10 (1) The medical debt buyer or collector is prohibited from engaging in 11 any collection actions, as defined herein, to obtain payment for the 12 care; 13 (2) The medical debt buyer is prohibited from charging interest on the 14 debt in excess of that described in subdivision three of this section; 15 (3) The debt is returnable to or recallable by the medical creditor 16 upon a determination by the medical creditor or medical debt buyer that 17 the individual is eligible for financial assistance; and 18 (4) If the individual is determined to be eligible for financial 19 assistance and the debt is not returned to or recalled by the medical 20 creditor, the medical debt buyer is required to adhere to procedures 21 which shall be specified in the agreement that ensure that the individ- 22 ual does not pay, and has no obligation to pay, the medical debt buyer EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD16413-02-0S. 8366 2 1 and the medical creditor together more than he or she is personally 2 responsible for paying in compliance with this section. 3 (ii) Reporting adverse information about a patient to a consumer 4 reporting agency; or 5 (iii) Actions that require a legal or judicial process, including but 6 not limited to: 7 (1) Placing or executing a lien on the individual's property; 8 (2) Attaching or seizing an individual's bank account or any other 9 personal property; 10 (3) Commencing or prosecuting a civil action against an individual; 11 (4) Garnishing an individual's wages; or 12 (5) Any other involuntary collection activity. 13 (b) "Consumer reporting agency" means any person, which, for monetary 14 fees, dues, or on a cooperative nonprofit basis, regularly engages in 15 whole or in part in the practice of assembling or evaluating consumer 16 credit information or other information on consumers for the purpose of 17 furnishing consumer reports to third parties. 18 (c) "Declared state disaster emergency" means the declaration of a 19 state of emergency pursuant to article two-B of the executive law. 20 (d) "Healthcare professional" means a person licensed or certified 21 pursuant to title eight of the education law. 22 (e) "Healthcare services" means services for the diagnosis, 23 prevention, treatment, cure or relief of a physical, dental, behavioral 24 substance use disorder or mental health condition, illness, injury or 25 disease. These services include, but are not limited to, any procedures, 26 products, devices or medications. 27 (f) "Hospital" means all providers licensed under this article. 28 (g) "Medical debt" means a debt arising from the receipt of healthcare 29 services. 30 (h) "Medical debt buyer" means a person or entity that is engaged in 31 the business of purchasing medical debts for collection purposes, wheth- 32 er it collects the debt itself or hires a third party for collection or 33 an attorney for litigation in order to collect such debt. 34 (i) "Medical debt collector" means any person or entity that regularly 35 collects or attempts to collect, directly or indirectly, medical debts 36 originally owed or due or asserted to be owed or due to another. A 37 medical debt buyer is considered to be a medical debt collector for all 38 purposes. 39 (j) "Patient" means the person who received healthcare services, and 40 for the purposes of this section shall include: a parent if the patient 41 is a minor; a legal guardian if the patient is an adult under guardian- 42 ship; an authorized representative; or a guarantor. 43 (k) "Period of suspension" means a period consisting of the first day 44 of a declared state disaster emergency related to the COVID-19 pandemic 45 and until no less than sixty days after a declared state disaster emer- 46 gency related to the COVID-19 pandemic is no longer in effect anywhere 47 in the state. 48 2. Involuntary collection activity. No hospital or healthcare profes- 49 sional shall engage in any collection actions during the period of 50 suspension. 51 3. No accrual of interest. Interest shall not accrue on any medical 52 debt described under subdivision two for which collection was suspended 53 for the period of suspension. 54 4. Notice. To inform patients of the actions taken in accordance with 55 this section and ensure an effective transition, all hospitals and 56 healthcare professionals shall:S. 8366 3 1 (a) Not later than fifteen days after the effective date of this 2 section, notify patients: 3 (i) of the actions taken in accordance with subdivisions two and three 4 of this section for whom collections have been suspended and interest 5 waived; 6 (ii) of the option to continue making payments toward any amount due; 7 and 8 (iii) that the program described in this section is a temporary 9 program. 