CT
Connecticut Senate Bill SB00683

Connecticut 2021 Regular Session

Connecticut Senate Bill SB00683 Compare Versions

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4-Substitute Senate Bill No. 683
7+General Assembly Substitute Bill No. 683
8+January Session, 2021
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6-Public Act No. 21-129
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912 AN ACT CONCERNING HO SPITAL BILLING AND COLLECTION
1013 EFFORTS BY HOSPITALS AND COLLECTION AGEN CIES.
1114 Be it enacted by the Senate and House of Representatives in General
1215 Assembly convened:
1316
14-Section 1. Section 19a-673 of the general statutes is repealed and the
15-following is substituted in lieu thereof (Effective October 1, 2022):
16-(a) As used in this section:
17-(1) "Affiliated with" means (A) employed by a hospital or health
18-system, (B) under a professional services agreement with a hospital or
19-health system that permits such hospital or health system to bill on
20-behalf of such entity, or (C) a clinical faculty member of a medical
21-school, as defined in section 33-182aa, who is affiliated with a hospital
22-or health system in a manner that permits such hospital or health system
23-to bill on behalf of such clinical faculty member.
24-(2) "Collection agent" has the same meaning as provided in section
25-19a-509b.
26-[(1)] (3) "Cost of providing services" means a hospital's published
27-charges at the time of billing, multiplied by the hospital's most recent
28-relationship of costs to charges as taken from the hospital's most recently
29-available annual financial filing with the unit. Substitute Senate Bill No. 683
17+Section 1. Section 19a-673 of the general statutes is repealed and the 1
18+following is substituted in lieu thereof (Effective October 1, 2021): 2
19+(a) As used in this section: 3
20+(1) "Collection agent" has the same meaning as provided in section 4
21+19a-509b. 5
22+[(1)] (2) "Cost of providing services" means a hospital's published 6
23+charges at the time of billing, multiplied by the hospital's most recent 7
24+relationship of costs to charges as taken from the hospital's most recently 8
25+available annual financial filing with the unit. 9
26+(3) "High deductible health plan" has the same meaning as provided 10
27+in Section 220(c)(2) or Section 223(c)(2) of the Internal Revenue Code of 11
28+1986, or any subsequent corresponding internal revenue code of the 12
29+United States, as amended from time to time. 13
30+[(2)] (4) "Hospital" [means an institution licensed by the Department 14
31+of Public Health as a short-term general hospital] has the same meaning 15
32+as provided in section 19a-490. 16 Substitute Bill No. 683
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33-[(2)] (4) "Hospital" [means an institution licensed by the Department
34-of Public Health as a short-term general hospital] has the same meaning
35-as provided in section 19a-490.
36-(5) "Owned by" means owned by a hospital or health system when
37-billed under the hospital's tax identification number.
38-[(3)] (6) "Poverty income guidelines" means the poverty income
39-guidelines issued from time to time by the United States Department of
40-Health and Human Services.
41-[(4)] (7) "Uninsured patient" means any person who is liable for one
42-or more hospital charges whose income is at or below two hundred fifty
43-per cent of the poverty income guidelines who (A) has applied and been
44-denied eligibility for any medical or health care coverage provided
45-under the Medicaid program due to failure to satisfy income or other
46-eligibility requirements, and (B) is not eligible for coverage for hospital
47-services under the Medicare or CHAMPUS programs, or under any
48-Medicaid or health insurance program of any other nation, state,
49-territory or commonwealth, or under any other governmental or
50-privately sponsored health or accident insurance or benefit program
51-including, but not limited to, workers' compensation and awards,
52-settlements or judgments arising from claims, suits or proceedings
53-involving motor vehicle accidents or alleged negligence.
54-(b) No hospital or entity that is owned by or affiliated with such
55-hospital that has provided health care [services] to an uninsured patient
56-may collect from the uninsured patient more than the cost of providing
57-[services] such health care.
