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 Section 19a-508c of the general statutes is repealed and the 1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