2002 Legislation
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HOUSE BILL NO. 704 – Health care billing disclosure

HOUSE BILL NO. 704

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H0704......................................................by STATE AFFAIRS
HEALTH CARE BILLING DISCLOSURE - Adds to existing law to require the
disclosure by health care providers and health insurance carriers of
certain information to patients; and to provide penalties.
                                                                        
02/28    House intro - 1st rdg - to printing
03/01    Rpt prt - to Bus

Bill Text


                                                                        
                                                                        
  ||||              LEGISLATURE OF THE STATE OF IDAHO             ||||
 Fifty-sixth Legislature                  Second Regular Session - 2002
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                                     HOUSE BILL NO. 704
                                                                        
                                 BY STATE AFFAIRS COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO HEALTH CARE BILLING; AMENDING TITLE 39, IDAHO CODE, BY  THE  ADDI-
  3        TION  OF A NEW CHAPTER 84, TITLE 39, IDAHO CODE, TO PROVIDE A SHORT TITLE,
  4        TO REQUIRE DISCLOSURE OF CERTAIN INFORMATION BY HEALTH CARE PROVIDERS  AND
  5        HEALTH  INSURANCE CARRIERS, TO PROVIDE AN EXCEPTION, TO PROVIDE FOR PENAL-
  6        TIES, TO PROHIBIT RETALIATORY ACTIONS AND TO DEFINE TERMS.
                                                                        
  7    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
  8        SECTION 1.  That Title 39, Idaho Code, be, and the same is hereby  amended
  9    by  the addition thereto of a NEW CHAPTER, to be known and designated as Chap-
 10    ter 84, Title 39, Idaho Code, and to read as follows:
                                                                        
 11                                      CHAPTER 84
 12                          HEALTH CARE BILLING DISCLOSURE ACT
                                                                        
 13        39-8401.  SHORT TITLE. This chapter shall be known and may be cited as the
 14    "Health Care Billing Disclosure Act."
                                                                        
 15        39-8402.  DISCLOSURE REQUIRED. (1) Upon a patient's request, a health care
 16    provider shall provide to a patient  or  to  the  legal  representative  of  a
 17    patient,  prior to the delivery of any health care services, written notifica-
 18    tion of the following information:
 19        (a)  The business name of the health insurance carrier  or  carriers  with
 20        which the health care provider participates and from which the health care
 21        provider accepts reimbursement as payment in full after the payment of any
 22        deductibles,  copayments  or  coinsurance  by  the patient pursuant to the
 23        patient's contract with the health insurance carrier;
 24        (b)  If the health care provider is not a participating or preferred  pro-
 25        vider with the patient's health insurance carrier, whether the health care
 26        provider  will  bill the patient for the balance of any charges for health
 27        care services which are not otherwise reimbursed by the  patient's  health
 28        insurance carrier;
 29        (c)  Whether  the health care provider will charge the patient interest on
 30        the billed charges for the health care services and,  if  so,  the  annual
 31        rate of the interest that will be charged;
 32        (d)  A  reasonable  range  of the total charges for the anticipated health
 33        care services provided or to be provided by the health care  provider,  if
 34        such charges can reasonably be determined; and
 35        (e)  A  general list of anticipated charges that may not be covered by the
 36        patient's health insurance carrier including any charges that  may  exceed
 37        the usual, customary or reasonable allowances of the health insurance car-
 38        rier  for  purposes  of reimbursement; provided however, that such list is
 39        intended only to notify the patient of  any  possible  additional  charges
 40        and, if provided prior to the rendering of health care services, shall not
 41        limit the charges to be billed to the patient.
                                                                        
                                           2
                                                                        
  1        (2)  Upon a patient's request, a health insurance carrier shall provide to
  2    a  patient  or to the legal representative of a patient, prior to the delivery
  3    of any health care services, written notification of the usual,  customary  or
  4    reasonable  allowances  for which reimbursement will be provided by the health
  5    insurance carrier for the anticipated health care services.
  6        (3)  If, following the initial delivery of health care services, there is
  7    a change in either the health care provider's status  as  a  participating  or
  8    preferred  provider  with  the  patient's  health  insurance carrier or in the
  9    health care provider's business practice related to the billing of health care
 10    services, the health care provider shall, upon a patient's request, provide to
 11    the patient written notification of such changes prior to the delivery of  any
 12    additional health care services.
                                                                        
 13        39-8403.  EXCEPTION.  A  health  care provider or health insurance carrier
 14    shall not be required to provide written notification to the  patient  as  set
 15    forth  in  section  39-8402,  Idaho Code, prior to the delivery of health care
 16    services if such requirement would jeopardize the  health  or  safety  of  the
 17    patient;  provided  however, that the health care provider or health insurance
 18    carrier shall provide such written notification to the patient  or  the  legal
 19    representative of the patient at the earliest opportunity following the deliv-
 20    ery of health care services to the patient.
                                                                        
