Connecticut 2020 Regular Session

Connecticut House Bill HB05487 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
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4	4	LCO No. 2638 1 of 11
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6	6	General Assembly Raised Bill No. 5487
7	7	February Session, 2020
8	8	LCO No. 2638
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11	11	Referred to Committee on PUBLIC HEALTH
12	12
13	13
14	14	Introduced by:
15	15	(PH)
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18	18
19	19
20	20	AN ACT CONCERNING TH E OFFICE OF HEALTH STRATEGY'S
21	21	RECOMMENDATIONS REGA RDING VARIOUS REVISIONS TO
22	22	HOSPITAL OR HEALTH S YSTEM FACILITY FEES.
23	23	Be it enacted by the Senate and House of Representatives in General
24	24	Assembly convened:
25	25
26	26	Section 1. Section 19a-508c of the general statutes is repealed and the 1
27	27	following is substituted in lieu thereof (Effective from passage): 2
28	28	(a) As used in this section: 3
29	29	(1) "Affiliated provider" means a provider that is: (A) Employed by a 4
30	30	hospital or health system, (B) under a professional services agreement 5
31	31	with a hospital or health system that permits such hospital or health 6
32	32	system to bill on behalf of such provider, or (C) a clinical faculty member 7
33	33	of a medical school, as defined in section 33-182aa, that is affiliated with 8
34	34	a hospital or health system in a manner that permits such hospital or 9
35	35	health system to bill on behalf of such clinical faculty member; 10
36	36	(2) "Campus" means: (A) The physical area immediately adjacent to a 11
37	37	hospital's main buildings and other areas and structures that are not 12
38	38	strictly contiguous to the main buildings but are located within two 13 Raised Bill No. 5487
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41	41
42	42	LCO No. 2638 2 of 11
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44	44	hundred fifty yards of the main buildings, or (B) any other area that has 14
45	45	been determined on an individual case basis by the Centers for Medicare 15
46	46	and Medicaid Services to be part of a hospital's campus; 16
47	47	(3) "Facility fee" means any fee charged or billed by a hospital or 17
48	48	health system for outpatient services provided in a hospital-based 18
49	49	facility that is: (A) Intended to compensate the hospital or health system 19
50	50	for the operational expenses of the hospital or health system, and (B) 20
51	51	separate and distinct from a professional fee; 21
52	52	(4) "Health system" means: (A) A parent corporation of one or more 22
53	53	hospitals and any entity affiliated with such parent corporation through 23
54	54	ownership, governance, membership or other means, or (B) a hospital 24
55	55	and any entity affiliated with such hospital through ownership, 25
56	56	governance, membership or other means; 26
57	57	(5) "Hospital" has the same meaning as provided in section 19a-490; 27
58	58	(6) "Hospital-based facility" means a facility that is owned or 28
59	59	operated, in whole or in part, by a hospital or health system where 29
60	60	hospital or professional medical services are provided; 30
61	61	(7) "Payer mix" means the proportion of different sources of payment 31
62	62	received by a hospital or health system, including, but not limited to, 32
63	63	Medicare, Medicaid, other government-provided insurance, private 33
64	64	insurance and self-pay patients; 34
65	65	[(7)] (8) "Professional fee" means any fee charged or billed by a 35
66	66	provider for professional medical services provided in a hospital-based 36
67	67	facility; and 37
68	68	[(8)] (9) "Provider" means an individual, entity, corporation or health 38
69	69	care provider, whether for profit or nonprofit, whose primary purpose 39
70	70	is to provide professional medical services. 40
71	71	(b) If a hospital or health system charges a facility fee utilizing a 41
72	72	current procedural terminology evaluation and management (CPT 42
73	73	E/M) code for outpatient services provided at a hospital-based facility 43 Raised Bill No. 5487
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77	77	LCO No. 2638 3 of 11
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79	79	where a professional fee is also expected to be charged, the hospital or 44
80	80	health system shall provide the patient with a written notice that 45
81	81	includes the following information: 46
82	82	(1) That the hospital-based facility is part of a hospital or health 47
83	83	system and that the hospital or health system charges a facility fee that 48
84	84	is in addition to and separate from the professional fee charged by the 49
85	85	provider; 50
86	86	(2) (A) The amount of the patient's potential financial liability, 51
87	87	including any facility fee likely to be charged, and, where professional 52
88	88	medical services are provided by an affiliated provider, any professional 53
89	89	fee likely to be charged, or, if the exact type and extent of the 54
90	90	professional medical services needed are not known or the terms of a 55
91	91	patient's health insurance coverage are not known with reasonable 56
92	92	certainty, an estimate of the patient's financial liability based on typical 57
