DAL 16-13: Surprise Bill Law Second Phase

August 29, 2016


Dear Chief Executive Officer:

The New State Department of Health is sending you the attached letter and documents as part of the 2014-2015 New York State budget's the "Emergency Medical Services and Surprise Bills" law, commonly referred to as the "Surprise Bill Law", which was passed to protect consumers against unknowingly receiving care from out-of-network providers and resulting in surprise medical bills. The law amended the New York Insurance Law, Public Health Law and Financial Services Law, and went into effect March 31, 2015. The Emergency Medical Services and Surprise Bill Law can be found in Part H of Chapter 60 of the Laws of New York (2014), and available through the following link:

Your facility is being asked to respond as part of the secondof four phases of our evaluation. The purpose of this letter is to inform you of your obligations under Section 24 of the Public Health Law to disclose to patients or prospective patients the health plan networks that your hospital participates in. In addition, the law requires disclosure of the standard charges for hospital items and services that may not be covered by a patient's specific health care plan, including physician services, for which the patient may be charged. These new disclosure requirements must be added to your hospital's website and provided to a patient in advance of non-emergency hospital services, as detailed below.

Every hospital must post on its website the hospital's standard charges for items and services; the health plans in which the hospital participates; and, the physician groups and physicians that the hospital contract with or employs and the health care plans in which they participate. Specifically, the hospital website posting must include a list of the hospital's standard charges for items and services provided by the hospital, to the extent required by federal guidelines, including diagnosis-related groups (DRGs) established under section 1886(d)(4) of the federal social security act [PHL § 24(5)].

§ 300gg-18(e). On August 22, 2014, the Centers for Medicare & Medicaid Services

Note: The Affordable Care Act requires each hospital to establish and make public a list of its standard charges for items and services provided by the hospital. 42 U.S.C.

(CMS) published a final rule that allows hospitals to either make public a list of their standard charges or their policy for allowing the public to view a list of those charges in response to an inquiry. 79 Fed. Reg. 50145-50146.

Given the CMS final rule, State law only requires posting standard charges on the hospital's website if the hospital does not make the list of charges publicly available in some other way.

It is important to note that the posted material must be prominent on your hospital's website with the services appropriately labeled to be easily identified. Please also include a copy of your policy and procedures for providing the required educational materials to patients in advance of non-emergency admissions, and copies of the materials provided.

The Department of Health is evaluating compliance with the Law, and has attached a fillable checklist of requirements you must post on your hospital's website. Please complete the checklist and email the above referenced documentation with the subject line titled "Surprise Bills Law" to hospinfo@health.ny.gov. A list of the hospitals which are to respond to this second phase of the survey is attached.

Please submit this information within 30 business days from the date of this letter. Failure to comply with this request may result in a citation. If you have any questions, please contact (518) 402-1003.

Please make certain that all appropriate staff in your facility are aware of their responsibilities pertaining to these disclosures and their importance. Thank you in advance for your attention to these requirements and your efforts to assure compliance.


Ruth Leslie Director
Division of Hospitals and Diagnostic & Treatment Centers