Connecticut 2023 Regular Session

Connecticut Senate Bill SB01203 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
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2	2
3	3	LCO No. 5093 1 of 11
4	4
5	5	General Assembly Raised Bill No. 1203
6	6	January Session, 2023
7	7	LCO No. 5093
8	8
9	9
10	10	Referred to Committee on HUMAN SERVICES
11	11
12	12
13	13	Introduced by:
14	14	(HS)
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16	16
17	17
18	18
19	19	AN ACT CONCERNING MEDICAL DEBT.
20	20	Be it enacted by the Senate and House of Representatives in General
21	21	Assembly convened:
22	22
23	23	Section 1. (NEW) (Effective from passage) (a) As used in this section, 1
24	24	"hospital financial assistance", "financial assistance" and "hospital" have 2
25	25	the same meanings as provided in section 19a-509b of the general 3
26	26	statutes, as amended by this act. On and after October 1, 2023, each 4
27	27	hospital shall provide financial assistance to any patient who (1) is 5
28	28	enrolled in (A) the federal Supplemental Nutrition Assistance Program, 6
29	29	or (B) the federal Special Supplemental Food Program for Women, 7
30	30	Infants and Children, or (2) regardless of immigration status, has a 8
31	31	household income verified by the hospital that does not exceed two 9
32	32	hundred fifty per cent of the federal poverty level, without an asset 10
33	33	limit, using software that conforms to electronic income verification 11
34	34	industry standards. Such hospital shall not require the patient to apply 12
35	35	for the Connecticut medical assistance program, Medicare, other 13
36	36	government-funded coverage or insurance through Access Health 14
37	37	Connecticut, unless the hospital has a reasonable basis to believe that 15
38	38	the patient will qualify for such program. 16 Raised Bill No. 1203
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40	40
41	41
42	42	LCO No. 5093 2 of 11
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44	44	(b) If such financial assistance is provided, it shall apply to all 17
45	45	medically necessary services and supplies. 18
46	46	(c) Prior to January 1, 2024, the Health Systems Planning Unit of the 19
47	47	Office of Health Strategy shall develop, in consultation with the 20
48	48	Connecticut Hospital Association, a uniform application for financial 21
49	49	assistance and make such form available on its Internet web site. Each 22
50	50	hospital shall accept such completed uniform application by patients 23
51	51	applying for such hospital's financial assistance program. Such 24
52	52	application may be periodically revised by the Health System Planning 25
53	53	Unit of the Office of Health Strategy. Not later than ninety days after the 26
54	54	unit publishes the form on the Internet web site of the Office of Health 27
55	55	Strategy, hospitals shall make the form available in the patient 28
56	56	admissions office, emergency room, social services department and 29
57	57	patient accounts or billing office. A link to the form shall be included in 30
58	58	all billing statements issued by a hospital. A paper copy of the form shall 31
59	59	be included in hospital discharge paperwork provided to each patient. 32
60	60	If during the admission process or during its review of the financial 33
61	61	resources of the patient, the hospital reasonably believes the patient will 34
62	62	have limited funds to pay for any portion of the patient's hospitalization 35
63	63	not covered by insurance, the hospital shall provide the form to each 36
64	64	such patient. Each hospital shall require its collection agents to include 37
65	65	a form in all bills and collection notices sent by such collection agents. 38
66	66	(d) The Attorney General may investigate the facts and circumstances 39
67	67	concerning any alleged violation of this section and, in connection with 40
68	68	such investigation, issue subpoenas and written interrogatories in the 41
69	69	same manner and to the same extent as is provided in section 35-42 of 42
70	70	the general statutes. 43
71	71	Sec. 2. Section 19a-509b of the general statutes is repealed and the 44
72	72	following is substituted in lieu thereof (Effective October 1, 2023): 45
73	73	(a) As used in this section, (1) "hospital bed fund" means any gift of 46
74	74	money, stock, bonds, financial instruments or other property made by 47
75	75	any donor for the purpose of establishing a fund to provide medical 48 Raised Bill No. 1203
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77	77
78	78
79	79	LCO No. 5093 3 of 11
