Bill Summary – FastDemocracy

General Assembly                       Raised Bill No. 6488
      January Session, 2021                  LCO No. 3368
     Referred to Committee on PUBLIC HEALTH
     Introduced by:
       (PH)
 AN ACT CONCERNING THE OFFICE OF HEALTH STRATEGY'S
 RECOMMENDATIONS REGARDING VARIOUS REVISIONS TO
 HOSPITAL OR HEALTH SYSTEM FACILITY FEES.
 Be it enacted by the Senate and House of Representatives in General
 Assembly convened:
       Section 1. Section 19a-508c of the general statutes is repealed and the
    following is substituted in lieu thereof (Effective from passage):
      (a) As used in this section:
      (1) "Affiliated provider" means a provider that is: (A) Employed by a
   hospital or health system, (B) under a professional services agreement
   with a hospital or health system that permits such hospital or health
   system to bill on behalf of such provider, or (C) a clinical faculty member
   of a medical school, as defined in section 33-182aa, that is affiliated with
   a hospital or health system in a manner that permits such hospital or
   health system to bill on behalf of such clinical faculty member;
      (2) "Campus" means: (A) The physical area immediately adjacent to a
   hospital's main buildings and other areas and structures that are not
   strictly contiguous to the main buildings but are located within two
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 hundred fifty yards of the main buildings, or (B) any other area that has
 been determined on an individual case basis by the Centers for Medicare
 and Medicaid Services to be part of a hospital's campus;
    (3) "Facility fee" means any fee charged or billed by a hospital or
 health system for outpatient services provided in a hospital-based
 facility that is: (A) Intended to compensate the hospital or health system
 for the operational expenses of the hospital or health system, and (B)
 separate and distinct from a professional fee;
   (4) "Health system" means: (A) A parent corporation of one or more
 hospitals and any entity affiliated with such parent corporation through
 ownership, governance, membership or other means, or (B) a hospital
 and any entity affiliated with such hospital through ownership,
 governance, membership or other means;
   (5) "Hospital" has the same meaning as provided in section 19a-490;
   (6) "Hospital-based facility" means a facility that is owned or
 operated, in whole or in part, by a hospital or health system where
 hospital or professional medical services are provided;
    (7) "Payer mix" means the proportion of different sources of payment
 received by a hospital or health system, including, but not limited to,
 Medicare, Medicaid, other government-provided insurance, private
 insurance and self-pay patients;
    [(7)] (8) "Professional fee" means any fee charged or billed by a
 provider for professional medical services provided in a hospital-based
 facility; and
     [(8)] (9) "Provider" means an individual, entity, corporation or health
 care provider, whether for profit or nonprofit, whose primary purpose
 is to provide professional medical services.
   (b) If a hospital or health system charges a facility fee utilizing a
 current procedural terminology evaluation and management (CPT
 E/M) code for outpatient services provided at a hospital-based facility
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 where a professional fee is also expected to be charged, the hospital or
 health system shall provide the patient with a written notice that
 includes the following information:
     (1) That the hospital-based facility is part of a hospital or health
 system and that the hospital or health system charges a facility fee that
 is in addition to and separate from the professional fee charged by the
 provider;
    (2) (A) The amount of the patient's potential financial liability,
 including any facility fee likely to be charged, and, where professional
 medical services are provided by an affiliated provider, any professional
 fee likely to be charged, or, if the exact type and extent of the
 professional medical services needed are not known or the terms of a
 patient's health insurance coverage are not known with reasonable
 certainty, an estimate of the patient's financial liability based on typical
 or average charges for visits to the hospital-based facility, including the
 facility fee, (B) a statement that the patient's actual financial liability will
 depend on the professional medical services actually provided to the
 patient, (C) an explanation that the patient may incur financial liability
 that is greater than the patient would incur if the professional medical
 services were not provided by a hospital-based facility, and (D) a
 telephone number the patient may call for additional information
 regarding such patient's potential financial liability, including an
 estimate of the facility fee likely to be charged based on the scheduled
 professional medical services; and
    (3) That a patient covered by a health insurance policy should contact
 the health insurer for additional information regarding the hospital's or
 health system's charges and fees, including the patient's potential
 financial liability, if any, for such charges and fees.
