A 1257: Provides that the submission of claims for services provided by home care agencies shall be done on forms approved by the centers for Medicare and Medicaid services.

  
  STATE OF NEW YORK ________________________________________________________________________ 1257 2025-2026 Regular Sessions  IN ASSEMBLY January 9, 2025 ___________ Introduced by M. of A. PAULIN, SAYEGH, JACKSON, TAPIA, SEPTIMO, DE LOS SANTOS, SIMONE, WEPRIN, REYES, BRABENEC, SIMON, STERN, COLTON, RAGA, BURDICK, STECK, GALLAHAN -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to the submission of claims for services provided by home care agencies The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Section 3614-e of the public health law, as added by 2 section 49 of part B of chapter 57 of the laws of 2015, is amended to 3 read as follows: 4 § 3614-e. Electronic payment of claims. 1. The payment of claims 5 submitted under contracts or agreements with insurers under the medical 6 assistance program for home and community-based long-term care services 7 provided under this article, by fiscal intermediaries operating pursuant 8 to section three hundred sixty-five-f of the social services law, and by 9 residential health care facilities operating pursuant to article twen- 10 ty-eight of this chapter shall be paid via electronic funds transfer. 11 Claims for services provided by home care agencies licensed or certified 12 under this article and by fiscal intermediaries operating pursuant to 13 section three hundred sixty-five-f of the social services law shall be 14 only submitted and remitted on forms approved by the centers for Medi- 15 care and Medicaid services. Claims shall be submitted to insurers 16 directly or by a billing entity selected by the home care agency 17 licensed or certified under this article or by a fiscal intermediary 18 operating pursuant to section three hundred sixty-five-f of the social 19 services law. Insurers shall not require the utilization by contract or 20 action any specific billing entity by a home care agency licensed or 21 certified under this article or by a fiscal intermediary operating 22 pursuant to section three hundred sixty-five-f of the social services 23 law; nor impede the timely processing and payment of claims. EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD03466-01-5 
 A. 1257 2 1 2. Nothing shall limit an insurer's ability to review or audit claims 2 for fraud, waste, and abuse. 3 3. Such insurers shall include but not be limited to Medicaid managed 4 care plans and managed long-term care plans. 5 § 2. This act shall take effect on the thirtieth day after it shall 6 have become a law.