10 (b) Beginning on the first day after the expiration of the period of 11 suspension, carry out a program to provide no fewer than six notices by 12 postal mail, telephone or electronic communication to patients indicat- 13 ing: 14 (i) when the patient's normal payment obligations will resume; 15 (ii) with respect to notices submitted by hospitals, that the patient 16 may be eligible to enroll in the hospital's financial assistance plan 17 pursuant to section twenty-eight hundred seven-k of this article; and 18 (iii) with respect to notices submitted by healthcare professionals, 19 that the patient may be eligible to enroll in a financial assistance 20 plan, if the healthcare professional has a financial assistance policy 21 for his or her patients. 22 5. Proof of submission of claim. With respect to patients who are 23 uninsured on the date that the treating hospital or healthcare profes- 24 sional renders testing or treatment services related to COVID-19, 25 including, but not limited to, diagnostic evaluations, testing or other 26 methods to rule out diseases with similar symptoms to COVID-19, no 27 hospital or healthcare professional may engage in any collection actions 28 to collect payment for such services, unless the treating hospital or 29 healthcare professional produces a sworn affidavit that he, she or it 30 submitted a claim for payment for such services to the federal depart- 31 ment of health and human services, health resources and services admin- 32 istration (HRSA), in accordance with federal law, and that HRSA denied 33 the claim. 34 6. Private right of action. Every violation of this section shall be 35 deemed a deceptive act and practice subject to enforcement under article 36 twenty-two-A of the general business law. Nothing in this section shall 37 be construed to restrict any right which any person may have under any 38 other statute or the common law. 39 § 2. The debtor and creditor law is amended by adding a new article 40 10-B to read as follows: 41 ARTICLE 10-B 42 TEMPORARY RELIEF FROM COLLECTION OF MEDICAL DEBT DURING THE 43 COVID-19 PANDEMIC 44 Section 286. Definitions. 45 287. Requirements. 46 § 286. Definitions. As used in this article, the following terms shall 47 have the following meanings: 48 1. "Collection action" means any of the following: 49 (a) Selling an individual's debt to another party, except if, prior to 50 the sale, the medical creditor has entered into a legally binding writ- 51 ten agreement with the medical debt buyer of the debt pursuant to which: 52 (i) The medical debt buyer or collector is prohibited from engaging in 53 any collection actions, as defined herein, to obtain payment for the 54 care; 55 (ii) The medical debt buyer is prohibited from charging interest on 56 the debt in excess of that described in this section;S. 8366 4 1 (iii) The debt is returnable to or recallable by the medical creditor 2 upon a determination by the medical creditor or medical debt buyer that 3 the individual is eligible for financial assistance; and 4 (iv) If the individual is determined to be eligible for financial 5 assistance and the debt is not returned to or recalled by the medical 6 creditor, the medical debt buyer is required to adhere to procedures 7 which shall be specified in the agreement that ensure that the individ- 8 ual does not pay, and has no obligation to pay, the medical debt buyer 9 and the medical creditor together more than he or she is personally 10 responsible for paying in compliance with this section. 11 (b) Reporting adverse information about a patient to a consumer 12 reporting agency; or 13 (c) Actions that require a legal or judicial process, including but 14 not limited to: 15 (i) Placing or executing a lien on the individual's property; 16 (ii) Attaching or seizing an individual's bank account or any other 17 personal property; 18 (iii) Commencing or prosecuting a civil action against an individual; 19 (iv) Garnishing an individual's wages; or 20 (v) Any other involuntary collection activity. 21 2. "Consumer reporting agency" means any person, which, for monetary 22 fees, dues, or on a cooperative nonprofit basis, regularly engages in 23 whole or in part in the practice of assembling or evaluating consumer 24 credit information or other information on consumers for the purpose of 25 furnishing consumer reports to third parties. 26 3. "Declared state disaster emergency" means the declaration of a 27 state of emergency pursuant to article two-B of the executive law. 28 4. "Healthcare professional" means a person licensed or certified 29 pursuant to title eight of the education law. 30 5. "Healthcare services" means services for the diagnosis, prevention, 31 treatment, cure or relief of a physical, dental, behavioral substance 32 use disorder or mental health condition, illness, injury or disease. 