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General Assembly Committee Bill No. 683
January Session, 2021
LCO No. 5644
Referred to Committee on PUBLIC HEALTH
Introduced by:
(PH)
AN ACT CONCERNING HO SPITAL BILLING AND COLLECTION
EFFORTS BY HOSPITALS AND COLLECTION AGENCIES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-673 of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2021): 2
(a) As used in this section: 3
(1) "Collection agent" has the same meaning as provided in section 4
19a-509b. 5
[(1)] (2) "Cost of providing services" means a hospital's published 6
charges at the time of billing, multiplied by the hospital's most recent 7
relationship of costs to charges as taken from the hospital's most recently 8
available annual financial filing with the unit. 9
(3) "High deductible health plan" has the same meaning as provided 10
in Section 220(c)(2) or Section 223(c)(2) of the Internal Revenue Code of 11
1986, or any subsequent corresponding internal revenue code of the 12
United States, as amended from time to time. 13
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[(2)] (4) "Hospital" [means an institution licensed by the Department 14
of Public Health as a short-term general hospital] has the same meaning 15
as provided in section 19a-490. 16
[(3)] (5) "Poverty income guidelines" means the poverty income 17
guidelines issued from time to time by the United States Department of 18
Health and Human Services. 19
(6) "Underinsured patient" means any person who is insured under a 20
high deductible health plan and liable for one or more hospital charges, 21
and whose income is at or below six hundred per cent of the poverty 22
income guidelines. 23
[(4)] (7) "Uninsured patient" means any person who is liable for one 24
or more hospital charges whose income is at or below two hundred fifty 25
per cent of the poverty income guidelines who (A) has applied and been 26
denied eligibility for any medical or health care coverage provided 27
under the Medicaid program due to failure to satisfy income or other 28
eligibility requirements, and (B) is not eligible for coverage for hospital 29
services under the Medicare or CHAMPUS programs, or under any 30
Medicaid or health insurance program of any other nation, state, 31
territory or commonwealth, or under any other governmental or 32
privately sponsored health or accident insurance or benefit program 33
including, but not limited to, workers' compensation and awards, 34
settlements or judgments arising from claims, suits or proceedings 35
involving motor vehicle accidents or alleged negligence. 36
(b) (1) No hospital or entity that is owned by or affiliated with such 37
hospital that has provided health care [services] to an uninsured patient 38
may collect from the uninsured patient more than the cost of providing 39
services. 40
(2) No hospital or entity that is owned by or affiliated with such 41
hospital that has provided health care to an underinsured patient on or 42
after October 1, 2021, may collect from the underinsured patient more 43
than the cost of providing services plus interest at an annual rate that is 44
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not greater than the lesser of: 45
(A) The weekly average one-year constant maturity yield of United 46
States Treasury securities as published by the Board of Governors of the 47
Federal Reserve System for the week preceding the date on which such 48
underinsured patient first receives a bill for such health care if such 49
average is equal to or greater than two per cent per annum; 50
(B) A rate established by the executive director of the Office of Health 51
Strategy, established under section 19a-754, and in effect on the date on 52
which such underinsured patient first receives a bill for such health care 53
if the Board of Governors of the Federal Reserve System discontinues 54
the rate described in subparagraph (A) of this subdivision; or 55
(C) Five per cent. 56
(c) Each collection agent [, as defined in section 19a-509b,] engaged in 57
collecting a debt from a patient arising from [services] health care 58
provided at a hospital shall provide written notice to such patient as to 59
whether the hospital deems the patient an insured patient, 60
underinsured patient or [an] uninsured patient and the reasons for such 61
determination. 62
Sec. 2. Section 19a-673b of the general statutes is repealed and the 63
following is substituted in lieu thereof (Effective October 1, 2021): 64
(a) No hospital, as defined in section 19a-490, or entity that is owned 65
by or affiliated with such hospital shall refer to a collection agent, as 66
defined in section 19a-509b, or initiate an action against an individual 67
patient or such patient's estate to collect fees arising from health care 68
provided at a hospital [on] or entity that is owned by or affiliated with 69
such hospital: 70
(1) On or after October 1, 2003, unless the hospital or entity that is 71
owned by or affiliated with such hospital has [made a determination 72
whether] determined that such individual patient is [(1)] an uninsured 73
patient, as defined in section 19a-673, as amended by this act, [and (2) 74
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not eligible] who is ineligible for the hospital bed fund; [.] or 75
(2) On or after October 1, 2021, unless the hospital or entity that is 76
owned by or affiliated with such hospital has determined that such 77
individual patient is: 78
(A) An uninsured patient, as defined in section 19a-673, as amended 79
by this act, who is ineligible for the hospital bed fund; or 80