93	93	or average charges for visits to the hospital-based facility, including the 58
94	94	facility fee, (B) a statement that the patient's actual financial liability will 59
95	95	depend on the professional medical services actually provided to the 60
96	96	patient, (C) an explanation that the patient may incur financial liability 61
97	97	that is greater than the patient would incur if the professional medical 62
98	98	services were not provided by a hospital-based facility, and (D) a 63
99	99	telephone number the patient may call for additional information 64
100	100	regarding such patient's potential financial liability, including an 65
101	101	estimate of the facility fee likely to be charged based on the scheduled 66
102	102	professional medical services; and 67
103	103	(3) That a patient covered by a health insurance policy should contact 68
104	104	the health insurer for additional information regarding the hospital's or 69
105	105	health system's charges and fees, including the patient's potential 70
106	106	financial liability, if any, for such charges and fees. 71
107	107	(c) If a hospital or health system charges a facility fee without 72
108	108	utilizing a current procedural terminology evaluation and management 73
109	109	(CPT E/M) code for outpatient services provided at a hospital-based 74
110	110	facility, located outside the hospital campus, the hospital or health 75 Raised Bill No. 5487
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114	114	LCO No. 2638 4 of 11
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116	116	system shall provide the patient with a written notice that includes the 76
117	117	following information: 77
118	118	(1) That the hospital-based facility is part of a hospital or health 78
119	119	system and that the hospital or health system charges a facility fee that 79
120	120	may be in addition to and separate from the professional fee charged by 80
121	121	a provider; 81
122	122	(2) (A) A statement that the patient's actual financial liability will 82
123	123	depend on the professional medical services actually provided to the 83
124	124	patient, (B) an explanation that the patient may incur financial liability 84
125	125	that is greater than the patient would incur if the hospital-based facility 85
126	126	was not hospital-based, and (C) a telephone number the patient may call 86
127	127	for additional information regarding such patient's potential financial 87
128	128	liability, including an estimate of the facility fee likely to be charged 88
129	129	based on the scheduled professional medical services; and 89
130	130	(3) That a patient covered by a health insurance policy should contact 90
131	131	the health insurer for additional information regarding the hospital's or 91
132	132	health system's charges and fees, including the patient's potential 92
133	133	financial liability, if any, for such charges and fees. 93
134	134	(d) [On and after January 1, 2016, each] Each initial billing statement 94
135	135	that includes a facility fee shall: (1) Clearly identify the fee as a facility 95
136	136	fee that is billed in addition to, or separately from, any professional fee 96
137	137	billed by the provider; (2) provide the corresponding Medicare facility 97
138	138	fee reimbursement rate for the same service as a comparison or, if there 98
139	139	is no corresponding Medicare facility fee for such service, (A) the 99
140	140	approximate amount Medicare would have paid the hospital for the 100
141	141	facility fee on the billing statement, or (B) the percentage of the hospital's 101
142	142	charges that Medicare would have paid the hospital for the facility fee; 102
143	143	(3) include a statement that the facility fee is intended to cover the 103
144	144	hospital's or health system's operational expenses; (4) inform the patient 104
145	145	that the patient's financial liability may have been less if the services had 105
146	146	been provided at a facility not owned or operated by the hospital or 106
147	147	health system; and (5) include written notice of the patient's right to 107 Raised Bill No. 5487
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151	151	LCO No. 2638 5 of 11
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153	153	request a reduction in the facility fee or any other portion of the bill and 108
154	154	a telephone number that the patient may use to request such a reduction 109
155	155	without regard to whether such patient qualifies for, or is likely to be 110
156	156	granted, any reduction. Not later than October 1, 2020, and annually 111
157	157	thereafter, each hospital, health system and hospital-based facility shall 112
158	158	submit to the Health Planning Unit of the Office of Health Strategy a 113
159	159	sample of a billing statement issued by such hospital, health system or 114
160	160	hospital-based facility that complies with the provisions of this 115
161	161	subsection and which represents the format of billing statements 116
162	162	received by patients. Such billing statement shall not contain patient 117
163	163	identifying information. 118
164	164	(e) The written notice described in subsections (b) to (d), inclusive, 119