33 These services include, but are not limited to, any procedures, 34 products, devices or medications. 35 6. "Hospital" means all hospitals licensed under article twenty-eight 36 of the public health law. 37 7. "Medical debt" means a debt arising from the receipt of healthcare 38 services. 39 8. "Medical debt buyer" means a person or entity that is engaged in 40 the business of purchasing medical debts for collection purposes, wheth- 41 er it collects the debt itself or hires a third party for collection or 42 an attorney for litigation in order to collect such debt. 43 9. "Medical debt collector" means any person or entity that regularly 44 collects or attempts to collect, directly or indirectly, medical debts 45 originally owed or due or asserted to be owed or due to another. A 46 medical debt buyer is considered to be a medical debt collector for all 47 purposes. 48 10. "Patient" means the person who received healthcare services, and 49 for the purposes of this article shall include: a parent if the patient 50 is a minor; a legal guardian if the patient is an adult under guardian- 51 ship; an authorized representative; or a guarantor. 52 11. "Period of suspension" means a period consisting of the first day 53 of a declared state disaster emergency related to the COVID-19 pandemic 54 and until no less than sixty days after a declared state disaster emer- 55 gency related to the COVID-19 pandemic is no longer in effect anywhere 56 in the state.S. 8366 5 1 § 287. Requirements. 1. Temporary relief from collection of medical 2 debt. All medical debt buyers and collectors shall suspend all payments 3 due for medical debt through the period of suspension. 4 2. No accrual of interest. Interest shall not accrue on any medical 5 debt described under subdivision one of this section for which payment 6 was suspended for the period of suspension. 7 3. Involuntary collection activity. No medical debt buyer or collector 8 shall engage in any collection actions during the period of suspension. 9 4. Notice. To inform patients of the actions taken in accordance with 10 this section and ensure an effective transition, all medical debt buyers 11 and collectors shall: 12 (a) Not later than fifteen days after the effective date of this 13 section, notify patients: 14 (i) of the actions taken in accordance with subdivisions one and two 15 of this section for whom payments have been suspended and interest 16 waived; 17 (ii) of the actions taken in accordance with subdivision three of this 18 section for whom collections have been suspended; 19 (iii) of the option to continue making payments toward any amount due; 20 and 21 (iv) that the program described under this section is a temporary 22 program. 23 (b) Beginning on the first day after the expiration of the period of 24 suspension, carry out a program to provide no fewer than six notices by 25 postal mail, telephone or electronic communication to patients indicat- 26 ing: 27 (i) when the patient's normal payment obligations will resume; and 28 (ii) that the patient may be eligible to enroll in a financial assist- 29 ance plan pursuant to any applicable and available financial assistance 30 policy of either the medical debt buyer or collector. 31 5. Proof of submission of claim. With respect to patients who are 32 uninsured on the date that the treating hospital or healthcare profes- 33 sional renders testing or treatment services related to COVID-19, 34 including, but not limited to, diagnostic evaluations, testing or other 35 methods to rule out diseases with similar symptoms to COVID-19, no 36 medical debt buyer or collector may engage in any collection actions to 37 collect payment for such services, unless the treating hospital or 38 healthcare professional produces a sworn affidavit that he, she or it 39 submitted a claim for payment for such services to the federal depart- 40 ment of health and human services, health resources and services admin- 41 istration (HRSA), in accordance with federal law, and that HRSA denied 42 the claim. 43 6. Private right of action. Every violation of this section shall be 44 deemed a deceptive act and practice subject to enforcement under article 45 twenty-two-A of the general business law. Nothing in this section shall 46 be construed to restrict any right which any person may have under any 47 other statute or the common law. 48 § 3. Section 5004 of the civil practice law and rules, as amended by 49 chapter 258 of the laws of 1981, is amended to read as follows: 50 § 5004. Rate of interest. Interest shall be at the rate of nine per 51 centum per annum, except where otherwise provided by statute, provided 52 that in medical debt actions by a hospital licensed under article twen- 53 ty-eight of the public health law or a health care professional licensed 54 or certified pursuant to title eight of the education law the interest 55 rate shall be calculated at the one-year United States treasury bill 56 rate. For the purposes of this section, the "one-year United StatesS. 