58-(c) Each collection agent [, as defined in section 19a-509b,] engaged in
59-collecting a debt from a patient arising from [services] health care
60-provided at a hospital shall provide written notice to such patient as to
61-whether the hospital deems the patient an insured patient or [an] Substitute Senate Bill No. 683
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39+[(3)] (5) "Poverty income guidelines" means the poverty income 17
40+guidelines issued from time to time by the United States Department of 18
41+Health and Human Services. 19
42+(6) "Underinsured patient" means any person who is insured under a 20
43+high deductible health plan and liable for one or more hospital charges, 21
44+and whose income is at or below six hundred per cent of the poverty 22
45+income guidelines. 23
46+[(4)] (7) "Uninsured patient" means any person who is liable for one 24
47+or more hospital charges whose income is at or below two hundred fifty 25
48+per cent of the poverty income guidelines who (A) has applied and been 26
49+denied eligibility for any medical or health care coverage provided 27
50+under the Medicaid program due to failure to satisfy income or other 28
51+eligibility requirements, and (B) is not eligible for coverage for hospital 29
52+services under the Medicare or CHAMPUS programs, or under any 30
53+Medicaid or health insurance program of any other nation, state, 31
54+territory or commonwealth, or under any other governmental or 32
55+privately sponsored health or accident insurance or benefit program 33
56+including, but not limited to, workers' compensation and awards, 34
57+settlements or judgments arising from claims, suits or proceedings 35
58+involving motor vehicle accidents or alleged negligence. 36
59+(b) (1) No hospital or entity that is owned by or affiliated with such 37
60+hospital that has provided health care [services] to an uninsured patient 38
61+may collect from the uninsured patient more than the cost of providing 39
62+[services] such health care. 40
63+(2) No hospital or entity that is owned by or affiliated with such 41
64+hospital that has provided health care to an underinsured patient on or 42
65+after October 1, 2021, may collect from the underinsured patient more 43
66+than the cost of providing health care plus interest at an annual rate that 44
67+is not greater than the lesser of: 45
68+(A) The weekly average one-year constant maturity yield of United 46
69+States Treasury securities as published by the Board of Governors of the 47 Substitute Bill No. 683
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65-uninsured patient and the reasons for such determination.
66-Sec. 2. Section 19a-673b of the general statutes is repealed and the
67-following is substituted in lieu thereof (Effective October 1, 2022):
68-(a) As used in this section:
69-(1) "Affiliated with" means (A) employed by a hospital or health
70-system, (B) under a professional services agreement with a hospital or
71-health system that permits such hospital or health system to bill on
72-behalf of such entity, or (C) a clinical faculty member of a medical
73-school, as defined in section 33-182aa, who is affiliated with a hospital
74-or health system in a manner that permits such hospital or health system
75-to bill on behalf of such clinical faculty member.
76-(2) "Owned by" means owned by a hospital or health system when
77-billed under the hospital's tax identification number.
78-[(a)] (b) No hospital, as defined in section 19a-490, or entity that is
79-owned by or affiliated with such hospital shall refer to a collection agent,
80-as defined in section 19a-509b, or initiate an action against an individual
81-patient or such patient's estate to collect fees arising from health care
82-provided at a hospital or entity that is owned by or affiliated with such
83-hospital on or after October 1, 2003, unless the hospital [has made a
84-determination whether] or entity that is owned by or affiliated with such
85-hospital has determined that such individual patient is [(1)] an
86-uninsured patient, as defined in section 19a-673, as amended by this act,
87-[and (2) not eligible] who is ineligible for the hospital bed fund.
88-(c) On or after October 1, 2022, no hospital or entity that is owned by
89-or affiliated with such hospital, as defined in section 19a-490, and no
90-collection agent, as defined in section 19a-509b, that receives a referral
91-from a hospital or entity that is owned by or affiliated with such
92-hospital, shall: Substitute Senate Bill No. 683
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96-(1) Report an individual patient to a credit rating agency, as defined
97-in section 36a-695, for a period of one year beginning on the date that
98-such patient first receives a bill for health care provided by the hospital
99-or entity that is owned by or affiliated with such hospital to such patient
100-on or after October 1, 2022;
101-(2) Initiate an action to foreclose a lien on an individual patient's
102-primary residence if the lien was filed to secure payment for health care
103-provided by the hospital or entity that is owned by or affiliated with
104-such hospital to such patient on or after October 1, 2022; or
105-(3) Apply to a court for an execution against an individual patient's
106-wages pursuant to section 52-361a, or otherwise seek to garnish such
107-patient's wages, to collect payment for health care provided by the
108-hospital or entity that is owned by or affiliated with such hospital to
109-such patient on or after October 1, 2022, if such patient is eligible for the
110-hospital bed fund.
