LCO \\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00683-R02-
SB.docx
1 of 6
General Assembly Substitute Bill No. 683
January Session, 2021
AN ACT CONCERNING HO SPITAL BILLING AND COLLECTION
EFFORTS BY HOSPITALS AND COLLECTION AGEN CIES.
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 Section 19a-673 of the general statutes is repealed and the 1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
[(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 Substitute Bill No. 683
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00683-
R02-SB.docx }
2 of 6
[(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] such health care. 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 health care plus interest at an annual rate that 44
is 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 Substitute Bill No. 683
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00683-
R02-SB.docx }
3 of 6
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-754a, 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
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 Substitute Bill No. 683
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00683-
R02-SB.docx }
4 of 6
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 received a final adverse 85
determination, as defined in section 38a-591a, for such health care. 86
(b) On or after October 1, 2021, no hospital or entity that is owned by 87
or affiliated with such hospital, as defined in section 19a-490, and no 88
collection agent, as defined in section 19a-509b, that receives a referral 89
from a hospital or entity that is owned by or affiliated with such 90
hospital, shall: 91
(1) Report an individual patient to a credit rating agency, as defined 92
in section 36a-695, for a period of one year beginning on the date that 93
such patient first receives a bill for health care provided by the hospital 94
or entity that is owned by or affiliated with such hospital to such patient 95
on or after October 1, 2021; 96
(2) Initiate an action to foreclose a lien on an individual patient's 97
primary residence if the lien was filed to secure payment for health care 98
provided by the hospital or entity that is owned by or affiliated with 99
such hospital to such patient on or after October 1, 2021; or 100
(3) Apply to a court for an execution against an individual patient's 101
wages pursuant to section 52-361a, or otherwise seek to garnish such 102
patient's wages, to collect payment for health care provided by the 103
hospital or entity that is owned by or affiliated with such hospital to 104
such patient on or after October 1, 2021, if such patient is eligible for the 105
hospital bed fund. 106
[(b)] (c) Nothing in [this] subsection (a) or (b) of this section shall 107 Substitute Bill No. 683
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00683-
R02-SB.docx }
5 of 6
affect [a hospital's] the ability of a hospital or entity that is owned by or 108
affiliated with such hospital to initiate an action against an individual 109
patient or such patient's estate to collect coinsurance, deductibles or fees 110
arising from health care provided at a hospital or entity that is owned 111
by or affiliated with such hospital where such coinsurance, deductibles 112
or fees may be eligible for reimbursement through awards, settlements 113
or judgments arising from claims, suits or proceedings. In addition, 114
nothing in [this section] said subsections shall affect [a hospital's] the 115
ability of a hospital or entity that is owned by or affiliated with such 116
hospital to initiate an action against an individual patient or such 117
patient's estate where payment or reimbursement has been made, or 118
likely is to be made, directly to the patient. 119
Sec. 3. Section 19a-673d of the general statutes is repealed and the 120
following is substituted in lieu thereof (Effective October 1, 2021): 121
If, at any point in the debt collection process, whether before or after 122
the entry of judgment, a hospital [, a consumer collection agency acting 123
on behalf of the hospital, an attorney representing the hospital or any 124
employee or agent of the hospital] or entity that is owned by or affiliated 125
with such hospital, as defined in section 19a-490, or a collection agent, 126
as defined in section 19a-509b, becomes aware that a debtor from whom 127
the hospital or entity that is owned by or affiliated with such hospital is 128
seeking payment for [services] health care rendered receives 129
information that the debtor has requested review of an adverse 130
determination, as defined in section 38a-591a, for such health care and 131
has not received a final adverse determination, as defined in section 38a-132
591a, or is eligible for hospital bed funds, free or reduced price hospital 133
services [,] or any other program which would result in the elimination 134
of liability for the debt or reduction in the amount of such liability, [the] 135
such hospital [, collection agency, attorney, employee or agent] or entity 136
that is owned by or affiliated with such hospital or collection agent shall 137
promptly discontinue all collection efforts against such debtor for such 138
health care and refer the collection file for such health care to [the] such 139
hospital [for determination of such eligibility. The] or entity that is 140 Substitute Bill No. 683
LCO {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-00683-
R02-SB.docx }
6 of 6
owned by or affiliated with such hospital until such hospital or entity 141
determines whether such debtor is eligible for such elimination or 142
reduction or receives such final adverse determination. Such collection 143
[effort] efforts shall not resume until such hospital or entity makes such 144
determination [is made] or such debtor receives such final adverse 145
determination. 146
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 Legislative Commissioners:
In Sec. 1(b)(1), "services" was bracketed and "such health care" was
inserted after the closing bracket for accuracy; in Sec. (1)(b)(2)(B), "19a-
754" was changed to "19a-754a" for accuracy; and in Sec. 2(a)(2)(B), "not
received" was changed to "received" for accuracy.
PH Joint Favorable Subst. -LCO