    (c) If a hospital or health system charges a facility fee without
 utilizing a current procedural terminology evaluation and management
 (CPT E/M) code for outpatient services provided at a hospital-based
 facility, located outside the hospital campus, the hospital or health
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 system shall provide the patient with a written notice that includes the
 following information:
    (1) That the hospital-based facility is part of a hospital or health
 system and that the hospital or health system charges a facility fee that
 may be in addition to and separate from the professional fee charged by
 a provider;
    (2) (A) A statement that the patient's actual financial liability will
 depend on the professional medical services actually provided to the
 patient, (B) an explanation that the patient may incur financial liability
 that is greater than the patient would incur if the hospital-based facility
 was not hospital-based, and (C) a telephone number the patient may call
 for additional information regarding such patient's potential financial
 liability, including an estimate of the facility fee likely to be charged
 based on the scheduled professional medical services; and
    (3) That a patient covered by a health insurance policy should contact
 the health insurer for additional information regarding the hospital's or
 health system's charges and fees, including the patient's potential
 financial liability, if any, for such charges and fees.
    (d) [On and after January 1, 2016, each] Each initial billing statement
 that includes a facility fee shall: (1) Clearly identify the fee as a facility
 fee that is billed in addition to, or separately from, any professional fee
 billed by the provider; (2) provide the corresponding Medicare facility
 fee reimbursement rate for the same service as a comparison or, if there
 is no corresponding Medicare facility fee for such service, (A) the
 approximate amount Medicare would have paid the hospital for the
 facility fee on the billing statement, or (B) the percentage of the hospital's
 charges that Medicare would have paid the hospital for the facility fee;
 (3) include a statement that the facility fee is intended to cover the
 hospital's or health system's operational expenses; (4) inform the patient
 that the patient's financial liability may have been less if the services had
 been provided at a facility not owned or operated by the hospital or
 health system; and (5) include written notice of the patient's right to
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 request a reduction in the facility fee or any other portion of the bill and
 a telephone number that the patient may use to request such a reduction
 without regard to whether such patient qualifies for, or is likely to be
 granted, any reduction. Not later than October 1, 2021, and annually
 thereafter, each hospital, health system and hospital-based facility shall
 submit to the Health Planning Unit of the Office of Health Strategy a
 sample of a billing statement issued by such hospital, health system or
 hospital-based facility that complies with the provisions of this
 subsection and which represents the format of billing statements
 received by patients. Such billing statement shall not contain patient
 identifying information.
    (e) The written notice described in subsections (b) to (d), inclusive,
 and (h) to (j), inclusive, of this section shall be in plain language and in
 a form that may be reasonably understood by a patient who does not
 possess special knowledge regarding hospital or health system facility
 fee charges. On and after October 1, 2021, such notices shall be printed
 in at least the top fifteen languages spoken in the state, as determined
 by statistics prepared by the United States Census Bureau, based on the
 most recent decennial census.
    (f) (1) For nonemergency care, if a patient's appointment is scheduled
 to occur ten or more days after the appointment is made, such written
 notice shall be sent to the patient by first class mail, encrypted electronic
 mail or a secure patient Internet portal not less than three days after the
 appointment is made. If an appointment is scheduled to occur less than
 ten days after the appointment is made or if the patient arrives without
 an appointment, such notice shall be hand-delivered to the patient when
 the patient arrives at the hospital-based facility.
    (2) For emergency care, such written notice shall be provided to the
 patient as soon as practicable after the patient is stabilized in accordance
 with the federal Emergency Medical Treatment and Active Labor Act,
 42 USC 1395dd, as amended from time to time, or is determined not to
 have an emergency medical condition and before the patient leaves the
 hospital-based facility. If the patient is unconscious, under great duress
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 or for any other reason unable to read the notice and understand and
 act on his or her rights, the notice shall be provided to the patient's
 representative as soon as practicable.
    (g) Subsections (b) to (f), inclusive, and (l) of this section shall not
 apply if a patient is insured by Medicare or Medicaid or is receiving
 services under a workers' compensation plan established to provide
 medical services pursuant to chapter 568.