111-[(b)] (d) Nothing in [this] subsection (b) or (c) of this section shall
112-affect [a hospital's] the ability of a hospital or entity that is owned by or
113-affiliated with such hospital to initiate an action against an individual
114-patient or such patient's estate to collect coinsurance, deductibles or fees
115-arising from health care provided at a hospital or entity that is owned
116-by or affiliated with such hospital where such coinsurance, deductibles
117-or fees may be eligible for reimbursement through awards, settlements
118-or judgments arising from claims, suits or proceedings. In addition,
119-nothing in [this section] said subsections shall affect [a hospital's] the
120-ability of a hospital or entity that is owned by or affiliated with such
121-hospital to initiate an action against an individual patient or such
122-patient's estate where payment or reimbursement has been made, or
123-likely is to be made, directly to the patient.
124-Sec. 3. Section 19a-673d of the general statutes is repealed and the
125-following is substituted in lieu thereof (Effective October 1, 2022): Substitute Senate Bill No. 683
76+Federal Reserve System for the week preceding the date on which such 48
77+underinsured patient first receives a bill for such health care if such 49
78+average is equal to or greater than two per cent per annum; 50
79+(B) A rate established by the executive director of the Office of Health 51
80+Strategy, established under section 19a-754a, and in effect on the date on 52
81+which such underinsured patient first receives a bill for such health care 53
82+if the Board of Governors of the Federal Reserve System discontinues 54
83+the rate described in subparagraph (A) of this subdivision; or 55
84+(C) Five per cent. 56
85+(c) Each collection agent [, as defined in section 19a-509b,] engaged in 57
86+collecting a debt from a patient arising from [services] health care 58
87+provided at a hospital shall provide written notice to such patient as to 59
88+whether the hospital deems the patient an insured patient , 60
89+underinsured patient or [an] uninsured patient and the reasons for such 61
90+determination. 62
91+Sec. 2. Section 19a-673b of the general statutes is repealed and the 63
92+following is substituted in lieu thereof (Effective October 1, 2021): 64
93+(a) No hospital, as defined in section 19a-490, or entity that is owned 65
94+by or affiliated with such hospital shall refer to a collection agent, as 66
95+defined in section 19a-509b, or initiate an action against an individual 67
96+patient or such patient's estate to collect fees arising from health care 68
97+provided at a hospital [on] or entity that is owned by or affiliated with 69
98+such hospital: 70
99+(1) On or after October 1, 2003, unless the hospital or entity that is 71
100+owned by or affiliated with such hospital has [made a determination 72
101+whether] determined that such individual patient is [(1)] an uninsured 73
102+patient, as defined in section 19a-673, as amended by this act, [and (2) 74
103+not eligible] who is ineligible for the hospital bed fund; [.] or 75
104+(2) On or after October 1, 2021, unless the hospital or entity that is 76
105+owned by or affiliated with such hospital has determined that such 77 Substitute Bill No. 683
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129-(a) As used in this section:
130-(1) "Affiliated with" means (A) employed by a hospital or health
131-system, (B) under a professional services agreement with a hospital or
132-health system that permits such hospital or health system to bill on
133-behalf of such entity, or (C) a clinical faculty member of a medical
134-school, as defined in section 33-182aa, who is affiliated with a hospital
135-or health system in a manner that permits such hospital or health system
136-to bill on behalf of such clinical faculty member.
137-(2) "Owned by" means owned by a hospital or health system when
138-billed under the hospital's tax identification number.
