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General Assembly Substitute Bill No. 6740
January Session, 2023
AN ACT CONCERNING HOSPITAL FINANCIAL POLICIES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 19a-673b of the general statutes is repealed and the 1
following is substituted in lieu thereof (Effective October 1, 2023): 2
(a) As used in this section: 3
(1) "Affiliated with" means (A) employed by a hospital or health 4
system, (B) under a professional services agreement with a hospital or 5
health system that permits such hospital or health system to bill on 6
behalf of such entity, or (C) a clinical faculty member of a medical 7
school, as defined in section 33-182aa, who is affiliated with a hospital 8
or health system in a manner that permits such hospital or health system 9
to bill on behalf of such clinical faculty member. 10
(2) "Owned by" means owned by a hospital or health system when 11
billed under the hospital's tax identification number. 12
(3) "Hospital financial assistance" means any program administered 13
by a hospital that reduces, in whole or in part, a patient's liability for the 14
cost of providing services, as defined in section 19a-673. 15
(b) No hospital, as defined in section 19a-490, or entity that is owned 16 Substitute Bill No. 6740
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by or affiliated with such hospital shall refer to a collection agent, as 17
defined in section 19a-509b, as amended by this act, or initiate an action 18
against an individual patient or such patient's estate to collect fees 19
arising from health care provided at a hospital or entity that is owned 20
by or affiliated with such hospital on or after October 1, 2003, unless the 21
hospital or entity that is owned by or affiliated with such hospital has 22
determined that such individual patient is an uninsured patient, as 23
defined in section 19a-673, who is ineligible for the hospital bed fund or 24
hospital financial assistance. 25
(c) On or after October 1, 2022, no hospital or entity that is owned by 26
or affiliated with such hospital, as defined in section 19a-490, and no 27
collection agent, as defined in section 19a-509b, as amended by this act, 28
that receives a referral from a hospital or entity that is owned by or 29
affiliated with such hospital, shall: 30
(1) Report an individual patient to a credit rating agency, as defined 31
in section 36a-695, for a period of one year beginning on the date that 32
such patient first receives a bill for health care provided by the hospital 33
or entity that is owned by or affiliated with such hospital to such patient 34
on or after October 1, 2022; 35
(2) Initiate an action to foreclose a lien on an individual patient's 36
primary residence if the lien was filed to secure payment for health care 37
provided by the hospital or entity that is owned by or affiliated with 38
such hospital to such patient on or after October 1, 2022; or 39
(3) Apply to a court for an execution against an individual patient's 40
wages pursuant to section 52-361a, or otherwise seek to garnish such 41
patient's wages, to collect payment for health care provided by the 42
hospital or entity that is owned by or affiliated with such hospital to 43
such patient on or after October 1, 2022, if such patient is eligible for the 44
hospital bed fund. 45
(d) Nothing in subsection (b) or (c) of this section shall affect the 46
ability of a hospital or entity that is owned by or affiliated with such 47 Substitute Bill No. 6740
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hospital to initiate an action against an individual patient or such 48
patient's estate to collect coinsurance, deductibles or fees arising from 49
health care provided at a hospital or entity that is owned by or affiliated 50
with such hospital where such coinsurance, deductibles or fees may be 51
eligible for reimbursement through awards, settlements or judgments 52
arising from claims, suits or proceedings. In addition, nothing in said 53
subsections shall affect the ability of a hospital or entity that is owned 54
by or affiliated with such hospital to initiate an action against an 55
individual patient or such patient's estate where payment or 56
reimbursement has been made, or likely is to be made, directly to the 57
patient. 58
Sec. 2. (NEW) (Effective October 1, 2023) (a) As used in this section, (1) 59
"hospital" has the same meaning as provided in section 19a-490 of the 60
general statutes; and (2) "hospital financial assistance" means any 61
program administered by a hospital that reduces, in whole or in part, a 62
patient's liability for the cost of providing services, as defined in section 63
19a-673 of the general statutes. 64
(b) On and after October 1, 2023, each hospital shall provide hospital 65
financial assistance to any patient, regardless of such patient's 66
