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