Bill > A01257

This bill amends the New York Public Health Law to specify how home care agencies and fiscal intermediaries (organizations that process payments and claims on behalf of service providers) must submit claims for medical services. Specifically, the bill requires that claims for services provided by home care agencies licensed or certified under the state's public health law must be submitted only on forms approved by the Centers for Medicare and Medicaid Services (CMS), a federal agency that administers major healthcare programs. The bill also stipulates that these claims can be submitted directly to insurers or through a billing entity chosen by the home care agency or fiscal intermediary. Importantly, the bill prohibits insurers from mandating the use of a specific billing entity and requires them to process and pay claims in a timely manner. The bill does not limit insurers' ability to review or audit claims for potential fraud, waste, and abuse, and applies to various types of insurers including Medicaid managed care plans and managed long-term care plans. The legislation will take effect 30 days after becoming law.

Health and Social Services

https://www.nysenate.gov/legislation/bills/2025/A1257