For Immediate Released
Release # 2007-0105
New York City Council
City Hall, New York, NY 10007
(212) 788-7116

October 30th, 2007

COUNCIL RELEASES INVESTIGATION ON COMPLIANCE WITH “MANNY’S LAW”
Finds that while many hospitals are protecting the rights of uninsured patients, too many are still not sufficiently informing patients about financial assistance

Manny’s Law requires many hospitals in New York to develop a comprehensive financial aid program for uninsured and underinsured patients. Additionally, the law requires hospitals to post language-appropriate information about the availability of financial assistance in conspicuous areas throughout the hospital.

The Council’s investigation has found that while the great majority of hospitals surveyed have made great progress in the first six months that the law has been in effect, far too many appear to be falling short of the law’s requirements. These failures could leave patients vulnerable to the same lack of care that led to the untimely death of Manny Lanza, for whom the law is named. “In just six months, the vast majority of City hospitals have begun informing patients about financial support options,” said Speaker Christine Quinn. “However, it only takes one New Yorker to be denied information at one hospital, and we could have another tragedy on our hands. The Council has some simple recommendations we think can improve compliance even further, and we look forward to working with the Department of Health and with local hospitals to address our outstanding concerns.”

“No one should be denied emergency health care because of the language they speak, the neighborhood they live in, or how much money they have in their pocket,” said Investigations Committee Chair Eric Gioia. “And no mother should have to live with the knowledge that her child died unnecessarily. Manny's Law was passed to make sure that doesn't happen again, and happily, our investigation shows that most hospitals have taken steps to comply with Manny's law and provide this vital information. But there are still gaps that must be filled - this is an area where we don't want to take any chances.”

Background
In 2005, Long Island resident Manny Lanza was diagnosed with arteriovenous malformation, a serious brain condition. He had been working 50 hours a week at a fast-food restaurant, but his job was considered part-time and his employer did not offer him health insurance. He was referred to St. Luke’s-Roosevelt Hospital in Manhattan for treatment, where they reportedly refused to perform a needed procedure unless he was insured.

His family attempted to enroll him in Medicaid, but the delay in treatment proved deadly. In 2005, at the age of 24, Manny died in his bedroom at home from causes related to his brain disorder.

In her first act as Speaker in January 2006, Speaker Quinn introduced the Patient Information Act, or Manny’s Law, in response to Manny Lanza’s tragic and untimely death. To expand enforcement beyond what could be done locally, the Council also worked with the State Legislature to pass a bill that integrated and expanded upon the Council’s legislation. The State version of Manny’s Law went into effect on January 1, 2007.

New York State hospitals receive nearly $1 billion each year from the State’s Bad Debt and Charity Care, Indigent Care, and Disproportionate Share pool to help cover the costs of caring for uninsured or underinsured patients. However, prior to January 2007 hospitals were not required to meet any guidelines, such as offering a certain portion of their health care free or at a discount, or notifying patients about the availability of financial assistance.

Findings
Between July 9 and August 13 of this year, the Council investigated 59 hospitals in New York City’s five boroughs through site visits, telephone calls, and document requests. Hospitals were evaluated in three key areas:

1. Signage - Manny’s Law requires hospitals with 24-hour emergency departments to notify patients of their financial assistance program through “conspicuous posting of languageappropriate information in the general hospital.” Our investigators surveyed 10 common and conspicuous areas of each hospital and noted whether posters were displayed.

Of the 59 hospitals visited:
• 37 hospitals (63%) had posters in 2 or more areas surveyed
• 9 hospitals (15%) had posters in only 1 area surveyed
• and 1 hospital (2%) had posters in all areas surveyed
• However, 13 hospitals (22%) had no signs posted.
2. Verbal Information about Manny’s Law - Through site visits and phone calls, our investigators surveyed billing office staff in an effort to simulate the experience that an uninsured patient might encounter inquiring about how to pay for care.