139-(b) If, at any point in the debt collection process, whether before or
140-after the entry of judgment, a hospital [, a consumer collection agency
141-acting on behalf of the hospital, an attorney representing the hospital or
142-any employee or agent of the hospital] or entity that is owned by or
143-affiliated with such hospital, as defined in section 19a-490, or a collection
144-agent, as defined in section 19a-509b, becomes aware that a debtor from
145-whom the hospital or entity that is owned by or affiliated with such
146-hospital is seeking payment for [services] health care rendered receives
147-information that the debtor is eligible for hospital bed funds, free or
148-reduced price hospital services [,] or any other program which would
149-result in the elimination of liability for the debt or reduction in the
150-amount of such liability, [the] such hospital [, collection agency,
151-attorney, employee or agent] or entity that is owned by or affiliated with
152-such hospital or collection agent shall promptly discontinue all
153-collection efforts against such debtor for such health care and refer the
154-collection file for such health care to [the] such hospital [for
155-determination of such eligibility. The] or entity that is owned by or
156-affiliated with such hospital until such hospital or entity determines
157-whether such debtor is eligible for such elimination or reduction. Such
158-collection [effort] efforts shall not resume until such hospital or entity
159-makes such determination. [is made.] Substitute Senate Bill No. 683
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112+individual patient is: 78
113+(A) An uninsured patient, as defined in section 19a-673, as amended 79
114+by this act, who is ineligible for the hospital bed fund; or 80
115+(B) An underinsured patient, as defined in section 19a-673, as 81
116+amended by this act, who is ineligible for the hospital bed fund and, if 82
117+such underinsured patient has requested review of an adverse 83
118+determination, as defined in section 38a-591a, for health care provided 84
119+at such hospital, such underinsured patient has received a final adverse 85
120+determination, as defined in section 38a-591a, for such health care. 86
121+(b) On or after October 1, 2021, no hospital or entity that is owned by 87
122+or affiliated with such hospital, as defined in section 19a-490, and no 88
123+collection agent, as defined in section 19a-509b, that receives a referral 89
124+from a hospital or entity that is owned by or affiliated with such 90
125+hospital, shall: 91
126+(1) Report an individual patient to a credit rating agency, as defined 92
127+in section 36a-695, for a period of one year beginning on the date that 93
128+such patient first receives a bill for health care provided by the hospital 94
129+or entity that is owned by or affiliated with such hospital to such patient 95
130+on or after October 1, 2021; 96
131+(2) Initiate an action to foreclose a lien on an individual patient's 97
132+primary residence if the lien was filed to secure payment for health care 98
133+provided by the hospital or entity that is owned by or affiliated with 99
134+such hospital to such patient on or after October 1, 2021; or 100
135+(3) Apply to a court for an execution against an individual patient's 101
136+wages pursuant to section 52-361a, or otherwise seek to garnish such 102
137+patient's wages, to collect payment for health care provided by the 103
138+hospital or entity that is owned by or affiliated with such hospital to 104
139+such patient on or after October 1, 2021, if such patient is eligible for the 105
140+hospital bed fund. 106
141+[(b)] (c) Nothing in [this] subsection (a) or (b) of this section shall 107 Substitute Bill No. 683
162142
163-Sec. 4. Section 19a-508c of the general statutes is repealed and the
164-following is substituted in lieu thereof (Effective October 1, 2022):
165-(a) As used in this section:
166-(1) "Affiliated provider" means a provider that is: (A) Employed by a
167-hospital or health system, (B) under a professional services agreement
168-with a hospital or health system that permits such hospital or health
169-system to bill on behalf of such provider, or (C) a clinical faculty member
170-of a medical school, as defined in section 33-182aa, that is affiliated with
171-a hospital or health system in a manner that permits such hospital or
172-health system to bill on behalf of such clinical faculty member;
173-(2) "Campus" means: (A) The physical area immediately adjacent to a
174-hospital's main buildings and other areas and structures that are not
175-strictly contiguous to the main buildings but are located within two
176-hundred fifty yards of the main buildings, or (B) any other area that has
177-been determined on an individual case basis by the Centers for Medicare
178-and Medicaid Services to be part of a hospital's campus;
179-(3) "Facility fee" means any fee charged or billed by a hospital or
180-health system for outpatient services provided in a hospital-based
181-facility that is: (A) Intended to compensate the hospital or health system
182-for the operational expenses of the hospital or health system, and (B)
183-separate and distinct from a professional fee;
184-(4) "Health system" means: (A) A parent corporation of one or more
185-hospitals and any entity affiliated with such parent corporation through
186-ownership, governance, membership or other means, or (B) a hospital
187-and any entity affiliated with such hospital through ownership,
188-governance, membership or other means;
189-(5) "Hospital" has the same meaning as provided in section 19a-490;
190-(6) "Hospital-based facility" means a facility that is owned or Substitute Senate Bill No. 683
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194-operated, in whole or in part, by a hospital or health system where
195-hospital or professional medical services are provided;
196-(7) "Payer mix" means the proportion of different sources of payment
197-received by a hospital or health system, including, but not limited to,
198-Medicare, Medicaid, other government-provided insurance, private
199-insurance and self-pay patients;
200-[(7)] (8) "Professional fee" means any fee charged or billed by a
201-provider for professional medical services provided in a hospital-based
202-facility; [and]
203-[(8)] (9) "Provider" means an individual, entity, corporation or health
204-care provider, whether for profit or nonprofit, whose primary purpose
205-is to provide professional medical services; and
206-(10) "Tagline" means a short statement written in a non-English
207-language that indicates the availability of language assistance services
208-free of charge.