165	165	and (h) to (j), inclusive, of this section shall be in plain language and in 120
166	166	a form that may be reasonably understood by a patient who does not 121
167	167	possess special knowledge regarding hospital or health system facility 122
168	168	fee charges. On and after October 1, 2020, such notices shall be printed 123
169	169	in at least the top fifteen languages spoken in the state, as determined 124
170	170	by statistics prepared by the United States Census Bureau, based on the 125
171	171	most recent decennial census. 126
172	172	(f) (1) For nonemergency care, if a patient's appointment is scheduled 127
173	173	to occur ten or more days after the appointment is made, such written 128
174	174	notice shall be sent to the patient by first class mail, encrypted electronic 129
175	175	mail or a secure patient Internet portal not less than three days after the 130
176	176	appointment is made. If an appointment is scheduled to occur less than 131
177	177	ten days after the appointment is made or if the patient arrives without 132
178	178	an appointment, such notice shall be hand-delivered to the patient when 133
179	179	the patient arrives at the hospital-based facility. 134
180	180	(2) For emergency care, such written notice shall be provided to the 135
181	181	patient as soon as practicable after the patient is stabilized in accordance 136
182	182	with the federal Emergency Medical Treatment and Active Labor Act, 137
183	183	42 USC 1395dd, as amended from time to time, or is determined not to 138
184	184	have an emergency medical condition and before the patient leaves the 139
185	185	hospital-based facility. If the patient is unconscious, under great duress 140 Raised Bill No. 5487
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189	189	LCO No. 2638 6 of 11
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191	191	or for any other reason unable to read the notice and understand and 141
192	192	act on his or her rights, the notice shall be provided to the patient's 142
193	193	representative as soon as practicable. 143
194	194	(g) Subsections (b) to (f), inclusive, and (l) of this section shall not 144
195	195	apply if a patient is insured by Medicare or Medicaid or is receiving 145
196	196	services under a workers' compensation plan established to provide 146
197	197	medical services pursuant to chapter 568. 147
198	198	(h) A hospital-based facility shall prominently display written notice 148
199	199	in locations that are readily accessible to and visible by patients, 149
200	200	including patient waiting or appointment check-in areas, stating: (1) 150
201	201	That the hospital-based facility is part of a hospital or health system, (2) 151
202	202	the name of the hospital or health system, and (3) that if the hospital-152
203	203	based facility charges a facility fee, the patient may incur a financial 153
204	204	liability greater than the patient would incur if the hospital-based 154
205	205	facility was not hospital-based. On and after October 1, 2020, each such 155
206	206	written notice shall be printed in at least the top fifteen languages 156
207	207	spoken in the state, as determined by statistics prepared by the United 157
208	208	States Census Bureau, based on the most recent decennial census. Not 158
209	209	later than October 1, 2020, and annually thereafter, each hospital-based 159
210	210	facility shall submit a copy of the written notice required by this 160
211	211	subsection to the Health Systems Planning Unit of the Office of Health 161
212	212	Strategy. 162
213	213	(i) A hospital-based facility shall clearly hold itself out to the public 163
214	214	and payers as being hospital-based, including, at a minimum, by stating 164
215	215	the name of the hospital or health system in its signage, marketing 165
216	216	materials, Internet web sites and stationery. 166
217	217	(j) A hospital-based facility shall, when scheduling services for which 167
218	218	a facility fee may be charged, inform the patient (1) that the hospital-168
219	219	based facility is part of a hospital or health system, (2) of the name of the 169
220	220	hospital or health system, (3) that the hospital or health system may 170
221	221	charge a facility fee in addition to and separate from the professional fee 171
222	222	charged by the provider, and (4) of the telephone number the patient 172 Raised Bill No. 5487
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226	226	LCO No. 2638 7 of 11
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228	228	may call for additional information regarding such patient's potential 173
229	229	financial liability. 174
230	230	(k) (1) [On and after January 1, 2016, if any transaction, as] If any 175
231	231	transaction described in subsection (c) of section 19a-486i, results in the 176
232	232	establishment of a hospital-based facility at which facility fees [will 177
233	233	likely] may be billed, the hospital or health system, that is the purchaser 178
234	234	in such transaction shall, not later than thirty days after such transaction, 179
235	235	provide written notice, by first class mail, of the transaction to each 180
