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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
]]]] 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.
]]]] 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)".
]]]] 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
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