209-(b) If a hospital or health system charges a facility fee utilizing a
210-current procedural terminology evaluation and management (CPT
211-E/M) code or assessment and management (CPT A/M) code for
212-outpatient services provided at a hospital-based facility where a
213-professional fee is also expected to be charged, the hospital or health
214-system shall provide the patient with a written notice that includes the
215-following information:
216-(1) That the hospital-based facility is part of a hospital or health
217-system and that the hospital or health system charges a facility fee that
218-is in addition to and separate from the professional fee charged by the
219-provider;
220-(2) (A) The amount of the patient's potential financial liability,
221-including any facility fee likely to be charged, and, where professional Substitute Senate Bill No. 683
148+affect [a hospital's] the ability of a hospital or entity that is owned by or 108
149+affiliated with such hospital to initiate an action against an individual 109
150+patient or such patient's estate to collect coinsurance, deductibles or fees 110
151+arising from health care provided at a hospital or entity that is owned 111
152+by or affiliated with such hospital where such coinsurance, deductibles 112
153+or fees may be eligible for reimbursement through awards, settlements 113
154+or judgments arising from claims, suits or proceedings. In addition, 114
155+nothing in [this section] said subsections shall affect [a hospital's] the 115
156+ability of a hospital or entity that is owned by or affiliated with such 116
157+hospital to initiate an action against an individual patient or such 117
158+patient's estate where payment or reimbursement has been made, or 118
159+likely is to be made, directly to the patient. 119
160+Sec. 3. Section 19a-673d of the general statutes is repealed and the 120
161+following is substituted in lieu thereof (Effective October 1, 2021): 121
162+If, at any point in the debt collection process, whether before or after 122
163+the entry of judgment, a hospital [, a consumer collection agency acting 123
164+on behalf of the hospital, an attorney representing the hospital or any 124
165+employee or agent of the hospital] or entity that is owned by or affiliated 125
166+with such hospital, as defined in section 19a-490, or a collection agent, 126
167+as defined in section 19a-509b, becomes aware that a debtor from whom 127
168+the hospital or entity that is owned by or affiliated with such hospital is 128
169+seeking payment for [services] health care rendered receives 129
170+information that the debtor has requested review of an adverse 130
171+determination, as defined in section 38a-591a, for such health care and 131
172+has not received a final adverse determination, as defined in section 38a-132
173+591a, or is eligible for hospital bed funds, free or reduced price hospital 133
174+services [,] or any other program which would result in the elimination 134
175+of liability for the debt or reduction in the amount of such liability, [the] 135
176+such hospital [, collection agency, attorney, employee or agent] or entity 136
177+that is owned by or affiliated with such hospital or collection agent shall 137
178+promptly discontinue all collection efforts against such debtor for such 138
179+health care and refer the collection file for such health care to [the] such 139
180+hospital [for determination of such eligibility. The] or entity that is 140 Substitute Bill No. 683
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225-medical services are provided by an affiliated provider, any professional
226-fee likely to be charged, or, if the exact type and extent of the
227-professional medical services needed are not known or the terms of a
228-patient's health insurance coverage are not known with reasonable
229-certainty, an estimate of the patient's financial liability based on typical
230-or average charges for visits to the hospital-based facility, including the
231-facility fee, (B) a statement that the patient's actual financial liability will
232-depend on the professional medical services actually provided to the
233-patient, (C) an explanation that the patient may incur financial liability
234-that is greater than the patient would incur if the professional medical
235-services were not provided by a hospital-based facility, and (D) a
236-telephone number the patient may call for additional information
237-regarding such patient's potential financial liability, including an
238-estimate of the facility fee likely to be charged based on the scheduled
239-professional medical services; and
240-(3) That a patient covered by a health insurance policy should contact
241-the health insurer for additional information regarding the hospital's or
242-health system's charges and fees, including the patient's potential
243-financial liability, if any, for such charges and fees.
