Simplifying Administrative Processes to Help Patients

A state Workgroup investigating ways to simplify administrative processes around health care recommended a number of policy changes that could make life easier for patients. The Health Care Administrative Simplification Workgroup was created in the FY20-21 enacted budget and submitted its final report to the Legislature a few weeks ago.

Several of the Workgroup’s recommendations had been proposed through last year’s Patient Medical Debt Protection Act, which would have enacted significant financial protections for patients – but did not pass the state Legislature. Key recommendations from the Workgroup include:

  1. Standardizing the Financial Assistance Application: The Workgroup recommended that the state develop a standardized form to be used at all hospitals for financial assistance applications. New York State started auditing hospitals’ compliance with the hospital financial assistance law in 2012. Hospitals routinely fail this audit by requiring information Social Security numbers, and tax returns as part of the application. This leads to low- and moderate-income patients becoming responsible for bills that the state has already determined they cannot afford. A standard application would eliminate these hurdles.
  2. Regulating Facility Fees: Another piece of the Patient Medical Debt Protection Act that appears in the Workgroup recommendations is that providers inform patients about facility fees before they receive services. The Workgroup also recommends prohibiting facility fees charges for preventive care visits. Facility fees are overhead charges for hospital care, but they are increasingly charged to patients who receive services elsewhere as more and more doctors’ offices are purchased by hospitals. This recommendation could be enacted this year by passing A3470B/S2521B.
  3. Standardizing Financial Liability Forms: Another patient-friendly recommendation from the Workgroup is for providers to standardize patient financial liability forms. Patients are sometimes asked to sign these forms before appointments without adequate time to understand what they are signing. This is an unfair practice, as the forms ask patients to accept financial responsibility for the costs of care before they know what care they need or how much it costs. Patients have even been denied care for refusing to sign the forms.

           Another batch of recommendations in the report would improve the prior authorization process, which is how health plans decide whether a doctor’s recommendation is medically necessary before approving payment. The Workgroup recommended that plans clearly identify which services require pre-authorization, review those services annually to decide if pre-authorization is sensible, and flag situations where patients are required to get multiple pre-authorizations for the same treatment when it is needed more than once. The Workgroup also recommends that health plans post their clinical review process in an easily accessible location on their websites so that patients and anyone helping them can understand why services are authorized or not. Patients need this information to appeal decisions that might be against medical best practices or are inappropriate for their specific health care needs.

The Biden Administration is planning to draft a new public charge rule, and is gathering information before it does so through a public comment process. Advocates have until October 22 to submit their comments (you can read the request for comments here.)

The previous Administration’s expansion of the public charge rule is still harming New Yorkers. The Trump Administration proposed a major expansion of public charge in September 2018. The proposal, if enacted in full, would have meant immigrants who used a long list of public programs could later be denied permanent residency. The final rule was much smaller in scope than what was originally proposed, and did not include health programs like Medicaid.

Further, the final rule was revoked by President Biden in March 2021. But the proposal caused damage in-and-of itself: immigrants who were not subject to the rule still fear enrolling in programs that will help them access health care, even when those programs were not part of the expanded public charge rule. This confusion and fear surrounding the rule is known as the “chilling effect.” Immigrants were afraid to make mistakes that would jeopardize their future here while the rule was in place, and they are still afraid that a future Administration will use their health care needs against them. As many as 260,000 low-income children lost access to desperately needed health care and other services during 2020 because of the chilling effect.

President Biden must address these fears by clearly defining public charge in regulations. Public charge was applied narrowly before the Trump Administration, so narrowly it was almost never used. The new rule should explicitly and narrowly define public charge to avoid future abuses. It should also explicitly list programs that are not subject to public charge, like Medicaid and SNAP. Protecting Immigrant Families has created a sign-on letter for advocates with other recommendations; the deadline to sign on is October 20. Advocates who sign the joint letter should also consider submitting their own individual comments. Another good resource is this Health Affairs blog post.

New York State and the Biden Administration also need to do more to make sure immigrants can access health care:

  • Some New Yorkers are barred from enrolling in public health coverage because of their status. New York could immediately provide relief to those excluded immigrants by passing A880/S1572, which would allow income-eligible immigrants to enroll in the Essential Plan. 
  • At the federal level, the Biden Administration should remove the 5-year bar to becoming eligible for Medicaid coverage.

By CSS NY

This week, CSS VP of Health Initiatives Elisabeth Benjamin joined David Lombardo on The Capitol Pressroom to discuss how Governor Kathy Hochul can use her new position to make our state’s health care system work better for patients.

Below are six items that should be on Governor Hochul’s health care to-do list:

1. PASS THE NEW YORK HEALTH ACT

Our health care system is failing the people it’s meant to serve — the patients. While the Cuomo administration had a track record of catering to big industry players, Governor Hochul can immediately turn the page by focusing on care over profit.

The New York Health Act would allocate resources fairly, ensure coverage for all New Yorkers, and be user-friendly without the navigational headaches under the current byzantine system.

2. PASS COVERAGE4ALL TO EXPAND THE ESSENTIAL PLAN TO IMMIGRANTS

While the New York Health Act would be a game-changer for our state, it will take time to implement. There are several moves that Hochul’s administration can make now to provide immediate relief for New Yorkers who need access to affordable care. First among them is passing the Coverage4All bill.