8366 6 1 treasury bill rate" means the weekly average one-year constant maturity 2 treasury yield, as published by the board of governors of the federal 3 reserve system, for the calendar week preceding the date of the entry of 4 the judgment awarding damages. Provided however, that this section shall 5 not apply to any provision of the tax law which provides for the annual 6 rate of interest to be paid on a judgment or accrued claim. The accrual 7 of interest shall be tolled during the period of time when the state 8 disaster emergency order related to the COVID-19 pandemic is in effect. 9 § 4. The insurance law is amended by adding a new section 3244 to read 10 as follows: 11 § 3244. Extension of premium payment periods; COVID-19. (a) Defi- 12 nitions. As used in this section, the following terms shall have the 13 following meanings: 14 (1) "Credit reporting agency" means a reporting agency that regularly 15 engages in the practice of assembling or evaluating and maintaining, for 16 the purpose of furnishing credit reports to third parties bearing on a 17 person's credit worthiness, credit standing, or credit capacity, and 18 credit account information from persons who furnish that information 19 regularly and in the ordinary course of business. 20 (2) "Late fee" means a fee associated with an insurance premium 21 payment that is made at a time later than the premium due date, but 22 prior to both insurance policy or contract termination and the time in 23 which an insurer, HMO, or student health plan may reject premium 24 payment. 25 (3) "Medical debt buyer" means a person or entity that is engaged in 26 the business of purchasing medical debts for collection purposes, wheth- 27 er it collects the debt itself or hires a third-party for collection or 28 an attorney for litigation in order to collect such debt. 29 (4) "Medical debt collector" means any person or entity that regularly 30 collects or attempts to collect, directly or indirectly, medical debts 31 originally owed or due or asserted to be owed or due to another. A 32 medical debt buyer is considered to be a medical debt collector for all 33 purposes. 34 (5) "Student health plan" has the meaning set forth in paragraph five 35 of subsection (a) of section one thousand one hundred twenty-four of 36 this chapter. 37 (6) "Child health plus" means coverage issued pursuant to section two 38 thousand five hundred eleven of the public health law. 39 (7) "HMO" shall mean a health maintenance organization operating in 40 accordance with the provisions of article forty-four of the public 41 health law or article forty-three of this chapter. 42 (b) Extension of premium payment periods. Every issuer of individual, 43 small group and student blanket comprehensive health insurance policies 44 subject to this article, as well as any issuer of a child health plus 45 policy where the policyholder or contract holder pays the entire premi- 46 um, shall, subject to consideration by the superintendent of the liquid- 47 ity and solvency of the applicable insurer, HMO, or student health plan, 48 shall extend the period for the payment of premiums for any policyholder 49 or contract holder who can demonstrate financial hardship as a result of 50 the COVID-19 pandemic to the later of the expiration of the applicable 51 contractual grace period and the date sixty days after a state disaster 52 emergency is no longer in effect with respect to the COVID-19 pandemic 53 anywhere in the state. Such an insurer, HMO, and student health plan 54 shall be responsible for the payment of claims during such period and 55 may not retroactively terminate the insurance policy for non-payment of 56 the premium during such period.S. 8366 7 1 (c) Requirements. With regard to an individual, small group, or 2 student blanket comprehensive health insurance policyholder or contract 3 holder who does not make a timely premium payment and can demonstrate 4 financial hardship as a result of the COVID-19 pandemic, the applicable 5 insurer, HMO, or student health plan: (1) shall not impose any late fees 6 relating to such premium payment; (2) shall not report the policyholder 7 or contract holder to a credit reporting agency or refer the policyhold- 8 er or contract holder to a medical debt buyer or collector with respect 9 to such premium payment; (3) shall provide information to the policy- 10 holder or contract holder regarding alternate policies available from 11 the insurer, HMO, or student health plan and provide contact information 12 for the NY state of health established pursuant to title seven of arti- 13 cle two of the public health law; and (4) shall provide information 14 regarding health insurance and medical debt consumer assistance avail- 15 able from the state designated consumer assistance program. 