During the 58 hospital billing office phone surveys:
• Staff at 43 hospitals (74%) told investigators about their financial assistance programs without prompting
• And staff at 8 hospitals (14%) told investigators about their financial assistance program when prompted
• However, staff at 4 hospitals (7%) never told investigators about their financial assistance program, even after prompting, including staff at 2 hospitals (3%) who said that a patient could not receive care if he/she were unable to pay

3. Phone Surveys

During 58 hospital billing office phone surveys:

• Staff at 43 hospitals (74%) told investigators about their financial assistance programs without prompting

• And staff at 8 hospitals (14%) told investigators about their financial assistance program when prompted

• However, Staff at 4 hospitals (7%) never told investigators about their financial assistance program, even after prompting, including staff at 2 hospitals (3%) who said that a patient could not receive care if he/she were unable to pay.

Recommendations

In an effort to bring all City hospitals to full compliance, the Council has issued a series of recommendations:

1. The State Department of Health should conduct annual random spot checks of hospitals to evaluate their compliance with Manny’s Law and the accessibility of their financial assistance programs. DOH needs to be pro-active in making sure hospitals have not only created a financial assistance policy, but also are hanging posters, and providing information in person, over the phone, and on bills.

2. DOH should more clearly define the “conspicuous places” in hospitals where posters about financial assistance must be placed, such as waiting rooms, outpatient clinics, and billing and Medicaid offices.

3. Hospitals should conduct further staff training on their financial assistance program. Investigators found inconsistent responses to both the phone and site visit surveys. Hospitals need to train their billing office staff, as well as other hospital staff, to ensure that all individuals interacting with patients are aware of financial assistance programs and how patients can apply.

4. Hospitals should follow the DOH’s sample financial assistance application. A number of hospital applications collected by the Council reveal questions that may be barriers for patients trying to access financial assistance. All hospitals should re-evaluate their application process to make sure that all information being asked of patients is absolutely necessary and reasonable to process their application.

“Today we are proud to announce that many more hospitals in New York City are complying with ‘Manny’s Law’, said Health Committee Chair Joel Rivera. “Since going into effect, this law has spoken directly to uninsured and underinsured New Yorkers with information that will help reverse what many health advocates say is a chronic problem: hospitals not offering enough information about financial assistance options. This gives us hope that no other family will have to experience the same tragedy as Manny Lanza’s parents.”

“I am very grateful to Speaker Quinn and the City Council for their hard work and outspoken advocacy when I was fighting get Manny's Law enacted, as well as for this important investigation into its implementation,” said New York State Senator Thomas K. Duane. “It was my goal through Manny's Law to ensure that no one else dies in New York State simply because he or she cannot afford to pay a medical bill. This investigation shows that we are moving closer to that goal, but there is still work to do. I appreciate the Council's recommendations to the New York State Department of Health and to hospital administrators and believe they provide a model for Manny's Law implementation across the State.”

“I want to thank Speaker Quinn and the Council for making Manny’s Law a reality,” said Levia Prieto, mother of Manny Lanza. “I am happy to hear that most New York City hospitals are providing information about Manny’s Law and financial services, and hope that all hospitals will soon do so. I don’t want what happened to Manny and my family to ever happen again.” “There's no excuse for any hospital to tell a New York City resident to go away unless they have insurance – that's exactly the kind of hospital behavior that resulted in Manny Lanza's death, said Chung-Wha Hong, Executive Director of the New York Immigration Coalition. “The great thing about New York's hospital financial assistance law is that it limits how much private hospitals can charge uninsured patients, and opens the door to hospital clinics and specialty care for all New Yorkers. The City Council's investigation shows that access has improved at many hospitals, but also points out hospitals that need to share information about discounts or else lose their extra funding.”

“This City Council report provides valuable insight into a critical access to health care problem,” said Judy Wessler, Director, Commision on the Public's Health System. “Based on the report, hospitals in New York City have made some progress, but more needs to be done. In June and early July, high school students supervised by CPHS visited Brooklyn and Manhattan hospitals to assess signage and found much less compliance with the state law. The City Council's findings, from just a few weeks later, show improvement and thus we are on the way, but still need to do more.”

###