2004 Legislation
Print Friendly

HOUSE BILL NO. 757 – Health care providers, notice

HOUSE BILL NO. 757

View Bill Status

View Bill Text

View Amendment

View Engrossed Bill (Original Bill with Amendment(s) Incorporated)

View Statement of Purpose / Fiscal Impact



Text to be added within a bill has been marked with Bold and
Underline. Text to be removed has been marked with
Strikethrough and Italic. How these codes are actually displayed will
vary based on the browser software you are using.

This sentence is marked with bold and underline to show added text.

This sentence is marked with strikethrough and italic, indicating
text to be removed.

Bill Status



H0757aa....................................................by STATE AFFAIRS
HEALTH CARE PROVIDERS - Adds to existing law relating to health care
insurance to require a notice by health care providers; to specify content
of the notice; to provide exceptions; to define terms; and to require
maintenance of an internet site and/or toll-free number by insurance
providers with current health care provider information.
                                                                        
02/24    House intro - 1st rdg - to printing
02/25    Rpt prt - to Bus
03/03    Rpt out - rec d/p - to 2nd rdg
03/04    2nd rdg - to 3rd rdg
03/05    To Gen Ord
03/10    Rpt out amen - to engros
03/11    Rpt engros - 1st rdg - to 2nd rdg as amen
03/12    2nd rdg - to 3rd rdg as amen
    Rls susp - PASSED - 66-1-3
      AYES -- Andersen, Barraclough, Barrett, Bauer, Bayer, Bedke, Bell,
      Black, Block, Boe, Bolz, Campbell, Cannon, Clark, Collins, Crow,
      Cuddy, Deal, Denney, Douglas, Eberle, Edmunson, Ellsworth, Eskridge,
      Field(18), Field(23), Gagner, Garrett, Harwood, Jaquet, Jones,
      Kellogg, Kulczyk, Lake, Langhorst, Martinez, McKague, Meyer, Miller,
      Mitchell, Moyle, Naccarato, Nielsen, Pasley-Stuart, Raybould,
      Ridinger, Ring, Ringo, Roberts, Robison, Rydalch, Sali, Sayler,
      Schaefer, Shepherd, Shirley, Skippen, Smith(30), Smith(24), Smylie,
      Snodgrass, Stevenson, Trail, Wills, Wood, Mr. Speaker
      NAYS -- Langford
      Absent and excused -- Bradford, Henbest, McGeachin
    Floor Sponsor - Gagner
    Title apvd - to Senate
03/15    Senate intro - 1st rdg - to Com/HuRes

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                                     HOUSE BILL NO. 757
                                                                        
                                 BY STATE AFFAIRS COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO HEALTH CARE INSURANCE; AMENDING CHAPTER 6, TITLE 48,  IDAHO  CODE,
  3        BY  THE  ADDITION OF A NEW SECTION 48-650, IDAHO CODE, TO REQUIRE A NOTICE
  4        BY HEALTH CARE PROVIDERS, TO SPECIFY CONTENT OF  THE  NOTICE,  TO  PROVIDE
  5        EXCEPTIONS  AND  TO  DEFINE TERMS; AND AMENDING CHAPTER 1, TITLE 41, IDAHO
  6        CODE, BY THE ADDITION OF A NEW SECTION  41-121,  IDAHO  CODE,  TO  REQUIRE
  7        MAINTENANCE  OF  AN  INTERNET  SITE  AND/OR  TOLL-FREE TELEPHONE NUMBER BY
  8        INSURANCE PROVIDERS WITH CURRENT HEALTH CARE PROVIDER INFORMATION.
                                                                        
  9    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 10        SECTION 1.  That Chapter 6, Title 48, Idaho Code,  be,  and  the  same  is
 11    hereby  amended by the addition thereto of a NEW SECTION, to be known and des-
 12    ignated as Section 48-650, Idaho Code, and to read as follows:
                                                                        