    (h) A hospital-based facility shall prominently display written notice
 in locations that are readily accessible to and visible by patients,
 including patient waiting or appointment check-in areas, stating: (1)
 That the hospital-based facility is part of a hospital or health system, (2)
 the name of the hospital or health system, and (3) that if the hospital-
 based facility charges a facility fee, the patient may incur a financial
 liability greater than the patient would incur if the hospital-based
 facility was not hospital-based. On and after October 1, 2021, each such
 written notice shall be printed in at least the top fifteen languages
 spoken in the state, as determined by statistics prepared by the United
 States Census Bureau, based on the most recent decennial census. Not
 later than October 1, 2021, and annually thereafter, each hospital-based
 facility shall submit a copy of the written notice required by this
 subsection to the Health Systems Planning Unit of the Office of Health
 Strategy.
    (i) A hospital-based facility shall clearly hold itself out to the public
 and payers as being hospital-based, including, at a minimum, by stating
 the name of the hospital or health system in its signage, marketing
 materials, Internet web sites and stationery.
    (j) A hospital-based facility shall, when scheduling services for which
 a facility fee may be charged, inform the patient (1) that the hospital-
 based facility is part of a hospital or health system, (2) of the name of the
 hospital or health system, (3) that the hospital or health system may
 charge a facility fee in addition to and separate from the professional fee
 charged by the provider, and (4) of the telephone number the patient
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 may call for additional information regarding such patient's potential
 financial liability.
    (k) (1) [On and after January 1, 2016, if any transaction, as] If any
 transaction described in subsection (c) of section 19a-486i, results in the
 establishment of a hospital-based facility at which facility fees [will
 likely] may be billed, the hospital or health system, that is the purchaser
 in such transaction shall, not later than thirty days after such transaction,
 provide written notice, by first class mail, of the transaction to each
 patient served within the [previous] three years preceding the date of
 the transaction by the health care facility that has been purchased as part
 of such transaction. On and after January 1, 2022, such hospital or health
 system shall, not later than thirty days after such transaction, provide
 written notice by first class mail, or any other method that provides
 individual notice, to each patient served within the three years
 preceding the date of the transaction by the health care facility that has
 been purchased as part of such transaction.
    (2) Such notice shall include the following information:
    (A) A statement that the health care facility is now a hospital-based
 facility and is part of a hospital or health system, the health care facility's
 full legal and business name and the date of such facility's acquisition
 by a hospital or health system;
   (B) The name, business address and phone number of the hospital or
 health system that is the purchaser of the health care facility;
    (C) A statement that the hospital-based facility bills, or is likely to bill,
 patients a facility fee that may be in addition to, and separate from, any
 professional fee billed by a health care provider at the hospital-based
 facility;
   (D) (i) A statement that the patient's actual financial liability will
 depend on the professional medical services actually provided to the
 patient, and (ii) an explanation that the patient may incur financial
 liability that is greater than the patient would incur if the hospital-based
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 facility were not a hospital-based facility;
    (E) The estimated amount or range of amounts the hospital-based
 facility may bill for a facility fee or an example of the average facility fee
 billed at such hospital-based facility for the most common services
 provided at such hospital-based facility; and
    (F) A statement that, prior to seeking services at such hospital-based
 facility, a patient covered by a health insurance policy should contact
 the patient's health insurer for additional information regarding the
 hospital-based facility fees, including the patient's potential financial
 liability, if any, for such fees.
    (3) A copy of the written notice provided to patients in accordance
 with this subsection shall be filed with the Health Systems Planning
 Unit of the Office of Health Strategy, established under section 19a-612.
 Said unit shall post a link to such notice on its Internet web site.
    (4) A hospital, health system or hospital-based facility shall not collect
 a facility fee for services provided at a hospital-based facility that is
 subject to the provisions of this subsection from the date of the
 transaction until at least thirty days after the written notice required
 pursuant to this subsection is mailed to the patient or a copy of such
 notice is filed with the Health Systems Planning Unit, whichever is later.
 A violation of this subsection shall be considered an unfair trade
 practice pursuant to section 42-110b.
    (5) Not later than July 1, 2022, and annually thereafter, each hospital-
 based facility that was the subject of a transaction, as described in
 subsection (c) of section 19a-486i, during the preceding calendar year
 shall report to the Health Systems Planning Unit the number of patients
 served by such hospital-based facility in the preceding three years, the
 number of patients notified in accordance with the provisions of this
 subsection and t