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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
]]]] 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.
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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