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46 | 39 | | |
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47 | 40 | | COMMITTEE SUBSTITUTE |
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48 | 41 | | |
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49 | 42 | | An Act relating to medical price transparency; |
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50 | 43 | | amending 63 O.S. 2021, Section 1-725.3, which relates |
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51 | 44 | | to health care provider price transparency; creating |
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52 | 45 | | penalties; providing for the allocation of penalties ; |
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53 | 46 | | amending 63 O.S. 2021, Section 1-725.4, which relates |
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54 | 47 | | to health care facility price transparency; creating |
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55 | 48 | | penalties; providing for the allocation of penalties; |
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56 | 49 | | and providing an effective date . |
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57 | 50 | | |
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58 | 51 | | |
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59 | 52 | | |
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60 | 53 | | |
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65 | 54 | | BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: |
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66 | 55 | | SECTION 1. AMENDATORY 63 O.S. 2021, Section 1-725.3, is |
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67 | 56 | | amended to read as follows : |
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68 | 57 | | Section 1-725.3 A. A health care provider shall make available |
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69 | 58 | | to the public, in a single do cument, either electronically or by |
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70 | 59 | | posting conspicuously on the provider 's website if one exists, the |
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102 | 90 | | provider shall make available the health care price s for the health |
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103 | 91 | | care services the provider most commonly provides. |
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104 | 92 | | B. The health care provider shall identify the services by: |
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105 | 93 | | 1. A Current Procedural Terminology code or other coding system |
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106 | 94 | | commonly used by the health care provider and accepted as a na tional |
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107 | 95 | | standard for billing; and |
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108 | 96 | | 2. A plain English description. |
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109 | 97 | | C. The health care provide r shall update the document as |
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110 | 98 | | frequently as the health care provider deems appropriate, but at |
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111 | 99 | | least annually. |
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112 | 100 | | D. On or after the effective date of this act, a health care |
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113 | 101 | | provider who is not in material compliance with Section 2718(e) of |
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114 | 102 | | the Public Health Service Act, P.L. 78-410, as amended, and rules |
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115 | 103 | | adopted by the United States Department of Health and Human Services |
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116 | 104 | | implementing Section 2718(e), with respect to "items of services" or |
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117 | 105 | | "items or services" as defined in 45 CFR 180.20, on the date that |
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118 | 106 | | items or services are purchased from or provided to a patient by the |
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119 | 107 | | health care provider , shall not initiate or pursue a collection |
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120 | 108 | | action against the patient or patient guarantor f or a debt owed for |
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121 | 109 | | the items or services. |
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153 | 140 | | provider takes collection action against the patient or patient |
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154 | 141 | | guarantor, the patient or patien t guarantor may file suit to |
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155 | 142 | | determine if the health care provider was materially out of |
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156 | 143 | | compliance with the Transparency in Health Care Prices Act, Section |
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157 | 144 | | 1-725.1 et seq. of this title, on the date of service , and the |
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158 | 145 | | noncompliance is related to the items or services . The health care |
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159 | 146 | | provider shall not take collection action against the patient or |
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160 | 147 | | patient guarantor while the lawsuit is pending. |
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161 | 148 | | F. A health care provider who has been found by a judge or |
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162 | 149 | | jury, considering compliance standards issued by the Centers for |
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163 | 150 | | Medicare and Medicaid Services, to be materially out of compliance |
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164 | 151 | | with the Transparency in Health Care Prices Act, Section 1-725.1 et |
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165 | 152 | | seq. of this title: |
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166 | 153 | | 1. Shall refund the payer any amount of the debt the payer has |
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167 | 154 | | paid and shall pay a penalty to the patient or patient guarantor in |
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168 | 155 | | an amount equal to the total amount of the debt; |
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169 | 156 | | 2. Shall dismiss or cause to be dismissed any court action with |
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170 | 157 | | prejudice and pay any attorney fees and costs incurred by the |
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171 | 158 | | patient or patient guarantor re lating to the action ; and |
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203 | 189 | | 1. Prohibit a health care provider from billing a patient , |
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204 | 190 | | patient guarantor, or third-party payer, including a health insurer, |