244-(c) If a hospital or health system charges a facility fee without
245-utilizing a current procedural terminology evaluation and management
246-(CPT E/M) code for outpatient services provided at a hospital-based
247-facility, located outside the hospital campus, the hospital or health
248-system shall provide the patient with a written notice that includes the
249-following information:
250-(1) That the hospital-based facility is part of a hospital or health
251-system and that the hospital or health system charges a facility fee that
252-may be in addition to and separate from the professional fee charged by
253-a provider;
254-(2) (A) A statement that the patient's actual financial liability will Substitute Senate Bill No. 683
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187+owned by or affiliated with such hospital until such hospital or entity 141
188+determines whether such debtor is eligible for such elimination or 142
189+reduction or receives such final adverse determination. Such collection 143
190+[effort] efforts shall not resume until such hospital or entity makes such 144
191+determination [is made] or such debtor receives such final adverse 145
192+determination. 146
193+This act shall take effect as follows and shall amend the following
194+sections:
257195
258-depend on the professional medical services actually provided to the
259-patient, (B) an explanation that the patient may incur financial liability
260-that is greater than the patient would incur if the hospital-based facility
261-was not hospital-based, and (C) a telephone number the patient may call
262-for additional information regarding such patient's potential financial
263-liability, including an estimate of the facility fee likely to be charged
264-based on the scheduled professional medical services; and
265-(3) That a patient covered by a health insurance policy should contact
266-the health insurer for additional information regarding the hospital's or
267-health system's charges and fees, including the patient's potential
268-financial liability, if any, for such charges and fees.
269-(d) [On and after January 1, 2016, each] Each initial billing statement
270-that includes a facility fee shall: (1) Clearly identify the fee as a facility
271-fee that is billed in addition to, or separately from, any professional fee
272-billed by the provider; (2) provide the corresponding Medicare facility
273-fee reimbursement rate for the same service as a comparison or, if there
274-is no corresponding Medicare facility fee for such service, (A) the
275-approximate amount Medicare would have paid the hospital for the
276-facility fee on the billing statement, or (B) the percentage of the hospital's
277-charges that Medicare would have paid the hospital for the facility fee;
278-(3) include a statement that the facility fee is intended to cover the
279-hospital's or health system's operational expenses; (4) inform the patient
280-that the patient's financial liability may have been less if the services had
281-been provided at a facility not owned or operated by the hospital or
282-health system; and (5) include written notice of the patient's right to
283-request a reduction in the facility fee or any other portion of the bill and
284-a telephone number that the patient may use to request such a reduction
285-without regard to whether such patient qualifies for, or is likely to be
286-granted, any reduction. Not later than October 15, 2022, and annually
287-thereafter, each hospital, health system and hospital-based facility shall
288-submit to the Health Planning Unit of the Office of Health Strategy a Substitute Senate Bill No. 683
196+Section 1 October 1, 2021 19a-673
197+Sec. 2 October 1, 2021 19a-673b
198+Sec. 3 October 1, 2021 19a-673d
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292-sample of a billing statement issued by such hospital, health system or
293-hospital-based facility that complies with the provisions of this
294-subsection and which represents the format of billing statements
295-received by patients. Such billing statement shall not contain patient
296-identifying information.
297-(e) The written notice described in subsections (b) to (d), inclusive,
298-and (h) to (j), inclusive, of this section shall be in plain language and in
299-a form that may be reasonably understood by a patient who does not
300-possess special knowledge regarding hospital or health system facility
301-fee charges. On and after October 1, 2022, such notices shall include tag
302-lines in at least the top fifteen languages spoken in the state indicating
303-that the notice is available in each of those top fifteen languages. The
304-fifteen languages shall be either the languages in the list published by
305-the Department of Health and Human Services in connection with
306-section 1557 of the Patient Protection and Affordable Care Act, P.L. 111-
307-148, or, as determined by the hospital or health system, the top fifteen
308-languages in the geographic area of the hospital-based facility.
309-(f) (1) For nonemergency care, if a patient's appointment is scheduled
310-to occur ten or more days after the appointment is made, such written
311-notice shall be sent to the patient by first class mail, encrypted electronic
312-mail or a secure patient Internet portal not less than three days after the
313-appointment is made. If an appointment is scheduled to occur less than
314-ten days after the appointment is made or if the patient arrives without
315-an appointment, such notice shall be hand-delivered to the patient when
316-the patient arrives at the hospital-based facility.
317-(2) For emergency care, such written notice shall be provided to the
318-patient as soon as practicable after the patient is stabilized in accordance
319-with the federal Emergency Medical Treatment and Active Labor Act,
320-42 USC 1395dd, as amended from time to time, or is determined not to
321-have an emergency medical condition and before the patient leaves the
322-hospital-based facility. If the patient is unconscious, under great duress Substitute Senate Bill No. 683
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326-or for any other reason unable to read the notice and understand and
327-act on his or her rights, the notice shall be provided to the patient's
328-representative as soon as practicable.
329-(g) Subsections (b) to (f), inclusive, and (l) of this section shall not
330-apply if a patient is insured by Medicare or Medicaid or is receiving
331-services under a workers' compensation plan established to provide
332-medical services pursuant to chapter 568.