236	236	patient served within the [previous] three years preceding the date of 181
237	237	the transaction by the health care facility that has been purchased as part 182
238	238	of such transaction. On and after January 1, 2021, such hospital or health 183
239	239	system shall, not later than thirty days after such transaction, provide 184
240	240	written notice by first class mail, or any other method that provides 185
241	241	individual notice, to each patient served within the three years 186
242	242	preceding the date of the transaction by the health care facility that has 187
243	243	been purchased as part of such transaction. 188
244	244	(2) Such notice shall include the following information: 189
245	245	(A) A statement that the health care facility is now a hospital-based 190
246	246	facility and is part of a hospital or health system, the health care facility's 191
247	247	full legal and business name and the date of such facility's acquisition 192
248	248	by a hospital or health system; 193
249	249	(B) The name, business address and phone number of the hospital or 194
250	250	health system that is the purchaser of the health care facility; 195
251	251	(C) A statement that the hospital-based facility bills, or is likely to bill, 196
252	252	patients a facility fee that may be in addition to, and separate from, any 197
253	253	professional fee billed by a health care provider at the hospital-based 198
254	254	facility; 199
255	255	(D) (i) A statement that the patient's actual financial liability will 200
256	256	depend on the professional medical services actually provided to the 201
257	257	patient, and (ii) an explanation that the patient may incur financial 202
258	258	liability that is greater than the patient would incur if the hospital-based 203 Raised Bill No. 5487
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261	261
262	262	LCO No. 2638 8 of 11
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264	264	facility were not a hospital-based facility; 204
265	265	(E) The estimated amount or range of amounts the hospital-based 205
266	266	facility may bill for a facility fee or an example of the average facility fee 206
267	267	billed at such hospital-based facility for the most common services 207
268	268	provided at such hospital-based facility; and 208
269	269	(F) A statement that, prior to seeking services at such hospital-based 209
270	270	facility, a patient covered by a health insurance policy should contact 210
271	271	the patient's health insurer for additional information regarding the 211
272	272	hospital-based facility fees, including the patient's potential financial 212
273	273	liability, if any, for such fees. 213
274	274	(3) A copy of the written notice provided to patients in accordance 214
275	275	with this subsection shall be filed with the Health Systems Planning 215
276	276	Unit of the Office of Health Strategy, established under section 19a-612. 216
277	277	Said unit shall post a link to such notice on its Internet web site. 217
278	278	(4) A hospital, health system or hospital-based facility shall not collect 218
279	279	a facility fee for services provided at a hospital-based facility that is 219
280	280	subject to the provisions of this subsection from the date of the 220
281	281	transaction until at least thirty days after the written notice required 221
282	282	pursuant to this subsection is mailed to the patient or a copy of such 222
283	283	notice is filed with the Health Systems Planning Unit, whichever is later. 223
284	284	A violation of this subsection shall be considered an unfair trade 224
285	285	practice pursuant to section 42-110b. 225
286	286	(5) Not later than July 1, 2021, and annually thereafter, each hospital-226
287	287	based facility that was the subject of a transaction, as described in 227
288	288	subsection (c) of section 19a-486i, during the preceding calendar year 228
289	289	shall report to the Health Systems Planning Unit the number of patients 229
290	290	served by such hospital-based facility in the preceding three years, the 230
291	291	number of patients notified in accordance with the provisions of this 231
292	292	subsection and the types of delivery methods used to notify such 232
293	293	patients, the number of patients that were notified by each delivery 233
294	294	method and the date or dates such notifications were sent. 234 Raised Bill No. 5487
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298	298	LCO No. 2638 9 of 11
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300	300	(l) Notwithstanding the provisions of this section, no hospital, health 235
301	301	system or hospital-based facility shall collect a facility fee for (1) 236
302	302	outpatient health care services that use a current procedural 237
303	303	terminology evaluation and management (CPT E/M) or assessment and 238
304	304	management (CPT A/M) code and are provided at a hospital-based 239
305	305	facility located off-site from a hospital campus, or (2) outpatient health 240
306	306	care services provided at a hospital-based facility located off-site from a 241
307	307	hospital campus, received by a patient who is uninsured of more than 242
308	308	the Medicare rate. Notwithstanding the provisions of this subsection, in 243
