2004 Legislation
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HOUSE BILL NO. 710 – Emergency services, reimbursement

HOUSE BILL NO. 710

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Bill Status



H0710...........................................................by BUSINESS
EMERGENCY SERVICES - Amends existing law to provide for the reimbursement
of emergency services; to provide application; and to define terms.
                                                                        
02/16    House intro - 1st rdg - to printing
02/17    Rpt prt - to Bus

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                                     HOUSE BILL NO. 710
                                                                        
                                   BY BUSINESS COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO EMERGENCY SERVICES; AMENDING CHAPTER 18, TITLE 41, IDAHO CODE,  BY
  3        THE  ADDITION  OF  A  NEW  SECTION 41-1846, IDAHO CODE, TO PROVIDE FOR THE
  4        REIMBURSEMENT OF EMERGENCY SERVICES, TO PROVIDE APPLICATION AND TO  DEFINE
  5        TERMS.
                                                                        
  6    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
  7        SECTION  1.  That  Chapter  18,  Title 41, Idaho Code, be, and the same is
  8    hereby amended by the addition thereto of a NEW SECTION, to be known and  des-
  9    ignated as Section 41-1846, Idaho Code, and to read as follows:
                                                                        
 10        41-1846.  REIMBURSEMENT  FOR  EMERGENCY SERVICES. (1) All medically neces-
 11    sary covered emergency services provided in a hospital to an individual who is
 12    unable to reasonably reach a participating provider, where  such  hospital  is
 13    contracted  with  the  individual's carrier, insurer or managed care organiza-
 14    tion, shall be reimbursed by the carrier, insurer or managed care organization
 15    to the patient at a benefit level as if the covered services were provided  by
 16    a  participating  provider  until  the member can reasonably be expected to be
 17    treated by a participating provider.
 18        (2)  All medically necessary covered services that are provided in a  hos-
 19    pital  by  a  nonparticipating provider to provide continuity of care during a
 20    brief transition period from emergency services, where such hospital  is  con-
 21    tracted with the member's carrier, insurer or managed care organization, shall
 22    be  reimbursed  by  the  carrier,  insurer or managed care organization to the
 23    patient at a benefit level as if the covered services were provided by a  par-
 24    ticipating  provider until the member can reasonably be expected to be treated
 25    by a participating provider.
 26        (3)  A nonparticipating provider shall neither bill nor require a  patient
 27    to  pay  for  medically  necessary covered emergency services in excess of the
 28    patient's deductible, copayment or coinsurance obligations, provided the  cov-
 29    ered  emergency  services  are reimbursed at a benefit level as if the covered
 30    services were provided by a participating provider.
 31        (4)  The provisions of this section shall be  applicable  only  for  those
 32    carriers,  insurers  or  managed care organizations offering plans or policies
 33    under chapter 21, 22, 39, 47 or 52, title 41, Idaho Code.
 34        (5)  As used in this section:
 35        (a)  "Emergency services" means those health care services that  are  pro-
 36        vided  in  a  hospital  after the sudden onset of a medical condition that
 37        manifests itself by symptoms of sufficient  severity  including,  but  not
 38        limited  to,  severe pain, that the absence of immediate medical attention
 39        could reasonably be expected by a prudent person who possesses an  average
 40        knowledge of health and medicine, to result in:
 41             (i)   Placing the patient's health in serious jeopardy;
 42             (ii)  Serious impairment to bodily functions; or
 43             (iii) Serious dysfunction of any bodily organ or part.
                                                                        
                                           2
                                                                        
  1        (b)  "Hospital"  means a facility in Idaho licensed under sections 39-1301
  2        through 39-1314, Idaho Code, and defined in section  39-1301(a)(1),  Idaho
  3        Code.

Statement of Purpose / Fiscal Impact


                      STATEMENT OF PURPOSE
                            RS 14045
                                
When a patient seeks emergency treatment at a hospital that
contracts with the patient's health insurance carrier, there is no
guarantee that the patient will receive that emergency care from
providers and other health care professionals who contract with the
patient's health insurance company.  When a patient acts in good
faith to seek emergency treatment at a contracting hospital, the
patient should not be penalized financially with potentially large
balance bills from non-contracting providers and other health
professionals.

This bill would require that if a health care provider or other
health care professional who does not contract with a health
insurance carrier renders emergency or post-stabilization service
to a patient in a hospital that contracts with that health
insurance carrier, the health care provider or other health care
professional shall collect from the health insurance carrier only
the amount paid to contracted providers for the same services, and
from the patient, any applicable coinsurance, co-pay or deductible
or any charges for non-covered services.
                                
                          FISCAL NOTE
None.



Contact:  Rep. Max Black
          332-1000
          
STATEMENT OF PURPOSE/FISCAL NOTE                    H 710