2007 Legislation
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HOUSE BILL NO. 138 – Emergency services, reimbursement

HOUSE BILL NO. 138

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Bill Status



H0138...........................................................by BUSINESS
EMERGENCY SERVICES - Adds to existing law to provide for the reimbursement
of emergency services; to provide application; and to define terms.
                                                                        
02/08    House intro - 1st rdg - to printing
02/09    Rpt prt - to Health/Wel

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-ninth Legislature                   First Regular Session - 2007
                                                                        
                                                                        
                              IN THE HOUSE OF REPRESENTATIVES
                                                                        
                                     HOUSE BILL NO. 138
                                                                        
                                   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 41-1847, 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 41-1847, Idaho Code, and to read as follows:
                                                                        
 10        41-1847.  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, managed care organization
 14    or self-funded plan, shall be reimbursed by the carrier, insurer, managed care
 15    organization or self-funded plan to the patient at a benefit level as  if  the
 16    covered  services  were  provided by a participating provider until the member
 17    can reasonably be expected to be 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, managed care organization or self-
 22    funded plan, shall be reimbursed by the carrier, insurer, managed care organi-
 23    zation or self-funded plan to the patient at a benefit level as if the covered
 24    services  were  provided by a participating provider until the member can rea-
 25    sonably be expected to be treated 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,  managed care organizations or self-funded plans offering
 33    plans or policies under chapter 21, 22, 39, 40, 41, 47 or 52, title 41,  Idaho
 34    Code.
 35        (5)  As used in this section:
 36        (a)  "Emergency  services"  means those health care services that are pro-
 37        vided in a hospital after the sudden onset of  a  medical  condition  that
 38        manifests  itself  by  symptoms  of sufficient severity including, but not
 39        limited to, severe pain, that the absence of immediate  medical  attention
 40        could  reasonably be expected by a prudent person who possesses an average
 41        knowledge of health and medicine, to result in:
 42             (i)   Placing the patient's health in serious jeopardy;
 43             (ii)  Serious impairment to bodily functions; or
                                                                        
                                       2
                                                                        
  1             (iii) Serious dysfunction of any bodily organ or part.
  2        (b)  "Hospital" means a facility in Idaho licensed under sections  39-1301
  3        through  39-1314,  Idaho Code, and defined in section 39-1301(a)(1), Idaho
  4        Code.

Statement of Purpose / Fiscal Impact


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                      STATEMENT OF PURPOSE

                            RS 16929

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
Name:     Rep. Carlos Bilbao            332-1000
          Rep. Tom Loertscher
          Sen. John Andreason



STATEMENT OF PURPOSE/FISCAL NOTE                             H 138