 21        39-8404.  FAILURE  TO  PROVIDE  WRITTEN  DISCLOSURE -- PENALTIES. (1) If a
 22    health care provider fails to provide written  notification  upon  request  as
 23    required  in  this  chapter,  a patient shall not be liable to the health care
 24    provider for charges that are not covered by the  patient's  contract  with  a
 25    health insurance carrier which are in excess of any deductibles, copayments or
 26    coinsurance  for  which  the  patient is responsible pursuant to the patient's
 27    contract with the health insurance carrier.
 28        (2)  In addition, if a health care provider or  health  insurance  carrier
 29    fails  to  provide written notification upon request as required in this chap-
 30    ter, such provider or carrier shall be subject to a penalty of not  more  than
 31    five  thousand  dollars  ($5,000) for each violation. An action to recover the
 32    civil penalty as provided in this subsection may be brought by  a  prosecuting
 33    attorney.  If  the prosecuting attorney does not file an action for such civil
 34    penalty within sixty (60) days from the date the action is  requested  by  the
 35    patient,  the  patient may file such action. Venue for such an action shall be
 36    proper in the judicial district for the county in which the health  care  ser-
 37    vices  are or were to be provided or the county in which the respective health
 38    care provider or health insurance carrier has its principal place of  business
 39    in this state.
 40        (3)  The  penalties  provided in this section are in addition to any other
 41    remedy at law or equity available to a patient.
 42        (4)  Any civil penalty imposed pursuant to this section shall be deposited
 43    in the state general fund. Attorney's fees shall be paid solely to  the  party
 44    successfully bringing the action.
                                                                        
 45        39-8405.  RETALIATORY  ACTION  PROHIBITED.  (1) A health insurance carrier
 46    shall not terminate or nonrenew a contract with a  health  care  provider,  or
 47    take  other retaliatory action against a health care provider, based upon such
 48    provider's disclosure to a patient of accurate  information  regarding  health
 49    care services to be rendered by the provider and coverage for such services by
 50    a patient's health insurance carrier.
 51        (2)  Nothing  in  this  section  shall  prohibit a contract provision that
 52    requires any contracting party to keep confidential specific amounts paid to a
                                                                        
                                           3
                                                                        
  1    provider, provider fee schedules,  provider  salaries  and  other  proprietary
  2    information of a specified contract issued by a health insurance carrier.
                                                                        
  3        39-8406.  DEFINITIONS. As used in this chapter:
  4        (1)  "Health  care  provider"  means  any  person  or health care facility
  5    licensed, registered, certified, permitted or otherwise officially  recognized
  6    by the state of Idaho to provide health care services in this state.
  7        (2)  "Health  care  services" means any services rendered to an individual
  8    for diagnosis, treatment or care of any injury, ailment or bodily condition.
  9        (3)  "Health insurance carrier" means  any  entity  that  provides  health
 10    insurance  in  this  state.  For purposes of this chapter, carrier includes an
 11    insurance company, a hospital or professional service corporation, a fraternal
 12    benefit society, a  health  maintenance  organization,  any  entity  providing
 13    health  insurance  coverage or benefits to residents of this state as certifi-
 14    cate holders under a group policy issued or delivered outside of  this  state,
 15    and  any  other entity providing a plan of health insurance or health benefits
 16    subject to state insurance regulation.
 17        (4)  "Patient" means an individual who receives, or requests  to  receive,
 18    health care services from a health care provider.

Statement of Purpose / Fiscal Impact




                     STATEMENT OF PURPOSE
                           RS 12172
                               
Health care costs are escalating at a higher rate than ever before.
Health care providers, health insurance companies and health care
consumers (patients) are challenged as medical bills or accounts
receivable go unpaid, insurance premium rate hikes occur, and balance
billing practices surprise and shock consumers.

The purpose of this legislation is to provide for disclosure and
responsibility in the area of health care billing. Upon request,
providers would be required to inform patients if the health care
provider is a participating provider in a network, if the provider
accepts the patient s insurance, if the provider will "balance bill",
and also provide a reasonable range of total charges.

Also, upon request, a health insurance carrier will provide to a
patient prior to the delivery of any anticipated health care services
written notification of the usual, customary or reasonable allowances
for which reimbursement will be provided. Certain exceptions are
provided and penalties for failure to provide disclosure are set
forth.



                        FISCAL IMPACT
None.



Contact
Name:  Rep. Kent Kunz
Phone: (208) 332-1000
      


STATEMENT OF PURPOSE/FISCAL NOTE                     H 704