309	309	circumstances when an insurance contract that is in effect on July 1, 244
310	310	2016, provides reimbursement for facility fees prohibited under the 245
311	311	provisions of this section, a hospital or health system may continue to 246
312	312	collect reimbursement from the health insurer for such facility fees until 247
313	313	the date of expiration of such contract, except that on and after July 1, 248
314	314	2020, any amendment extending the expiration date of such contract 249
315	315	shall not extend the time a hospital or health system may continue to 250
316	316	collect such reimbursement. A violation of this subsection shall be 251
317	317	considered an unfair trade practice pursuant to chapter 735a. The 252
318	318	provisions of this subsection shall not apply to a freestanding 253
319	319	emergency department. As used in this subsection, "freestanding 254
320	320	emergency department" means a freestanding facility that (A) is 255
321	321	structurally separate and distinct from a hospital, (B) provides 256
322	322	emergency care, (C) is a department of a hospital licensed under chapter 257
323	323	368v, and (D) has been issued a certificate of need to operate as a 258
324	324	freestanding emergency department pursuant to chapter 368z. 259
325	325	(m) (1) Each hospital and health system shall report not later than July 260
326	326	1, 2016, and annually thereafter to the executive director of the Office of 261
327	327	Health Strategy, on a form prescribed by the executive director, 262
328	328	concerning facility fees charged or billed during the preceding calendar 263
329	329	year. Such report shall include (A) the name and [location] address of 264
330	330	each facility owned or operated by the hospital or health system that 265
331	331	provides services for which a facility fee is charged or billed, (B) the 266
332	332	number of patient visits at each such facility for which a facility fee was 267
333	333	charged or billed, (C) the number, total amount and range of allowable 268 Raised Bill No. 5487
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335	335
336	336
337	337	LCO No. 2638 10 of 11
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339	339	facility fees paid at each such facility [by Medicare, Medicaid or under 269
340	340	private insurance policies] disaggregated by payer mix, (D) for each 270
341	341	facility, the total amount of facility fees charged and the total amount of 271
342	342	revenue received by the hospital or health system derived from facility 272
343	343	fees, (E) the total amount of facility fees charged and the total amount of 273
344	344	revenue received by the hospital or health system from all facilities 274
345	345	derived from facility fees, (F) a description of the ten procedures or 275
346	346	services that generated the greatest amount of facility fee gross revenue, 276
347	347	disaggregated by current procedural terminology category (CPT) code 277
348	348	for each such procedure or service and, for each such procedure or 278
349	349	service, patient volume and the total amount of gross and net revenue 279
350	350	received by the hospital or health system derived from facility fees, and 280
351	351	(G) the top ten procedures or services for which facility fees are charged 281
352	352	based on patient volume and the gross and net revenue received by the 282
353	353	hospital or health system for each such procedure or service. For 283
354	354	purposes of this subsection, "facility" means a hospital-based facility 284
355	355	that is located outside a hospital campus. 285
356	356	(2) On and after July 1, 2022, and annually thereafter, each hospital 286
357	357	and health system shall include in the report required under subdivision 287
358	358	(1) of this subsection (A) the number of patients who contacted the 288
359	359	hospital or health system to request a reduction of a facility fee for the 289
360	360	preceding calendar year, disaggregated by payer mix, (B) the number of 290
361	361	such patients who received a reduction of a facility fee, disaggregated 291
362	362	by payer mix, (C) the total amount of facility fees charged to patients 292
363	363	who requested reductions of facility fees, disaggregated by payer mix, 293
364	364	and (D) the total amount of reduced facility fees charged to such 294
365	365	patients, disaggregated by payer mix. 295
366	366	[(2)] (3) The executive director shall publish the information reported 296
367	367	pursuant to subdivision (1) of this subsection, or post a link to such 297
368	368	information, on the Internet web site of the Office of Health Strategy. 298
369	369	This act shall take effect as follows and shall amend the following
370	370	sections:
371	371
372	372	Section 1 from passage 19a-508c Raised Bill No. 5487
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375	375
376	376	LCO No. 2638 11 of 11
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378	378
379	379	Statement of Purpose:
380	380	To make various revisions to hospital or health system facility fees.
381	381	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
382	382	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
383	383	underlined.]
384	384