 13        48-650.  NOTICE BY  HEALTH  CARE  PROVIDERS.  (1)  Health  care  providers
 14    including,  but  not limited to, hospitals, skilled nursing facilities, physi-
 15    cians and other health care professionals licensed or otherwise authorized  to
 16    provide  health  care  services,  prior to the initial delivery of health care
 17    services to a patient, shall provide to the patient  or  the  patient's  legal
 18    representative written notice of the following:
 19        (a)  Whether  the  health  care  provider  participates with the patient's
 20        insurer, and on some of their plans accepts  the  insurer's  reimbursement
 21        for  covered  health  care  services as payment in full after deductibles,
 22        coinsurance or copayments that are the patient's  responsibility  pursuant
 23        to the patient's contract with the insurer;
 24        (b)  If  the health care provider is not a participating provider with the
 25        patient's insurer, whether the health care provider will bill the  patient
 26        for  charges  for health care services in excess of the insurer's payment;
 27        and
 28        (c)  Whether the health care provider will charge the patient interest  on
 29        the unpaid balance and the annual rate of interest that will be charged.
 30        (2)  After  the  initial delivery of health care services to a patient, if
 31    the health care  provider's  status  as  a  participating  provider  with  the
 32    patient's insurer changes to nonparticipating, or if the patient provides doc-
 33    umentation  to  the health care provider of a change in the patient's insurer,
 34    before the delivery of additional health care services  to  the  patient,  the
 35    health  care provider shall provide to the patient or the patient's legal rep-
 36    resentative written notice as required in subsection (1) of this section.
 37        (3)  The written notice shall inform the patient that many  insurers  pro-
 38    vide  more  than one (1) insurance product and may have multiple provider net-
 39    works. It shall notify the patient to contact the insurer  to  verify  whether
 40    the  patient  has insurance coverage for the provider's services or to inquire
 41    with the provider to ascertain whether the provider is within the  network  in
 42    which  the patient has insurance coverage. The notice also shall provide space
 43    for the patient to sign and acknowledge delivery of the notice.
                                                                        
                                           2
                                                                        
  1        (4)  A health care provider shall not be required to provide  the  written
  2    notice required by this section prior to the delivery of emergency health care
  3    services  to  a  patient,  however, the health care provider shall provide the
  4    notice to the patient or the patient's legal representative as soon thereafter
  5    as is practical.
  6        (5)  This section shall not apply to indirect health  care  providers  who
  7    provide  services  for the use of other health care providers who in turn pro-
  8    vide  services  directly  to  a  patient,  including,  but  not  limited   to,
  9    anesthesiologists, radiologists and pathologists.
 10        (6)  A  health  care  provider who does not provide the notice required by
 11    this section shall not bill the patient for charges in excess of  the  payment
 12    by  the  insurer  (if  not  paid  directly  to the provider) and the patient's
 13    responsibility for payment  of  deductible  and  copayments  pursuant  to  the
 14    patient's contract with the patient's insurer.
 15        (7)  As  used in this section, "insurer" means any insurer that sells hos-
 16    pital, medical, long-term care, dental or vision insurance policies or certif-
 17    icates, a subscriber contract provided by a hospital or  professional  service
 18    corporation  and  managed care organizations. "Insurer" does not include poli-
 19    cies or certificates of insurance for specific disease,  hospital  confinement
 20    indemnity,  accident-only,  credit,  medicare  supplement,  disability  income
 21    insurance,  student  health  benefits  only coverage issued as a supplement to
 22    liability insurance, worker's compensation or  similar  insurance,  automobile
 23    medical  payment  insurance  or  nonrenewable short-term coverage issued for a
 24    period of twelve (12) months or less.
                                                                        
 25        SECTION 2.  That Chapter 1, Title 41, Idaho Code,  be,  and  the  same  is
 26    hereby  amended by the addition thereto of a NEW SECTION, to be known and des-
 27    ignated as Section 41-121, Idaho Code, and to read as follows:
                                                                        
 28        41-121.  PROVISIONS GOVERNING  CONTRACT  PROVIDER  INFORMATION.  (1)  Each
 29    health  insurance carrier or third party administrator offering a contract for
 30    insurance or the administration of benefits in this  state  shall  maintain  a
 31    site on the internet and/or a toll-free telephone number which provides access
 32    to  a  current  and  complete directory of all contracting providers and other
 33    health care professionals. This information shall be updated at the  first  of
 34    each month.
 35        (2)  The health insurance carrier or third party administrator shall regu-
 36    larly  include the internet address and the toll-free telephone number provid-
 37    ing access to a current list of contracting providers and  other  health  care
 38    professionals  with  their regular informational mailings and written explana-
 39    tions of benefits.