16 (d) Other provisions. (1) Subject to consideration by the superinten- 17 dent of the liquidity and solvency of the applicable insurer, HMO, or 18 student health plan, the insurer, HMO, or student health plan also 19 shall, within ten business days following the effective date of this 20 section: 21 (A) mail or deliver, which may include electronic mail, written notice 22 to every individual, small group, or student blanket comprehensive 23 health insurance policyholder and contract holder of the provisions of 24 this section and a toll-free number that the individual, small group, or 25 student blanket comprehensive health insurance policyholder or contract 26 holder may call to discuss billing and make alternative payment arrange- 27 ments; and 28 (B) notify insurance producers and any third-party administrators with 29 whom or which the insurer does business of the provisions of this 30 section. 31 (2) A licensed insurance producer who procured the individual, small 32 group, or student blanket comprehensive health insurance policy for the 33 policyholder or contract holder shall mail or deliver, which may include 34 electronic mail, notice to the policyholder or contract holder of the 35 provisions of this section within ten business days following the effec- 36 tive date of this section. 37 (3) Solely for the purposes of this section, an insurer, HMO, or 38 student health plan shall accept a written attestation from an individ- 39 ual, small group, or student blanket comprehensive policyholder or 40 contract holder as proof of financial hardship as a result of the 41 COVID-19 pandemic. 42 (4) Nothing in this section shall prohibit an individual, small group, 43 or student blanket comprehensive health insurance policyholder or 44 contract holder from voluntarily cancelling a health insurance policy. 45 (5) The period to pay insurance premiums set forth in this section 46 shall not constitute a waiver or forgiveness of the premium. 47 (6) The period set forth in subsection (b) of this section applies 48 only to terminations attributed to a failure by an individual, small 49 group, or student blanket comprehensive health insurance policyholder or 50 contract holder to pay premiums during such period. If an insurer, HMO, 51 or student health plan terminates a policy for any other reason permit- 52 ted by law, the insurer, HMO, or student health plan shall comply with 53 statutory notice requirements. 54 § 5. The insurance law is amended by adding a new section 4331 to read 55 as follows:S. 8366 8 1 § 4331. Extension of premium payment periods; COVID-19. (a) Defi- 2 nitions. As used in this section, the following terms shall have the 3 following meanings: 4 (1) "Credit reporting agency" means a reporting agency that regularly 5 engages in the practice of assembling or evaluating and maintaining, for 6 the purpose of furnishing credit reports to third parties bearing on a 7 person's credit worthiness, credit standing, or credit capacity, and 8 credit account information from persons who furnish that information 9 regularly and in the ordinary course of business. 10 (2) "Late fee" means a fee associated with an insurance premium 11 payment that is made at a time later than the premium due date, but 12 prior to both insurance policy or contract termination and the time in 13 which an insurer, HMO, or student health plan may reject premium 14 payment. 15 (3) "Medical debt buyer" means a person or entity that is engaged in 16 the business of purchasing medical debts for collection purposes, wheth- 17 er it collects the debt itself or hires a third-party for collection or 18 an attorney for litigation in order to collect such debt. 19 (4) "Medical debt collector" means any person or entity that regularly 20 collects or attempts to collect, directly or indirectly, medical debts 21 originally owed or due or asserted to be owed or due to another. A 22 medical debt buyer is considered to be a medical debt collector for all 23 purposes. 24 (5) "Student health plan" has the meaning set forth in paragraph five 25 of subsection (a) of section one thousand one hundred twenty-four of 26 this chapter. 27 (6) "Child health plus" means coverage issued pursuant to section two 28 thousand five hundred eleven of the public health law. 29 (7) "HMO" shall mean a health maintenance organization operating in 30 accordance with the provisions of article forty-four of the public 31 health law or this article. 