80	80
81	81	care, including, but not limited to, inpatient or outpatient care, to 49
82	82	patients at a hospital. A hospital bed fund may be established by inter 50
83	83	vivos gift, bequest, subscription, solicitation, dedication or any other 51
84	84	means; (2) "hospital" means hospital as defined in section 19a-490; (3) 52
85	85	"hospital financial assistance" and "financial assistance" mean any 53
86	86	program administered by a hospital that reduces the patient's liability 54
87	87	for costs whether completely or in part; and (4) "collection agent" means 55
88	88	any person, either employed by or under contract to, a hospital, who is 56
89	89	engaged in the business of collecting payment from consumers for 57
90	90	medical services provided by the hospital, and includes, but is not 58
91	91	limited to, attorneys performing debt collection activities. 59
92	92	(b) (1) Each hospital [which holds or administers one or more hospital 60
93	93	bed funds] shall post or cause to be posted in a conspicuous public place 61
94	94	in each patient admitting location, including, but not limited to, the 62
95	95	admissions office, emergency room, social services department and 63
96	96	patient accounts or billing office, information in English and Spanish 64
97	97	regarding the availability of its hospital bed funds, in plain language in 65
98	98	a forty-eight to seventy-two point type size. Such information shall 66
99	99	include: (A) Notification of the existence of hospital bed funds and the 67
100	100	hospital's program to administer them, and (B) the person to contact for 68
101	101	application information. 69
102	102	(2) Each hospital [which has a hospital bed fund] shall train staff, 70
103	103	including, but not limited to, hospital social workers, discharge planners 71
104	104	and billing personnel concerning the existence of such fund, the 72
105	105	eligibility requirements and the procedures for application for such bed 73
106	106	funds and hospital financial assistance. 74
107	107	(c) Each hospital [that holds or administers one or more hospital bed 75
108	108	funds] shall make available in a place and manner allowing individual 76
109	109	members of the public to easily obtain it, a one-page summary in 77
110	110	English and Spanish describing hospital bed funds and how to apply for 78
111	111	them. Upon request, the summary shall be made available in each 79
112	112	language spoken by not less than five per cent of the population that 80
113	113	resides in the hospital's service area as described in section 19a-490i. The 81 Raised Bill No. 1203
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116	116
117	117	LCO No. 5093 4 of 11
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119	119	summary shall also describe any other policies regarding the provision 82
120	120	of [charity care and reduced cost services] hospital financial assistance 83
121	121	for the indigent as reported by the hospital to the Health Systems 84
122	122	Planning Unit of the Office of Health Strategy pursuant to section 19a-85
123	123	649, as amended by this act, and shall clearly distinguish hospital bed 86
124	124	funds from other sources of financial assistance. The summary shall 87
125	125	include notification that the patient is entitled to reapply upon rejection, 88
126	126	and that additional funds may become available on an annual basis. The 89
127	127	summary shall include an Internet web site link to the uniform 90
128	128	application described in section 1 of this act. The summary shall be 91
129	129	available in the patient admissions office, emergency room, social 92
130	130	services department and patient accounts or billing office, and from any 93
131	131	collection agent. An Internet web site link to the summary shall be 94
132	132	included in all billing statements issued by a hospital. A paper copy of 95
133	133	this summary shall be included in hospital discharge paperwork 96
134	134	provided to each patient. If during the admission process or during its 97
135	135	review of the financial resources of the patient, the hospital reasonably 98
136	136	believes the patient will have limited funds to pay for any portion of the 99
137	137	patient's hospitalization not covered by insurance, the hospital shall 100
138	138	provide the summary to each such patient. 101
139	139	(d) The summary described in subsection (c) of this section shall (1) 102
140	140	comply with the plain language standards for consumer contracts under 103
141	141	section 42-152; and (2) not contain a requirement that a patient shall 104