333-(h) A hospital-based facility shall prominently display written notice
334-in locations that are readily accessible to and visible by patients,
335-including patient waiting or appointment check-in areas, stating: (1)
336-That the hospital-based facility is part of a hospital or health system, (2)
337-the name of the hospital or health system, and (3) that if the hospital-
338-based facility charges a facility fee, the patient may incur a financial
339-liability greater than the patient would incur if the hospital-based
340-facility was not hospital-based. On and after October 1, 2022, such
341-notices shall include tag lines in at least the top fifteen languages spoken
342-in the state indicating that the notice is available in each of those top
343-fifteen languages. The fifteen languages shall be either the languages in
344-the list published by the Department of Health and Human Services in
345-connection with section 1557 of the Patient Protection and Affordable
346-Care Act, P.L. 111-148, or, as determined by the hospital or health
347-system, the top fifteen languages in the geographic area of the hospital-
348-based facility. Not later than October 1, 2022, and annually thereafter,
349-each hospital-based facility shall submit a copy of the written notice
350-required by this subsection to the Health Systems Planning Unit of the
351-Office of Health Strategy.
352-(i) A hospital-based facility shall clearly hold itself out to the public
353-and payers as being hospital-based, including, at a minimum, by stating
354-the name of the hospital or health system in its signage, marketing
355-materials, Internet web sites and stationery. Substitute Senate Bill No. 683
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359-(j) A hospital-based facility shall, when scheduling services for which
360-a facility fee may be charged, inform the patient (1) that the hospital-
361-based facility is part of a hospital or health system, (2) of the name of the
362-hospital or health system, (3) that the hospital or health system may
363-charge a facility fee in addition to and separate from the professional fee
364-charged by the provider, and (4) of the telephone number the patient
365-may call for additional information regarding such patient's potential
366-financial liability.
367-(k) (1) [On and after January 1, 2016, if any transaction, as] If any
368-transaction described in subsection (c) of section 19a-486i, results in the
369-establishment of a hospital-based facility at which facility fees [will
370-likely] may be billed, the hospital or health system, that is the purchaser
371-in such transaction shall, not later than thirty days after such transaction,
372-provide written notice, by first class mail, of the transaction to each
373-patient served within the [previous] three years preceding the date of
374-the transaction by the health care facility that has been purchased as part
375-of such transaction.
376-(2) Such notice shall include the following information:
377-(A) A statement that the health care facility is now a hospital-based
378-facility and is part of a hospital or health system, the health care facility's
379-full legal and business name and the date of such facility's acquisition
380-by a hospital or health system;
381-(B) The name, business address and phone number of the hospital or
382-health system that is the purchaser of the health care facility;
383-(C) A statement that the hospital-based facility bills, or is likely to bill,
384-patients a facility fee that may be in addition to, and separate from, any
385-professional fee billed by a health care provider at the hospital-based
386-facility;
387-(D) (i) A statement that the patient's actual financial liability will Substitute Senate Bill No. 683
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391-depend on the professional medical services actually provided to the
392-patient, and (ii) an explanation that the patient may incur financial
393-liability that is greater than the patient would incur if the hospital-based
394-facility were not a hospital-based facility;
395-(E) The estimated amount or range of amounts the hospital-based
396-facility may bill for a facility fee or an example of the average facility fee
397-billed at such hospital-based facility for the most common services
398-provided at such hospital-based facility; and
399-(F) A statement that, prior to seeking services at such hospital-based
400-facility, a patient covered by a health insurance policy should contact
401-the patient's health insurer for additional information regarding the
402-hospital-based facility fees, including the patient's potential financial
403-liability, if any, for such fees.
404-(3) A copy of the written notice provided to patients in accordance
405-with this subsection shall be filed with the Health Systems Planning
406-Unit of the Office of Health Strategy, established under section 19a-612.
407-Said unit shall post a link to such notice on its Internet web site.
408-(4) A hospital, health system or hospital-based facility shall not collect
409-a facility fee for services provided at a hospital-based facility that is
410-subject to the provisions of this subsection from the date of the
411-transaction until at least thirty days after the written notice required
412-pursuant to this subsection is mailed to the patient or a copy of such
413-notice is filed with the Health Systems Planning Unit, whichever is later.
414-A violation of this subsection shall be considered an unfair trade
415-practice pursuant to section 42-110b.