32 (b) Extension of premium payment periods. Every medical expense indem- 33 nity corporation, HMO, hospital service corporation or health service 34 corporation subject to this article which issues direct pay, small group 35 or student blanket comprehensive contracts, as well as any issuer of 36 child health plus coverage where the subscriber pays the entire premium, 37 subject to consideration by the superintendent of the liquidity and 38 solvency of the applicable medical expense indemnity corporation, HMO, 39 hospital service corporation or health service corporation, shall extend 40 the period for the payment of premiums for any policyholder or contract 41 holder who can demonstrate financial hardship as a result of the COVID- 42 19 pandemic to the later of the expiration of the applicable contractual 43 grace period and the date sixty days after a state disaster emergency is 44 no longer in effect with respect to the COVID-19 pandemic anywhere in 45 the state. Such a medical expense indemnity corporation, HMO, hospital 46 service corporation or health service corporation shall be responsible 47 for the payment of claims during such period and may not retroactively 48 terminate the contract for non-payment of the premium during such peri- 49 od. 50 (c) Requirements. With regard to a direct pay, small group, or student 51 blanket comprehensive health insurance contract holder who does not make 52 a timely premium payment and can demonstrate financial hardship as a 53 result of the COVID-19 pandemic, the applicable medical expense indem- 54 nity corporation, HMO, hospital service corporation or health service 55 corporation: (1) shall not impose any late fees relating to such premium 56 payment; (2) shall not report the contract holder to a credit reportingS. 8366 9 1 agency or refer the contract holder to a medical debt buyer or collector 2 with respect to such premium payment; (3) shall provide information to 3 the contract holder regarding alternate policies available from the 4 medical expense indemnity corporation, hospital service corporation or 5 health service corporation; and (4) shall provide information regarding 6 health insurance and medical debt consumer assistance available from the 7 state designated consumer assistance program. 8 (d) Other provisions. (1) Subject to consideration by the superinten- 9 dent of the liquidity and solvency of the applicable medical expense 10 indemnity corporation, HMO, hospital service corporation or health 11 service corporation, medical expense indemnity corporation, hospital 12 service corporation or health service corporation also shall, within ten 13 business days following the effective date of this section: 14 (A) mail or deliver, which may include electronic mail, written notice 15 to every direct pay, small group, or student blanket comprehensive 16 health insurance contract holder of the provisions of this section and a 17 toll-free number that the direct pay small group, or student blanket 18 comprehensive health contract holder may call to discuss billing and 19 make alternative payment arrangements; 20 (B) notify insurance producers and any third-party administrators with 21 whom or which the medical expense indemnity corporation, HMO, hospital 22 service corporation or health service corporation does business of the 23 provisions of this section. 24 (2) A licensed insurance producer who procured the direct pay, small 25 group, or student blanket comprehensive contract for the contract holder 26 shall mail or deliver, which may include electronic mail, notice to the 27 contract holder of the provisions of this section within ten business 28 days following the effective date of this section. 29 (3) Solely for the purposes of this section, a medical expense indem- 30 nity corporation, HMO, hospital service corporation or health service 31 corporation shall accept a written attestation from a direct pay, small 32 group, or student blanket comprehensive contract holder as proof of 33 financial hardship as a result of the COVID-19 pandemic. 34 (4) Nothing in this section shall prohibit a direct pay, small group, 35 or student blanket comprehensive contract holder from voluntarily 36 cancelling a contract. 37 (5) The period to pay premiums set forth in this section shall not 38 constitute a waiver or forgiveness of the premium. 39 (6) The period set forth in subsection (b) of this section applies 40 only to terminations attributed to a failure by a direct pay, small 41 group, or student blanket comprehensive contract holder to pay premiums 42 during such period. If a medical expense indemnity corporation, hospital 43 service corporation or health service corporation terminates a policy 44 for any other reason permitted by law, the insurer medical expense 45 indemnity corporation, hospital service corporation or health service 46 corporation shall comply with statutory notice requirements. 