immigration status, who is enrolled in (1) the federal Supplemental 67
Nutrition Assistance Program, or (2) the federal Special Supplemental 68
Food Program for Women, Infants and Children, provided such 69
hospital has verified that the patient's household income does not 70
exceed two hundred fifty per cent of the federal poverty level, without 71
an asset limit, using software that conforms to industry standards 72
concerning electronic income verification. Such hospital shall not 73
require the patient to apply for the Connecticut medical assistance 74
program, Medicare, other government-funded coverage or insurance 75
through the Connecticut Health Insurance Exchange prior to providing 76
hospital financial assistance, unless the hospital has a reasonable basis 77
to believe that the patient will qualify for one or more of such programs. 78
(c) If a hospital provides hospital financial assistance to a patient 79
pursuant to subsection (b) of this section, such financial assistance shall 80 Substitute Bill No. 6740
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cover all of the services and supplies that are medically necessary for 81
the patient. 82
(d) Not later than January 1, 2024, the Health Systems Planning Unit 83
of the Office of Health Strategy shall develop, in consultation with an 84
association of hospitals in the state, a uniform application for hospital 85
financial assistance and make such application available on the unit's 86
Internet web site. Each hospital shall accept such application when filed 87
by a patient seeking hospital financial assistance pursuant to subsection 88
(b) of this section. The Health Systems Planning Unit of the Office of 89
Health Strategy may periodically revise such application, as deemed 90
necessary by the executive director of said unit. Not later than ninety 91
days after the unit posts such application on its Internet web site, each 92
hospital shall make such form available in the hospital's patient 93
admissions office, emergency department, social services department 94
and patient accounts or billing office. Each hospital shall include (1) the 95
link to the Internet web site where such form is posted on all billing 96
statements issued by the hospital, and (2) a paper copy of such form in 97
hospital discharge paperwork provided to each patient. If a hospital 98
reasonably believes, during the admissions process or its review of the 99
financial resources of a patient, that the patient may have insufficient 100
funds to pay for any portion of the patient's hospitalization that is not 101
covered by the patient's insurance, the hospital shall provide such form 102
to the patient. Each hospital shall require each of its collection agents to 103
include such form in each bill and collection notice the collection agent 104
sends to a patient. 105
(e) The Attorney General may investigate the facts and circumstances 106
concerning any alleged violation of this section and, in connection with 107
such investigation, issue subpoenas and written interrogatories in the 108
same manner and to the same extent as provided in section 35-42 of the 109
general statutes. 110
Sec. 3. Section 19a-649 of the general statutes is repealed and the 111
following is substituted in lieu thereof (Effective October 1, 2023): 112 Substitute Bill No. 6740
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(a) The unit shall review annually the level of uncompensated care 113
provided by each hospital to the indigent. Each hospital shall file 114
annually with the unit its policies regarding the provision of charity care 115
and [reduced cost services to the indigent] hospital financial assistance, 116
as defined in section 2 of this act, excluding medical assistance 117
recipients, and its debt collection practices. A hospital shall file its 118
audited financial statements not later than February twenty-eighth, [of 119
each year] annually, except a health system, as defined in section 19a-120
508c, may file one such statement that includes the audited financial 121
statements for each hospital within the health system. Not later than 122
March thirty-first, [of each year] annually, the hospital shall file a 123
verification of the hospital's net revenue for the most recently completed 124
fiscal year in a format prescribed by the unit. 125
(b) Each hospital shall annually report, along with data submitted 126
pursuant to subsection (a) of this section, (1) the number of applicants 127
for charity care and [reduced cost services, (2)] hospital financial 128
assistance, (2) the number of patients requesting or reasonably believed 129
to have a need for hospital financial assistance pursuant to section 2 of 130
this act, (3) the number of approved applicants [, and (3)] for charity care 131
and hospital financial assistance, (4) the total and average charges and 132