142	142	apply for medical assistance before the patient will be screened for or 105
143	143	provided financial assistance. 106
144	144	[(d)] (e) Each hospital [which holds or administers one or more 107
145	145	hospital bed funds] shall require its collection agents to include a 108
146	146	summary as provided in subsection (c) of this section in all bills and 109
147	147	collection notices sent by such collection agents. 110
148	148	[(e)] (f) Applicants for assistance from [hospital bed funds] hospitals 111
149	149	shall be notified in writing of any award or any rejection and the reason 112
150	150	for such rejection. Patients who cannot pay any outstanding medical bill 113
151	151	at the hospital shall be allowed to apply or reapply for hospital bed 114 Raised Bill No. 1203
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153	153
154	154
155	155	LCO No. 5093 5 of 11
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157	157	funds and other programs providing hospital financial assistance. 115
158	158	Applicants deemed ineligible for hospital financial assistance shall be 116
159	159	offered a payment plan amounting to not more than two per cent of the 117
160	160	applicant's household income per year. No hospital or debt collector 118
161	161	may charge interest on medical debt if the patient is eligible for financial 119
162	162	assistance. 120
163	163	[(f)] (g) Each hospital [which holds or administers one or more 121
164	164	hospital bed funds] shall maintain and annually compile, at the end of 122
165	165	the fiscal year of the hospital, the following information: (1) The number 123
166	166	of applications for hospital bed funds; (2) the number of patients 124
167	167	receiving hospital bed fund grants and the actual dollar amounts 125
168	168	provided to each patient from such fund; (3) the fair market value of the 126
169	169	principal of each individual hospital bed fund, or the principal 127
170	170	attributable to each bed fund if held in a pooled investment; (4) the total 128
171	171	earnings for each hospital bed fund or the earnings attributable to each 129
172	172	hospital bed fund; (5) the dollar amount of earnings reinvested as 130
173	173	principal if any; and (6) the dollar amount of earnings available for 131
174	174	patient care. The information compiled pursuant to this subsection shall 132
175	175	be permanently retained by the hospital and made available to the 133
176	176	Health Systems Planning Unit upon request. 134
177	177	Sec. 3. Section 19a-649 of the general statutes is repealed and the 135
178	178	following is substituted in lieu thereof (Effective October 1, 2023): 136
179	179	(a) As used in this section, "hospital financial assistance" and 137
180	180	"financial assistance" have the same meaning as provided in section 19a-138
181	181	509b, as amended by this act. The unit shall review annually the level of 139
182	182	uncompensated care provided by each hospital to the indigent. Each 140
183	183	hospital shall file annually with the unit its policies regarding the 141
184	184	provision of [charity care and reduced cost services to the indigent] 142
185	185	financial assistance, excluding medical assistance recipients, and its debt 143
186	186	collection practices. A hospital shall file its audited financial statements 144
187	187	not later than February twenty-eighth of each year, except a health 145
188	188	system, as defined in section 19a-508c, may file one such statement that 146
189	189	includes the audited financial statements for each hospital within the 147 Raised Bill No. 1203
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191	191
192	192
193	193	LCO No. 5093 6 of 11
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195	195	health system. Not later than March thirty-first of each year, the hospital 148
196	196	shall file a verification of the hospital's net revenue for the most recently 149
197	197	completed fiscal year in a format prescribed by the unit. 150
198	198	(b) Each hospital shall annually report, along with data submitted 151
199	199	pursuant to subsection (a) of this section, (1) the number of applicants 152
200	200	for [charity care and reduced cost services, (2)] hospital financial 153
201	201	assistance, (2) the number of patients screened for hospital financial 154
202	202	assistance pursuant to section 19a-673b, as amended by this act, (3) the 155
203	203	number of approved applicants, [and (3)] (4) the total and average 156
204	204	charges and costs of the amount of [charity care and reduced cost 157
