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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
]]]] 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 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