HLS 18RS-2126 ORIGINAL
2018 Regular Session
HOUSE BILL NO. 824
BY REPRESENTATIVE TALBOT
INSURANCE/HEALTH: Provides relative to facility disclosure requirements
1 AN ACT
2To amend and reenact R.S. 22:1880(C) and (E) and to enact R.S. 22:1880(F), relative to
3 balance billing facility disclosure requirements; to require a healthcare facility to
4 provide a list of out-of-network providers to a patient; to require notice to insureds
5 of possible balance billing for services provided at a healthcare facility; to require
6 the posting of information on the facility's website; and to provide for related
7 matters.
8Be it enacted by the Legislature of Louisiana:
9 Section 1. R.S. 22:1880(C) and (E) are hereby amended and reenacted and R.S.
1022:1880(F) is hereby enacted to read as follows:
11 ยง1880. Balance billing disclosure
12 * * *
13 C. Facility disclosure requirements. Each healthcare facility not providing
14 surgical services shall do all of the following:
15 (1) Provide a written notice to an enrollee or insured at the first registration
16 contact with the enrollee or insured at the healthcare facility regarding
17 nonemergency services. A copy of the written notice shall be signed by the enrollee
18 or insured and be maintained by the healthcare facility. The written notice shall
19 disclose all of the following items: information:
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HB NO. 824
1 (a) Confirmation as to whether the facility is a participating provider
2 contracted with the enrollee's or insured's health insurance issuer on the date services
3 are to be rendered, based on the information received from the enrollee or insured
4 at the time the confirmation is provided.
5 (b) The following balance billing disclosure notice in minimum 12 twelve
6 point typeface:
7 "NOTICE
8 Professional services rendered by independent healthcare professionals are
9 not part of the hospital bill. These services will be billed to the patient separately.
10 Please understand that physicians or other healthcare professionals may be called
11 upon to provide care or services to you or on your behalf, but you may not actually
12 see, or be examined by, all physicians or healthcare professionals participating in
13 your care; for example, you may not see physicians providing radiology, pathology,
14 and EKG interpretation. In many instances, there will be a separate charge for
15 professional services rendered by physicians to you or on your behalf, and you will
16 receive a bill for these professional services that is separate from the bill for hospital
17 services. These independent healthcare professionals may not participate in your
18 health plan and you may be responsible for payment of all or part of the fees for the
19 services provided by these physicians who have provided out-of-network services,
20 in addition to applicable amounts due for copayments, coinsurance, deductibles, and
21 non-covered noncovered services.
22 We encourage you to contact your health plan to determine whether the
23 independent healthcare professionals are participating with your health plan. In
24 order to obtain the most accurate and up-to-date information about in-network and
25 out-of-network independent healthcare professionals, please contact the customer
26 service number of your health plan or visit its website. Your health plan is the
27 primary source of information on its provider network and benefits. To help you
28 determine whether the independent healthcare professionals who provide services
29 at this facility are participating with your health plan, this healthcare facility has
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HB NO. 824
1 provided you with a complete list of the names and contact information for each
2 individual or group."
3 (2) Provide a list to the enrollee or insured that contains the name and
4 contact information for each individual or group of hospital-contracted
5 anesthesiologists, pathologists, radiologists, hospitalists, intensivists, and
6 neonatologists who provide services at that facility and inform the enrollee or
7 insured that the enrollee or insured may request information from their the enrollee's
8 or insured's health insurance issuer as to whether those physicians are contracted
9 with the health insurance issuer and under what circumstances the enrollee or insured
10 may be responsible for payment of any amounts not paid by the health insurance
11 issuer.
12 (3) If the facility operates a website that includes a listing of physicians who
13 have been granted medical staff privileges to provide medical services at the facility,
14 post on the facility's website a list that contains the name and contact information for
15 each facility-based physician or facility-based physician group that has been granted
16 medical staff privileges to provide medical services at the facility, and an update of
17 the list within thirty days of any changes.
18 (4) If a facility meets the definition of a provider-based entity, as defined by
19 42 CFR 413.65, and the facility is located off of the main hospital campus the facility
20 shall disclose to the enrollee or insured the following:
21 (a) That the enrollee or insured is receiving services in a hospital-based
22 outpatient facility where the facility provides the use of the facility, medical, or
23 technical equipment, supplies, staff, and services.
24 (b) That depending on the enrollee's or insured's health insurance benefit
25 plan and the actual services furnished by the facility, the patient may receive a
26 facility charge billed separately from the physician that covers the fees for the use
27 of the facility, medical, or technical equipment, supplies, staff, and services.