205	205	services provided] hospital financial assistance provided both as 158
206	206	charged and adjusted to be not more than one hundred twenty-five per 159
207	207	cent of the Medicare rate, (5) the number of patients a hospital directly 160
208	208	assisted in applying for financial assistance, (6) the number of patients 161
209	209	a hospital provided with language translation assistance to apply for 162
210	210	financial assistance, (7) the race, ethnicity and insurance status, if 163
211	211	provided by the patient, of all applicants for financial assistance, 164
212	212	including, but not limited to, those screened by the hospital pursuant to 165
213	213	section 19a-673b, as amended by this act, (8) the race, ethnicity and 166
214	214	insurance status, if provided by the patient, of all patients approved for 167
215	215	financial assistance, (9) the race, ethnicity and insurance status, if 168
216	216	provided by the patient, of all patients whose debt was referred to 169
217	217	collection agents, and (10) the race, ethnicity and insurance status, if 170
218	218	provided by the patient, of all patients sued by the hospital or its 171
219	219	collection agent for the purposes of collecting a debt. 172
220	220	(c) Each hospital recognized as a nonprofit organization under 173
221	221	Section 501(c)(3) of the Internal Revenue Code of 1986, or any 174
222	222	subsequent corresponding internal revenue code of the United States, 175
223	223	as amended from time to time, shall, along with data submitted 176
224	224	annually pursuant to subsection (a) of this section, submit to the unit (1) 177
225	225	a complete copy of such hospital's most-recently completed Internal 178
226	226	Revenue Service form 990, including all parts and schedules; and (2) in 179
227	227	the form and manner prescribed by the unit, data compiled to prepare 180
228	228	such hospital's community health needs assessment, as required 181 Raised Bill No. 1203
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230	230
231	231
232	232	LCO No. 5093 7 of 11
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234	234	pursuant to Section 501(r) of the Internal Revenue Code of 1986, or any 182
235	235	subsequent corresponding internal revenue code of the United States, 183
236	236	as amended from time to time, provided such copy and data submitted 184
237	237	pursuant to this subsection shall not include: (A) Individual patient 185
238	238	information, including, but not limited to, patient-identifiable 186
239	239	information; (B) information that is not owned or controlled by such 187
240	240	hospital; (C) information that such hospital is contractually required to 188
241	241	keep confidential or that is prohibited from disclosure by a data use 189
242	242	agreement; or (D) information concerning research on human subjects 190
243	243	as described in section 45 CFR 46.101 et seq., as amended from time to 191
244	244	time. 192
245	245	Sec. 4. Section 19a-673 of the general statutes is repealed and the 193
246	246	following is substituted in lieu thereof (Effective October 1, 2023): 194
247	247	(a) As used in this section: 195
248	248	(1) "Affiliated with" means (A) employed by a hospital or health 196
249	249	system, (B) under a professional services agreement with a hospital or 197
250	250	health system that permits such hospital or health system to bill on 198
251	251	behalf of such entity, or (C) a clinical faculty member of a medical 199
252	252	school, as defined in section 33-182aa, who is affiliated with a hospital 200
253	253	or health system in a manner that permits such hospital or health system 201
254	254	to bill on behalf of such clinical faculty member. 202
255	255	(2) "Collection agent" has the same meaning as provided in section 203
256	256	19a-509b, as amended by this act. 204
257	257	(3) "Cost of providing services" means a hospital's published charges 205
258	258	at the time of billing, multiplied by the hospital's most recent 206
259	259	relationship of costs to charges as taken from the hospital's most recently 207
260	260	available annual financial filing with the unit. 208
261	261	(4) "Hospital" has the same meaning as provided in section 19a-490. 209
262	262	(5) "Owned by" means owned by a hospital or health system when 210
263	263	billed under the hospital's tax identification number. 211 Raised Bill No. 1203
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266	266
267	267	LCO No. 5093 8 of 11
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269	269	(6) "Poverty income guidelines" means the poverty income guidelines 212