costs of the amount of charity care and [reduced cost services provided] 133
hospital financial assistance provided, (5) the number of patients a 134
hospital directly assisted in applying for hospital financial assistance, (6) 135
the number of patients a hospital provided with language translation 136
assistance in applying for hospital financial assistance, (7) the race, 137
ethnicity and insurance status of all applicants for hospital financial 138
assistance, including such applicants whom the hospital reasonably 139
believed to have a need for such assistance pursuant to section 2 of this 140
act, (8) the race, ethnicity and insurance status of all patients approved 141
for hospital financial assistance, (9) the race, ethnicity and insurance 142
status of all patients whose hospital debt was referred to a collection 143
agent, and (10) the race, ethnicity and insurance status of all patients 144
sued by the hospital or its collection agent for the purpose of collecting 145
a debt. 146 Substitute Bill No. 6740
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(c) Each hospital recognized as a nonprofit organization under 147
Section 501(c)(3) of the Internal Revenue Code of 1986, or any 148
subsequent corresponding internal revenue code of the United States, 149
as amended from time to time, shall, along with data submitted 150
annually pursuant to subsection (a) of this section, submit to the unit (1) 151
a complete copy of such hospital's most-recently completed Internal 152
Revenue Service form 990, including all parts and schedules; and (2) in 153
the form and manner prescribed by the unit, data compiled to prepare 154
such hospital's community health needs assessment, as required 155
pursuant to Section 501(r) of the Internal Revenue Code of 1986, or any 156
subsequent corresponding internal revenue code of the United States, 157
as amended from time to time, provided such copy and data submitted 158
pursuant to this subsection shall not include: (A) Individual patient 159
information, including, but not limited to, patient-identifiable 160
information; (B) information that is not owned or controlled by such 161
hospital; (C) information that such hospital is contractually required to 162
keep confidential or that is prohibited from disclosure by a data use 163
agreement; or (D) information concerning research on human subjects 164
as described in section 45 CFR 46.101 et seq., as amended from time to 165
time. 166
Sec. 4. Section 19a-509b of the general statutes is repealed and the 167
following is substituted in lieu thereof (Effective October 1, 2023): 168
(a) As used in this section, (1) "hospital bed fund" means any gift of 169
money, stock, bonds, financial instruments or other property made by 170
any donor for the purpose of establishing a fund to provide medical 171
care, including, but not limited to, inpatient or outpatient care, to 172
patients at a hospital. A hospital bed fund may be established by inter 173
vivos gift, bequest, subscription, solicitation, dedication or any other 174
means; (2) "hospital" [means hospital as defined] has the same meaning 175
as provided in section 19a-490; (3) "collection agent" means any person, 176
either employed by or under contract to, a hospital, who is engaged in 177
the business of collecting payment from consumers for medical services 178
provided by the hospital, and includes, but is not limited to, attorneys 179 Substitute Bill No. 6740
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performing debt collection activities; and (4) "hospital financial 180
assistance" has the same meaning as provided in section 2 of this act. 181
(b) (1) Each hospital which holds or administers one or more hospital 182
bed funds shall post or cause to be posted in a conspicuous public place 183
in each patient admitting location, including, but not limited to, the 184
admissions office, emergency room, social services department and 185
patient accounts or billing office, information in English and Spanish 186
regarding the availability of its hospital bed funds, in plain language in 187
a forty-eight to seventy-two point type size. Such information shall 188
include: (A) Notification of the existence of hospital bed funds and the 189
hospital's program to administer them, and (B) the person to contact for 190
application information. 191
(2) Each hospital [which has a hospital bed fund] shall train staff, 192
including but not limited to, hospital social workers, discharge planners 193
and billing personnel concerning the existence of [such fund] any 194
hospital bed fund and hospital financial assistance, the eligibility 195
requirements for any such fund and such financial assistance, and the 196
procedures for [application] a patient to apply for any such fund or 197
financial assistance. 198
(c) Each hospital [that holds or administers one or more hospital bed 199