Immigrants have disproportionately served on the frontlines as essential workers during the COVID-19 pandemic, and yet more than 400,000 immigrants in New York State do not have health care coverage due to immigration status.

Passing Coverage4All would extend Essential Plan health insurance to immigrants who ould be eligible already because of their income if not for their immigration status.

3. ENACT THE PATIENT MEDICAL DEBT PROTECTION ACT

All of New York’s hospitals are non-profits, yet more than half sue their patients. These lawsuits are typically for small amounts — the median bill is $1,900 — and target low-income patients who cannot afford to pay.

The Patient Medical Debt Protection Act would protect consumers from aggressive medical debt collections. This series of bills would:

  • Ban hospitals from placing liens on patients’ home or garnishing their wages for medical debt. 
  • Make it easier for patients to obtain financial assistance that hospitals are required to provide by law based on their income by standardizing the application and eliminating the 90-day deadline to apply.
  • Stop providers from charging patients for facility fees if they will not be covered by insurance and require providers to notify patients that facility fees will be added to their bill ahead of time.

4. SUPPORT SAFETY NET PROVIDERS THROUGH THE INDIGENT CARE POOL

Over the last 20 years, New York has lost 25,000 hospitals beds, many in communities that already had less access to health care. New York’s $1.1 billion in Indigent Care Pool (ICP) funding is supposed to help hospitals provide care for patients who are uninsured or unable to pay—but many wealthier hospitals who receive large ICP windfalls provide little financial assistance to patients. New York State law defines some hospitals as qualified safety-nets based on their patient mix.

We should target ICP funds where they are needed most: safety-net hospitals that need this funding to stay operational in lower-income communities around the state.

5. GUARANTEE EQUITY IN THE MEDICAID PROGRAM FOR PEOPLE WHO ARE OLDER, BLIND, OR HAVE DISABILITIES

Did you know that Medicaid has much stricter income limits for senior citizens, people who are visually impaired, and people who have disabilities? These are people who need care just as much, if not more, than the average person. However, their income cap is $10,000 per year, while everyone else’s is $17,000. Further, they have to pass an asset test even if they meet the income requirements – that means they must drastically limit how much money they save in order to keep their health care.  

Many other states have fixed this inequity, and it’s time for New York to follow their lead. Eligibility for the Medicaid Aged and Disabled program should be increased to 138% of the FPL to match the rest of the Medicaid program and the asset test should be eliminated.

6. MAKE MARKETPLACE COVERAGE MORE AFFORDABLE FOR CONSUMERS

The Essential Plan, a basic health coverage plan with no deductibles and low co-pays, is a lifeline for over 800,00 New Yorkers. Expanding eligibility to 300% of the federal poverty line would make this affordable option available to many low-income workers who are less likely than higher earners to have an employer-sponsored plan.

Listen to Elisabeth’s full interview on The Capitol Pressroom here.

By Bob Cohen, Policy Director, Citizen Action of New York

In the 2021 session’s closing weeks, the Assembly and Senate each passed two important pieces of legislation, which — if signed by the Governor — will strongly assist health care consumers.

  • Lawsuits Against Consumers: Between 2015 and 2019, New York hospitals sued over 40,000 New Yorkers who could not pay their bills, according to a Community Service Society report. And in this time of COVID, consumers have been falling behind on many other bills, including for student loans, credit cards and gas and electric service. Legislation that passed both houses of the Legislature (A6474A/S5724A) would provide much needed relief by lowering the interest rates that may be charged on court judgments on consumer debt from an outrageous 9% to a more reasonable 2%.
  • Protecting Communities When Hospitals Downsize: Statewide, over 40 hospitals have closed since 2002 — disproportionately in neighborhoods populated by people of color and immigrants. The Assembly and Senate responded by passing legislation (A191A/S1451A) to require a “health equity assessment” when a hospital proposes to merge, close or otherwise reduce services, providing these neighborhoods with a vehicle to challenge service reductions that disproportionately harm underserved communities.

2021 was a disappointing year for health care consumers. The Legislature failed to act on NY Health, a critical bill to provide comprehensive coverage to all New Yorkers, eliminating premiums, co-pays, and other out-of-pocket costs. And even in the wage of COVID, modest legislation to extend Essential Plan coverage to low-income immigrants with COVID who are ineligible for coverage due to their immigration status did not pass. Finally, the Legislature failed to pass the Patient Medical Debt Protection Act (A1538/S3057), which would have provided strong protections to patients overrun by medical debt by, for example, banning deceptive “facilities fees” tacked onto hospital bills that don’t reflect medical services performed, and prohibiting consumers from receiving multiple bills from the same hospital stay.

Signing the interest rate and health equity bills will be an important signal that the Governor hears the cries of New York families struggling to obtain adequate health care and wrestling with large medical debts.

Patients and advocates can help by contacting Governor Hochul and letting her know that these bills are important. New Yorkers can email or call her office at 1-518-474-8390. Elected officials want to hear from constituents – these contacts are important! If you are an organization and interested in submitting a memo of support, HCFANY has templates. You can also support these bills by sharing your health care stories, whether with the Governor or with us. How has being in a neighborhood without adequate hospital beds affected you? Have you been put into collections or sued over medical debt? Your experiences are important!