270	270	issued from time to time by the United States Department of Health and 213
271	271	Human Services. 214
272	272	(7) "Uninsured patient" means any person who is liable for one or 215
273	273	more hospital charges whose income is at or below two hundred fifty 216
274	274	per cent of the poverty income guidelines who (A) has applied and been 217
275	275	denied eligibility for any medical or health care coverage provided 218
276	276	under the Medicaid program due to failure to satisfy income or other 219
277	277	eligibility requirements, and (B) is not eligible for coverage for hospital 220
278	278	services under the Medicare or CHAMPUS programs, or under any 221
279	279	Medicaid or health insurance program of any other nation, state, 222
280	280	territory or commonwealth, or under any other governmental or 223
281	281	privately sponsored health or accident insurance or benefit program 224
282	282	including, but not limited to, workers' compensation and awards, 225
283	283	settlements or judgments arising from claims, suits or proceedings 226
284	284	involving motor vehicle accidents or alleged negligence. 227
285	285	(8) "Underinsured patient" means any person who is liable for one or 228
286	286	more hospital charges that exceed two per cent of the person's annual 229
287	287	household income after the contribution of any insurance program in 230
288	288	which the person is enrolled. 231
289	289	(b) No hospital or entity that is owned by or affiliated with such 232
290	290	hospital that has provided health care to an uninsured or underinsured 233
291	291	patient may collect from the uninsured or underinsured patient more 234
292	292	than the cost of providing such health care. 235
293	293	(c) Each collection agent engaged in collecting a debt from a patient 236
294	294	arising from health care provided at a hospital shall provide written 237
295	295	notice to such patient as to whether the hospital deems the patient an 238
296	296	insured patient, underinsured patient or uninsured patient and the 239
297	297	reasons for such determination. 240
298	298	Sec. 5. Section 19a-673b of the general statutes is repealed and the 241
299	299	following is substituted in lieu thereof (Effective October 1, 2023): 242 Raised Bill No. 1203
300	300
301	301
302	302
303	303	LCO No. 5093 9 of 11
304	304
305	305	(a) As used in this section: 243
306	306	(1) "Affiliated with" means (A) employed by a hospital or health 244
307	307	system, (B) under a professional services agreement with a hospital or 245
308	308	health system that permits such hospital or health system to bill on 246
309	309	behalf of such entity, or (C) a clinical faculty member of a medical 247
310	310	school, as defined in section 33-182aa, who is affiliated with a hospital 248
311	311	or health system in a manner that permits such hospital or health system 249
312	312	to bill on behalf of such clinical faculty member. 250
313	313	(2) "Owned by" means owned by a hospital or health system when 251
314	314	billed under the hospital's tax identification number. 252
315	315	(3) "Hospital financial assistance" and "financial assistance" have the 253
316	316	same meaning as provided in section 19a-509b, as amended by this act. 254
317	317	(b) No hospital, as defined in section 19a-490, or entity that is owned 255
318	318	by or affiliated with such hospital shall refer to a collection agent, as 256
319	319	defined in section 19a-509b, as amended by this act, or initiate an action 257
320	320	against an individual patient or such patient's estate to collect fees 258
321	321	arising from health care provided at a hospital or entity that is owned 259
322	322	by or affiliated with such hospital on or after October 1, 2003, unless the 260
323	323	hospital or entity that is owned by or affiliated with such hospital has 261
324	324	determined that such individual patient is an uninsured patient or an 262
325	325	underinsured patient, as defined in section 19a-673, as amended by this 263
326	326	act, who is ineligible for the hospital bed fund and hospital financial 264
327	327	assistance as defined in subsection (a) of this section. 265
328	328	(c) On or after October 1, 2022, no hospital or entity that is owned by 266
329	329	or affiliated with such hospital, as defined in section 19a-490, and no 267
330	330	collection agent, as defined in section 19a-509b, as amended by this act, 268
331	331	that receives a referral from a hospital or entity that is owned by or 269
332	332	affiliated with such hospital, shall: 270