(B) An underinsured patient, as defined in section 19a-673, as 81
amended by this act, who is ineligible for the hospital bed fund and, if 82
such underinsured patient has requested review of an adverse 83
determination, as defined in section 38a-591a, for health care provided 84
at such hospital, such underinsured patient has not received a final 85
adverse determination, as defined in section 38a-591a, for such health 86
care. 87
(b) On or after October 1, 2021, no hospital or entity that is owned by 88
or affiliated with such hospital, as defined in section 19a-490, and no 89
collection agent, as defined in section 19a-509b, that receives a referral 90
from a hospital or entity that is owned by or affiliated with such 91
hospital, shall: 92
(1) Report an individual patient to a credit rating agency, as defined 93
in section 36a-695, for a period of one year beginning on the date that 94
such patient first receives a bill for health care provided by the hospital 95
or entity that is owned by or affiliated with such hospital to such patient 96
on or after October 1, 2021; 97
(2) Initiate an action to foreclose a lien on an individual patient's 98
primary residence if the lien was filed to secure payment for health care 99
provided by the hospital or entity that is owned by or affiliated with 100
such hospital to such patient on or after October 1, 2021; or 101
(3) Apply to a court for an execution against an individual patient's 102
wages pursuant to section 52-361a, or otherwise seek to garnish such 103
patient's wages, to collect payment for health care provided by the 104
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hospital or entity that is owned by or affiliated with such hospital to 105
such patient on or after October 1, 2021, if such patient is eligible for the 106
hospital bed fund. 107
[(b)] (c) Nothing in [this] subsection (a) or (b) of this section shall 108
affect [a hospital's] the ability of a hospital or entity that is owned by or 109
affiliated with such hospital to initiate an action against an individual 110
patient or such patient's estate to collect coinsurance, deductibles or fees 111
arising from health care provided at a hospital or entity that is owned 112
by or affiliated with such hospital where such coinsurance, deductibles 113
or fees may be eligible for reimbursement through awards, settlements 114
or judgments arising from claims, suits or proceedings. In addition, 115
nothing in [this section] said subsections shall affect [a hospital's] the 116
ability of a hospital or entity that is owned by or affiliated with such 117
hospital to initiate an action against an individual patient or such 118
patient's estate where payment or reimbursement has been made, or 119
likely is to be made, directly to the patient. 120
Sec. 3. Section 19a-673d of the general statutes is repealed and the 121
following is substituted in lieu thereof (Effective October 1, 2021): 122
If, at any point in the debt collection process, whether before or after 123
the entry of judgment, a hospital [, a consumer collection agency acting 124
on behalf of the hospital, an attorney representing the hospital or any 125
employee or agent of the hospital] or entity that is owned by or affiliated 126
with such hospital, as defined in section 19a-490, or a collection agent, 127
as defined in section 19a-509b, becomes aware that a debtor from whom 128
the hospital or entity that is owned by or affiliated with such hospital is 129
seeking payment for [services] health care rendered receives 130
information that the debtor has requested review of an adverse 131
determination, as defined in section 38a-591a, for such health care and 132
has not received a final adverse determination, as defined in section 38a-133
591a, or is eligible for hospital bed funds, free or reduced price hospital 134
services [,] or any other program which would result in the elimination 135
of liability for the debt or reduction in the amount of such liability, [the] 136
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such hospital [, collection agency, attorney, employee or agent] or entity 137
that is owned by or affiliated with such hospital or collection agent shall 138
promptly discontinue all collection efforts against such debtor for such 139
health care and refer the collection file for such health care to [the] such 140
hospital [for determination of such eligibility. The] or entity that is 141
owned by or affiliated with such hospital until such hospital or entity 142
determines whether such debtor is eligible for such elimination or 143
reduction or receives such final adverse determination. Such collection 144
[effort] efforts shall not resume until such hospital or entity makes such 145
determination [is made] or such debtor receives such final adverse 146
determination. 147
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2021 19a-673
Sec. 2 October 1, 2021 19a-673b
Sec. 3 October 1, 2021 19a-673d
Statement of Purpose:
To (1) restrict (A) the amount that a hospital or collection agent may
recover from an uninsured or underinsured patient for the unpaid cost
of health care, and (B) the manner in which a hospital or collection agent
may secure or recover payment for the unpaid cost of health care, and
(2) modify provisions concerning hospital billing practices to protect
patients who receive health care at outpatient clinics that are owned by,
or affiliated with, hospitals.
[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.]
Co-Sponsors: SEN. LOONEY, 11th Dist.
S.B. 683