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205 | 191 | | for items or services provided to the patient; and |
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206 | 192 | | 2. Require a health care provider to refund any payment made to |
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207 | 193 | | the health care provider for items or services provided to the |
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208 | 194 | | patient, so long as no collection action is taken in violation of |
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209 | 195 | | this section. |
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210 | 196 | | SECTION 2. AMENDATORY 63 O.S. 2021, Section 1-725.4, is |
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211 | 197 | | amended to read as follows : |
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212 | 198 | | Section 1-725.4 A. A health care facility shall make available |
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213 | 199 | | to the public, in a single document, either electronically or by |
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214 | 200 | | posting conspicuously on its web site if one exists, the health care |
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215 | 201 | | prices for at least: |
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216 | 202 | | 1. The twenty most used dia gnosis-related group codes or other |
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217 | 203 | | codes for inpatient health care services per specialty s ervice line |
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218 | 204 | | used by the health care facility for billing; and |
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219 | 205 | | 2. The twenty most used outpatient CPT codes or health care |
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220 | 206 | | services procedure codes per specialty se rvice line used for |
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221 | 207 | | billing. |
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253 | 238 | | C. The health care facility shall update the document as |
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254 | 239 | | frequently as it deems appropriate, but at least an nually. |
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255 | 240 | | D. On or after the effective date of t his act, a health care |
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256 | 241 | | facility that is not in material compliance with the Transparency in |
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257 | 242 | | Health Care Prices Act , Section 1-725.1 et seq. of this title, on |
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258 | 243 | | the date that items or s ervices are purchased by or provided to a |
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259 | 244 | | patient by the health care facility, shall not initiate or pursue a |
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260 | 245 | | collection action against the patient or patient guarantor for a |
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261 | 246 | | debt owed for the items or servi ces. |
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262 | 247 | | E. If a patient can demonstrate that a health care facility was |
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263 | 248 | | not in material compliance with federal laws, on or after the |
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264 | 249 | | effective date of this act, that items or services were purchased by |
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265 | 250 | | or provided to the patient , and the health care facility takes |
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266 | 251 | | collection action against the patient or patient guarantor , the |
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267 | 252 | | patient or patient guarantor may file suit to determine if the |
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268 | 253 | | health care facility was materially out of compliance with Section |
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269 | 254 | | 2718(e) of the Public Health Service Act, P.L. 78-410, as amended, |
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270 | 255 | | and rules adopted by the United States Department of Health and |
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271 | 256 | | Human Services implementing Section 2718(e), with respect to "items |
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272 | 257 | | of services" or "items or services" as defined in 45 CFR 180.20, on |
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304 | 288 | | F. A health care facility that has been found by a judge or |
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305 | 289 | | jury, considering compliance standards issued by the Centers for |
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306 | 290 | | Medicare and Medicaid Services, to be materially out of compliance |
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307 | 291 | | with the Transparency in Health Care Prices Act, Section 1-725.1 et |
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308 | 292 | | seq. of this title: |
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309 | 293 | | 1. Shall refund the payer any amount of the debt the payer has |
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310 | 294 | | paid and shall pay a penalty to the patient or patient guarantor in |
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311 | 295 | | an amount equal to the total amount of the debt; |
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312 | 296 | | 2. Shall dismiss or cause to be dismissed any court actio n with |
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313 | 297 | | prejudice and pay any attorney fees and costs incurred by the |
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314 | 298 | | patient or patient guarantor re lating to the action; and |
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315 | 299 | | 3. Shall remove or cause to be removed from the patient's or |
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316 | 300 | | patient guarantor's credit report any report made to a consumer |
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317 | 301 | | reporting agency relating to the debt. |
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318 | 302 | | G. Nothing in this section shall: |
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319 | 303 | | 1. Prohibit a health care facility from billing a patient, |
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320 | 304 | | patient guarantor, or third-party payer, including a health insurer, |
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321 | 305 | | for items or services provided to the patient ; and |
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322 | 306 | | 2. Require a health care facility to refund any payment made to |
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323 | 307 | | the health care facility for i tems or services provided to t he |
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