28 * * *
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1 E. Facility disclosure requirements prior to nonemergency surgery. Each
2 healthcare facility providing surgical services shall do all of the following:
3 (1) Provide a written notice to an enrollee or insured no later than seventy-
4 two hours prior to the scheduled date of a nonemergency surgical procedure. A copy
5 of the written notice shall be signed by the enrollee or insured and be maintained by
6 the healthcare facility. The written notice shall disclose all of the following
7 information:
8 (a) Confirmation as to whether the facility is a participating provider
9 contracted with the enrollee's or insured's health insurance issuer on the date services
10 are to be rendered, based on the information received from the enrollee or insured
11 at the time the confirmation is provided.
12 (b) The following balance billing disclosure notice:
13 "NOTICE
14 Professional services rendered by independent healthcare professionals are
15 not part of the hospital bill. These services will be billed to the patient separately.
16 Please understand that physicians or other healthcare professionals may be called
17 upon to provide care or services to you or on your behalf, but you may not actually
18 see, or be examined by, all physicians or healthcare professionals participating in
19 your care; for example, you may not see physicians providing radiology, pathology,
20 and EKG interpretation. In many instances, there will be a separate charge for
21 professional services rendered by physicians to you or on your behalf, and you will
22 receive a bill for these professional services that is separate from the bill for hospital
23 services. These independent healthcare professionals may not participate in your
24 health plan and you may be responsible for payment of all or part of the fees for the
25 services provided by these physicians who have provided out-of-network services,
26 in addition to applicable amounts due for copayments, coinsurance, deductibles, and
27 noncovered services.
28 We encourage you to contact your health plan to determine whether the
29 independent healthcare professionals are participating with your health plan. In
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HB NO. 824
1 order to obtain the most accurate and up-to-date information about in-network and
2 out-of-network independent healthcare professionals, please contact the customer
3 service number of your health plan or visit its website. Your health plan is the
4 primary source of information on its provider network and benefits. To help you
5 determine whether the independent healthcare professionals who provide services
6 at this facility are participating with your health plan, this healthcare facility has
7 provided you with a complete list of the names and contact information for each
8 individual or group."
9 (c) A list of all facility-based providers who will be providing services
10 during the surgical procedure but whose services are not included in the fee charged
11 by the healthcare facility and who will bill the enrollee or insured separately.
12 (2) Provide a list, upon request from an enrollee or insured, that contains the
13 name and contact information for each individual or group of hospital-contracted
14 anesthesiologists, pathologists, radiologists, hospitalists, intensivists, and
15 neonatologists who provide services at that facility and inform the enrollee or
16 insured that the enrollee or insured may request information from the enrollee's or
17 insured's health insurance issuer as to whether those providers are contracted with
18 the health insurance issuer and under what circumstances the enrollee or insured may
19 be responsible for payment of any amounts not paid by the health insurance issuer.
20 (3) If the facility operates a website that includes a listing of providers who
21 have been granted medical staff privileges to provide medical services at the facility,
22 post on the facility's website a list that contains the name and contact information for
23 each facility-based provider or facility-based provider group that has been granted
24 medical staff privileges to provide medical services at the facility, and an update of
25 the list within thirty days of any changes.
26 F. The provisions of this Section shall be enforced in accordance with R.S.
27 22:1879(D) and (E).
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HB NO. 824
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 824 Original 2018 Regular Session Talbot
Abstract: Requires a healthcare facility, at least 72 hours prior to the scheduled date of a
nonemergency surgery, to advise a patient of the potential use of out-of-network
providers.
Present law requires a healthcare facility, at the first registration contact with a patient, to
provide a written notice to the patient regarding the possibility of services being rendered
to the patient by facility-based providers who are out-of-network providers. Present law
further requires that the patient be informed in the written notice that the patient may be
responsible for all or part of the fees for out-of-network services.
Proposed law limits present law to facilities not providing surgical services.
Proposed law requires a healthcare facility providing surgical services, at least 72 hours prior
to a scheduled nonemergency surgery, to provide a written notice to the patient regarding
the possibility of services being rendered to the patient by facility-based providers who are
out-of-network providers and a list of all providers who will be providing services during
the surgical procedure whose fees are not included in the fees charged by the facility.
Proposed law further requires that the patient be informed in the written notice that the
patient may be responsible for all or part of the fees for out-of-network services.
(Amends R.S. 22:1880(C) and (E); Adds R.S. 22:1880(F))
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