Amendment


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                                                        
                                                                        
                                                     Moved by    Gagner              
                                                                        
                                                     Seconded by Black               
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                              HOUSE AMENDMENT TO H.B. NO. 757
                                                                        
  1                               AMENDMENTS TO SECTION 1
  2        On page 1 of the printed bill, in line 14,   delete  "including,  but  not
  3    limited  to, hospitals, skilled nursing facilities," and insert: "such as"; in
  4    line 19, delete "Whether" and insert: "The principal insurers with which", and
  5    also in line 19, delete "with the patient's"; in line 20,  delete  "insurer,";
  6    following line 23, insert:
  7        "(b)  If  asked,  the  health  care provider shall use its best efforts to
  8        inform the patient whether the health care provider participates with  the
  9        patient's insurer;";
 10    in  line  24, delete "(b)" and insert: "(c)"; and in line 28, delete "(c)" and
 11    insert: "(d)".

Engrossed Bill (Original Bill with Amendment(s) Incorporated)


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                               HOUSE BILL NO. 757, As Amended
                                                                        
                                 BY STATE AFFAIRS COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO HEALTH CARE INSURANCE; AMENDING CHAPTER 6, TITLE 48,  IDAHO  CODE,
  3        BY  THE  ADDITION OF A NEW SECTION 48-650, IDAHO CODE, TO REQUIRE A NOTICE
  4        BY HEALTH CARE PROVIDERS, TO SPECIFY CONTENT OF  THE  NOTICE,  TO  PROVIDE
  5        EXCEPTIONS  AND  TO  DEFINE TERMS; AND AMENDING CHAPTER 1, TITLE 41, IDAHO
  6        CODE, BY THE ADDITION OF A NEW SECTION  41-121,  IDAHO  CODE,  TO  REQUIRE
  7        MAINTENANCE  OF  AN  INTERNET  SITE  AND/OR  TOLL-FREE TELEPHONE NUMBER BY
  8        INSURANCE PROVIDERS WITH CURRENT HEALTH CARE PROVIDER INFORMATION.
                                                                        
  9    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 10        SECTION 1.  That Chapter 6, Title 48, Idaho Code,  be,  and  the  same  is
 11    hereby  amended by the addition thereto of a NEW SECTION, to be known and des-
 12    ignated as Section 48-650, Idaho Code, and to read as follows:
                                                                        
 13        48-650.  NOTICE BY HEALTH CARE PROVIDERS. (1) Health care  providers  such
 14    as physicians and other health care professionals licensed or otherwise autho-
 15    rized to provide health care services, prior to the initial delivery of health
 16    care  services  to  a  patient,  shall provide to the patient or the patient's
 17    legal representative written notice of the following:
 18        (a)  The principal insurers with which the health care  provider  partici-
 19        pates   and on some of their plans accepts the insurer's reimbursement for
 20        covered health care services as payment in full after  deductibles,  coin-
 21        surance  or  copayments  that are the patient's responsibility pursuant to
 22        the patient's contract with the insurer;
 23        (b)  If asked, the health care provider shall  use  its  best  efforts  to
 24        inform  the patient whether the health care provider participates with the
 25        patient's insurer;
 26        (c)  If the health care provider is not a participating provider with  the
 27        patient's  insurer, whether the health care provider will bill the patient
 28        for charges for health care services in excess of the  insurer's  payment;
 29        and
 30        (d)  Whether  the health care provider will charge the patient interest on
 31        the unpaid balance and the annual rate of interest that will be charged.
 32        (2)  After the initial delivery of health care services to a  patient,  if
 33    the  health  care  provider's  status  as  a  participating  provider with the
 34    patient's insurer changes to nonparticipating, or if the patient provides doc-
 35    umentation to the health care provider of a change in the  patient's  insurer,
 36    before  the  delivery  of  additional health care services to the patient, the
 37    health care provider shall provide to the patient or the patient's legal  rep-
 38    resentative written notice as required in subsection (1) of this section.
 39        (3)  The  written  notice shall inform the patient that many insurers pro-
 40    vide more than one (1) insurance product and may have multiple  provider  net-
 41    works.  It  shall  notify the patient to contact the insurer to verify whether
 42    the patient has insurance coverage for the provider's services or  to  inquire
 43    with  the  provider to ascertain whether the provider is within the network in
                                                                        
