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.