funds] shall make available in a place and manner allowing individual 200
members of the public to easily obtain it, a one-page summary in 201
English and Spanish describing any hospital bed funds and hospital 202
financial assistance and how to apply for [them] such funds, if such 203
funds exist, and such financial assistance. Upon request, a hospital shall 204
make the summary available in each additional language spoken by at 205
least five per cent of the population that resides in the geographic area 206
served by the hospital. The summary shall also describe any other 207
policies regarding the provision of charity care and [reduced cost 208
services for the indigent] other financial assistance as reported by the 209
hospital to the Health Systems Planning Unit of the Office of Health 210
Strategy pursuant to section 19a-649, as amended by this act, and shall 211
clearly distinguish hospital bed funds and hospital financial assistance 212 Substitute Bill No. 6740
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from other sources of financial assistance. The summary shall include 213
(1) notification that the patient is entitled to reapply upon rejection, and 214
that additional funds may become available on an annual basis, and (2) 215
a link to the application for hospital financial assistance described in 216
section 2 of this act. The summary shall be available in the patient 217
admissions office, emergency room, social services department and 218
patient accounts or billing office. [, and from any collection agent] Each 219
hospital shall include the link to the Internet web site where the 220
summary is posted in all billing statements issued by the hospital and 221
include a paper copy of the summary in all hospital discharge 222
paperwork provided to each patient. If during the admission process or 223
during its review of the financial resources of the patient, the hospital 224
reasonably believes the patient will have limited funds to pay for any 225
portion of the patient's hospitalization not covered by insurance, the 226
hospital shall provide the summary to each such patient. The summary 227
shall comply with the plain language standards described in section 42-228
152 and shall not include any statement that suggests that a patient is 229
required to apply for the Connecticut medical assistance program, 230
Medicare, other government-funded coverage or insurance through the 231
Connecticut Health Insurance Exchange. 232
(d) Each hospital [which holds or administers one or more hospital 233
bed funds] shall require its collection agents to include a summary as 234
provided in subsection (c) of this section in all bills and collection notices 235
sent by such collection agents. 236
(e) [Applicants] Each hospital shall notify an applicant for assistance 237
from hospital bed funds [shall be notified] or for hospital financial 238
assistance, in writing, of any award or any rejection and the reason for 239
such rejection. Patients who cannot pay any outstanding medical bill at 240
the hospital shall be allowed to apply or reapply for hospital bed funds 241
and other programs providing financial assistance. Each hospital shall 242
offer an applicant, who is deemed ineligible for hospital financial 243
assistance, a payment plan amounting to not more than two per cent of 244
the applicant's annual household income per year. No hospital nor 245 Substitute Bill No. 6740
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collection agent for a hospital may charge a patient interest on medical 246
debt if the patient is eligible for any financial assistance. 247
(f) Each hospital which holds or administers one or more hospital bed 248
funds shall maintain and annually compile, at the end of the fiscal year 249
of the hospital, the following information: (1) The number of 250
applications for hospital bed funds; (2) the number of patients receiving 251
hospital bed fund grants and the actual dollar amounts provided to each 252
patient from such fund; (3) the fair market value of the principal of each 253
individual hospital bed fund, or the principal attributable to each bed 254
fund if held in a pooled investment; (4) the total earnings for each 255
hospital bed fund or the earnings attributable to each hospital bed fund; 256
(5) the dollar amount of earnings reinvested as principal if any; and (6) 257
the dollar amount of earnings available for patient care. The information 258
compiled pursuant to this subsection shall be permanently retained by 259
the hospital and made available to the Health Systems Planning Unit 260
upon request. 261
This act shall take effect as follows and shall amend the following
sections:
Section 1 October 1, 2023 19a-673b
Sec. 2 October 1, 2023 New section
Sec. 3 October 1, 2023 19a-649
Sec. 4 October 1, 2023 19a-509b
PH Joint Favorable Subst.
FIN Joint Favorable