47 § 6. Subdivision 9 of section 364-j of the social services law, as 48 amended by chapter 433 of the laws of 1997, is amended to read as 49 follows: 50 9. Managed care providers shall inform participants of such provider's 51 grievance procedure and utilization review procedures [required pursuant52to sections forty-four hundred eight-c and] under article forty-nine 53 [hundred] of the public health law. A managed care provider or local 54 social services district, as appropriate, shall provide notice to 55 participants of their respective rights to a fair hearing and aid 56 continuing in accordance with applicable state and federal law. ManagedS. 8366 10 1 care providers shall provide written notice of the name, address, phone 2 number and website of the department of health designated independent 3 consumer assistance program and the independent substance use disorder 4 and mental health ombudsman established by section 33.27 of the mental 5 hygiene law on all notices of adverse determinations, grievances and 6 appeals. 7 § 7. Paragraph (b) of subdivision 2 and subdivision 7 of section 8 4408-a of the public health law, as added by chapter 705 of the laws of 9 1996, are amended to read as follows: 10 (b) The notice to an enrollee describing the grievance process shall 11 explain: (i) the process for filing a grievance with the organization; 12 (ii) the timeframes within which a grievance determination must be made; 13 [and] (iii) the right of an enrollee to designate a representative to 14 file a grievance on behalf of the enrollee; and (iv) notice of the name, 15 address, phone number and website of the department designated consumer 16 assistance program and the independent substance use disorder and mental 17 health ombudsman established by section 33.27 of the mental hygiene law 18 on all notices of adverse determinations, grievances and appeals. 19 7. The notice of a determination shall include: (i) the detailed 20 reasons for the determination; (ii) in cases where the determination has 21 a clinical basis, the clinical rationale for the determination; [and] 22 (iii) the procedures for the filing of an appeal of the determination, 23 including a form for the filing of such an appeal; and (iv) notice of 24 the name, address, phone number and website of the department designated 25 consumer assistance program and the independent substance use disorder 26 and mental health ombudsman established by section 33.27 of the mental 27 hygiene law on all notices of adverse determinations, grievances and 28 appeals. 29 § 8. Section 369-gg of the social services law is amended by adding a 30 new subdivision 3-a to read as follows: 31 3-a. Novel coronavirus, COVID-19 eligibility. A person shall also be 32 eligible to receive coverage for health care services under this title, 33 without regard to federal financial participation, if he or she is a 34 resident of the state, has or has had a confirmed or suspected case of 35 novel coronavirus, COVID-19, household income below two hundred percent 36 of the federal poverty line as defined and annually revised by the 37 United States department of health and human services for a household of 38 the same size, and is ineligible for federal financial participation in 39 the basic health program under 42 U.S.C. section 18051 on the basis of 40 immigration status, but otherwise meets the eligibility requirements in 41 paragraphs (b) and (c) of subdivision three of this section. An appli- 42 cant who fails to make an applicable premium payment shall lose eligi- 43 bility to receive coverage for health care services in accordance with 44 the time frames and procedures determined by the commissioner. 45 § 9. This act shall take effect immediately; provided, however, the 46 amendments to subdivision 9 of section 364-j of the social services law 47 made by section six of this act shall not affect the repeal of such 48 section and shall be deemed repealed therewith, provided further, that 49 section eight of this act shall expire and be deemed repealed 60 days 50 following the conclusion of the state disaster emergency declared pursu- 51 ant to executive order 202, provided that the commissioner of health 52 shall notify the legislative bill drafting commission upon the occur- 53 rence of the conclusion of such executive order in order that the 54 commission may maintain an accurate and timely effective data base of 55 the official text of the laws of the state of New York in furtherance ofS. 8366 11 1 effectuating the provisions of section 44 of the legislative law and 2 section 70-b of the public officers law.