416-(5) Not later than July 1, 2023, and annually thereafter, each hospital-
417-based facility that was the subject of a transaction, as described in
418-subsection (c) of section 19a-486i, during the preceding calendar year
419-shall report to the Health Systems Planning Unit the number of patients Substitute Senate Bill No. 683
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423-served by such hospital-based facility in the preceding three years.
424-(l) Notwithstanding the provisions of this section, no hospital, health
425-system or hospital-based facility shall collect a facility fee for (1)
426-outpatient health care services that use a current procedural
427-terminology evaluation and management (CPT E/M) code or
428-assessment and management (CPT A/M) code and are provided at a
429-hospital-based facility located off-site from a hospital campus, or (2)
430-outpatient health care services provided at a hospital-based facility
431-located off-site from a hospital campus, received by a patient who is
432-uninsured of more than the Medicare rate. Notwithstanding the
433-provisions of this subsection, in circumstances when an insurance
434-contract that is in effect on July 1, 2016, provides reimbursement for
435-facility fees prohibited under the provisions of this section, a hospital or
436-health system may continue to collect reimbursement from the health
437-insurer for such facility fees until the date of expiration, renewal or
438-amendment of such contract, whichever such date is the earliest. A
439-violation of this subsection shall be considered an unfair trade practice
440-pursuant to chapter 735a. The provisions of this subsection shall not
441-apply to a freestanding emergency department. As used in this
442-subsection, "freestanding emergency department" means a freestanding
443-facility that (A) is structurally separate and distinct from a hospital, (B)
444-provides emergency care, (C) is a department of a hospital licensed
445-under chapter 368v, and (D) has been issued a certificate of need to
446-operate as a freestanding emergency department pursuant to chapter
447-368z.
448-(m) (1) Each hospital and health system shall report not later than July
449-1, [2016] 2023, and annually thereafter to the executive director of the
450-Office of Health Strategy, on a form prescribed by the executive director,
451-concerning facility fees charged or billed during the preceding calendar
452-year. Such report shall include (A) the name and [location] address of
453-each facility owned or operated by the hospital or health system that Substitute Senate Bill No. 683
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457-provides services for which a facility fee is charged or billed, (B) the
458-number of patient visits at each such facility for which a facility fee was
459-charged or billed, (C) the number, total amount and range of allowable
460-facility fees paid at each such facility [by Medicare, Medicaid or under
461-private insurance policies] disaggregated by payer mix, (D) for each
462-facility, the total amount of facility fees charged and the total amount of
463-revenue received by the hospital or health system derived from facility
464-fees, (E) the total amount of facility fees charged and the total amount of
465-revenue received by the hospital or health system from all facilities
466-derived from facility fees, (F) a description of the ten procedures or
467-services that generated the greatest amount of facility fee gross revenue,
468-disaggregated by current procedural terminology category (CPT) code
469-for each such procedure or service and, for each such procedure or
470-service, patient volume and the total amount of gross and net revenue
471-received by the hospital or health system derived from facility fees, and
472-(G) the top ten procedures or services for which facility fees are charged
473-based on patient volume and the gross and net revenue received by the
474-hospital or health system for each such procedure or service. For
475-purposes of this subsection, "facility" means a hospital-based facility
476-that is located outside a hospital campus.
477-(2) The executive director shall publish the information reported
478-pursuant to subdivision (1) of this subsection, or post a link to such
479-information, on the Internet web site of the Office of Health Strategy.
480-Sec. 5. (Effective from passage) (a) The Office of Health Strategy shall,
481-within available appropriations:
482-(1) Study methods to improve oversight and regulation of mergers
483-and acquisitions of physician practices to improve health care quality
484-and choice in Connecticut, including, but not limited to, a review of
485-sections 19a-486i, 19a-639 and 19a-630 of the general statutes;
486-(2) Study methods to ensure the viability of physician practices; and Substitute Senate Bill No. 683
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490-(3) Develop legislative recommendations to improve reporting and
491-oversight of physician practice mergers and acquisitions, including, but
492-not limited to, the necessity for any amendments to section 19a-486i,
493-19a-639 or 19a-630 of the general statutes.
494-(b) Not later than February 1, 2023, the executive director of the Office
495-of Health Strategy shall report, in accordance with the provisions of
496-section 11-4a of the general statutes, to the joint standing committee of
497-the General Assembly having cognizance of matters relating to public
498-health regarding the outcome of the study and any recommendations
499-for legislative action as a result of such study.
201+PH Joint Favorable Subst. -LCO
202+APP Joint Favorable
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