333	333	(1) Report an individual patient to a credit rating agency, as defined 271
334	334	in section 36a-695, for a period of one year beginning on the date that 272
335	335	such patient first receives a bill for health care provided by the hospital 273 Raised Bill No. 1203
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337	337
338	338
339	339	LCO No. 5093 10 of 11
340	340
341	341	or entity that is owned by or affiliated with such hospital to such patient 274
342	342	on or after October 1, 2022; 275
343	343	(2) Initiate an action to foreclose a lien on an individual patient's 276
344	344	primary residence if the lien was filed to secure payment for health care 277
345	345	provided by the hospital or entity that is owned by or affiliated with 278
346	346	such hospital to such patient on or after October 1, 2022; or 279
347	347	(3) Apply to a court for an execution against an individual patient's 280
348	348	wages pursuant to section 52-361a, or otherwise seek to garnish such 281
349	349	patient's wages, to collect payment for health care provided by the 282
350	350	hospital or entity that is owned by or affiliated with such hospital to 283
351	351	such patient [on or after October 1, 2022,] if such patient is eligible for 284
352	352	the hospital bed fund or other hospital financial assistance. 285
353	353	(d) Nothing in subsection (b) or (c) of this section shall affect the 286
354	354	ability of a hospital or entity that is owned by or affiliated with such 287
355	355	hospital to initiate an action against an individual patient or such 288
356	356	patient's estate to collect coinsurance, deductibles or fees arising from 289
357	357	health care provided at a hospital or entity that is owned by or affiliated 290
358	358	with such hospital where such coinsurance, deductibles or fees may be 291
359	359	eligible for reimbursement through awards, settlements or judgments 292
360	360	arising from claims, suits or proceedings. In addition, nothing in said 293
361	361	subsections shall affect the ability of a hospital or entity that is owned 294
362	362	by or affiliated with such hospital to initiate an action against an 295
363	363	individual patient or such patient's estate where payment or 296
364	364	reimbursement has been made, or likely is to be made, directly to the 297
365	365	patient. 298
366	366	Sec. 6. (NEW) (Effective October 1, 2023) (a) As used in this section, (1) 299
367	367	"federal 340B drug pricing program" means the plan described in 300
368	368	Section 340B of the Public Health Service Act, 42 USC 256b, as amended 301
369	369	from time to time, (2) "340B covered entity" means a provider 302
370	370	participating in the federal 340B drug pricing program, (3) "prescription 303
371	371	drug" has the same meaning as provided in section 19a-754b of the 304
372	372	general statutes, and (4) "rebate" has the same meaning as provided in 305 Raised Bill No. 1203
373	373
374	374
375	375
376	376	LCO No. 5093 11 of 11
377	377
378	378	section 38a-479ooo of the general statutes. 306
379	379	(b) No 340B covered entity shall attempt to collect as medical debt 307
380	380	any payment for a prescription drug obtained with a rebate or at a 308
381	381	discounted price through the federal 340B drug pricing program by 309
382	382	such entity but charged to a patient of such entity at a higher price. 310
383	383	Sec. 7. (NEW) (Effective July 1, 2023) As used in this section, "hospital 311
384	384	price transparency rule" has the same meaning as provided in 45 CFR 312
385	385	180 and requires hospitals to publicly post the costs of their items and 313
386	386	services online. Any hospital that violates the provisions of 45 CFR 180 314
387	387	shall not seek to recover as medical debt from any patient the cost of an 315
388	388	item or service that the hospital has failed to publicly disclose in 316
389	389	accordance with the requirements of such rule.317
390	390	This act shall take effect as follows and shall amend the following
391	391	sections:
392	392
393	393	Section 1 from passage New section
394	394	Sec. 2 October 1, 2023 19a-509b
395	395	Sec. 3 October 1, 2023 19a-649
396	396	Sec. 4 October 1, 2023 19a-673
397	397	Sec. 5 October 1, 2023 19a-673b
398	398	Sec. 6 October 1, 2023 New section
399	399	Sec. 7 July 1, 2023 New section
400	400
401	401	Statement of Purpose:
402	402	To ameliorate the burden of medical debt.
403	403	[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
404	404	that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
405	405	underlined.]
406	406