                                           2
                                                                        
  1    which the patient has insurance coverage. The notice also shall provide  space
  2    for the patient to sign and acknowledge delivery of the notice.
  3        (4)  A  health  care provider shall not be required to provide the written
  4    notice required by this section prior to the delivery of emergency health care
  5    services to a patient, however, the health care  provider  shall  provide  the
  6    notice to the patient or the patient's legal representative as soon thereafter
  7    as is practical.
  8        (5)  This  section  shall  not apply to indirect health care providers who
  9    provide services for the use of other health care providers who in  turn  pro-
 10    vide   services  directly  to  a  patient,  including,  but  not  limited  to,
 11    anesthesiologists, radiologists and pathologists.
 12        (6)  A health care provider who does not provide the  notice  required  by
 13    this  section  shall not bill the patient for charges in excess of the payment
 14    by the insurer (if not paid  directly  to  the  provider)  and  the  patient's
 15    responsibility  for  payment  of  deductible  and  copayments  pursuant to the
 16    patient's contract with the patient's insurer.
 17        (7)  As used in this section, "insurer" means any insurer that sells  hos-
 18    pital, medical, long-term care, dental or vision insurance policies or certif-
 19    icates,  a  subscriber contract provided by a hospital or professional service
 20    corporation and managed care organizations. "Insurer" does not  include  poli-
 21    cies  or  certificates of insurance for specific disease, hospital confinement
 22    indemnity,  accident-only,  credit,  medicare  supplement,  disability  income
 23    insurance, student health benefits only coverage issued  as  a  supplement  to
 24    liability  insurance,  worker's  compensation or similar insurance, automobile
 25    medical payment insurance or nonrenewable short-term  coverage  issued  for  a
 26    period of twelve (12) months or less.
                                                                        
 27        SECTION  2.  That  Chapter  1,  Title  41, Idaho Code, be, and the same is
 28    hereby amended by the addition thereto of a NEW SECTION, to be known and  des-
 29    ignated as Section 41-121, Idaho Code, and to read as follows:
                                                                        
 30        41-121.  PROVISIONS  GOVERNING  CONTRACT  PROVIDER  INFORMATION.  (1) Each
 31    health insurance carrier or third party administrator offering a contract  for
 32    insurance  or  the  administration  of benefits in this state shall maintain a
 33    site on the internet and/or a toll-free telephone number which provides access
 34    to a current and complete directory of all  contracting  providers  and  other
 35    health  care  professionals. This information shall be updated at the first of
 36    each month.
 37        (2)  The health insurance carrier or third party administrator shall regu-
 38    larly include the internet address and the toll-free telephone number  provid-
 39    ing  access  to  a current list of contracting providers and other health care
 40    professionals with their regular informational mailings and  written  explana-
 41    tions of benefits.

Statement of Purpose / Fiscal Impact


                       STATEMENT OF PURPOSE

                             RS 14144

After medical treatment, patients often learn that their doctor
or hospital has not contracted with their insurance provider. As
a result, they are often faced with the "balance of the bill" out
of their own funds. This bill will provide a disclosure to the
patient at time of initial contact by the health care provider as
to whether they contract with the insurer.
If the disclosure is not signed, the health care provider will
not be able to "balance bill."




                          FISCAL IMPACT



There is no fiscal impact to the General Fund.



Contact
Name:   Representative Lee Gagner
Phone: 332-1000

STATEMENT OF PURPOSE/FISCAL NOTE                     H 757