Bill Summary – FastDemocracy

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68th Legislature 2023                                                                                              HB 45.1
                                                 HOUSE BILL NO. 45
                                            INTRODUCED BY B. KEENAN
                BY REQUEST OF THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES
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  A BILL FOR AN ACT ENTITLED: “AN ACT REVISING LAWS RELATING TO HOSPITAL CHARITY CARE
  AND COMMUNITY BENEFIT REQUIREMENTS; AUTHORIZING THE DEPARTMENT OF PUBLIC HEALTH
  AND HUMAN SERVICES TO ESTABLISH CHARITY CARE AND COMMUNITY BENEFIT STANDARDS FOR
  NONPROFIT HOSPITALS; ESTABLISHING CHARITY CARE AND COMMUNITY BENEFIT REPORTING
  REQUIREMENTS; PROVIDING RULEMAKING AUTHORITY; AND AMENDING SECTIONS 50-5-106, 50-5-
  112, 50-5-121, AND 50-5-245, MCA.”
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  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
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          Section 1. Section 50-5-106, MCA, is amended to read:
          "50-5-106.   Records and reports required of health care facilities -- confidentiality. (1) Health
  care facilities shall keep records and make reports as required by the department.
          (2)      Before February 1 April 15 of each year, every licensed health care facility shall submit an
  annual report for the preceding calendar year to the department.
          (3)      Before April 15 of each year, every hospital that is operating as a nonprofit health care facility
  shall submit to the department:
          (a)      both a charity care report and a community benefit report for the preceding year; and
          (b)      both a charity care plan and a community benefit plan for the current calendar year.
          (4)      (a) The report Reports required under this section must be on forms and contain information
  specified by the department.
          (b)      To the extent practicable, the department shall limit the information to be submitted for the
  charity care and community benefit reports required under subsection (3)(a) to data that is already being
  collected by the hospital.
          (5)      Information received by the department through reports, inspections, or provisions of parts 1
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68th Legislature 2023                                                                                                HB 45.1
  and 2 may not be disclosed in a way which that would identify patients. A department employee who discloses
  information that would identify a patient must be dismissed from employment and subject to the provisions of
  45-7-401 and 50-16-551, if applicable, unless the disclosure was authorized as permitted by law.
             (6)    Information and statistical reports from health care facilities which that are considered
  necessary by the department for health planning and resource development activities must be made available
  to the public and the health planning agencies within the state. Applications by health care facilities for
  certificates of need and any information relevant to review of these applications, pursuant to part 3, must be
  accessible to the public."
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             Section 2. Section 50-5-112, MCA, is amended to read:
             "50-5-112.   Civil penalties. (1) A Except as provided in 50-5-121, a person who commits an act
  prohibited by 50-5-111 is subject to a civil penalty not to exceed $1,000 for each day that a facility is in violation
  of a provision of part 1 or 2 of this chapter or of a rule, license provision, or order adopted or issued pursuant to
  part 1 or 2. The department or, upon request of the department, the county attorney of the county in which the
  health care facility in question is located may petition the court to impose the civil penalty. Venue for an action
  to collect a civil penalty pursuant to this section is in the county in which the facility is located.
             (2)    In determining the amount of penalty to be assessed for an alleged violation under this section,
  the court shall consider:
             (a)    the gravity of the violation in terms of the degree of physical or mental harm to a resident or
  patient;
             (b)    the degree of harm to the health, safety, rights, security, or welfare of a resident or patient;
             (c)    the degree of deviation committed by the facility from a requirement imposed by part 1 or 2 of
  this chapter or by a rule, license provision, or order adopted or issued pursuant to part 1 or 2; and
             (d)    other matters as justice may require.
             (3)    A penalty collected under this section must be deposited in the state general fund.
             (4)    In addition to or exclusive of the remedy provided in subsection (1), the department may pursue
  remedies available for a violation, as provided for in 50-5-108, or any other remedies available to it."
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68th Legislature 2023                                                                                                HB 45.1
          Section 3. Section 50-5-121, MCA, is amended to read:
          "50-5-121.      Hospital discrimination based on ability to pay prohibited -- community benefit and
  charity care requirements -- rulemaking authority. (1) (a) Except as provided in subsection (3), a A hospital
  must have in writing:
          (a)    a policy applying to all patients, including medicaid and medicare patients, that prohibits
  discrimination based on a patient's ability to pay; and.
          (b)    a charity care policy consistent with industry standards applicable to the area the facility serves
  and the tax status of the hospital.
          (2)(b)    A hospital may not transfer a patient to another hospital or health care facility based on the
  patient's ability to pay for health care services.
          (2)       (a) A hospital operating as a nonprofit health care facility must have in writing:
          (i)       a charity care policy consistent with federal standards and standards established by the
  department, applicable to the area the hospital serves; and
          (ii)      a community benefit policy consistent with federal standards and standards established by the
  department.
          (b)       A hospital operating as a nonprofit health care facility shall:
          (i)       adhere to the written charity care and community benefit policies; and
          (ii)      make the policies available to the public.
          (3)    A specialty hospital must have in writing a charity care policy consistent with industry standards for
  nonprofit hospitals irrespective of the tax status of the specialty hospital.
          (3)       No later than July 1, 2024, the department shall adopt rules to implement the charity care and
  community benefit requirements of this part, including but not limited to rules to:
          (a)       define charity care and community benefit;
          (b)       establish the standards for community benefit and charity care applicable to hospitals operating
  as nonprofit health care facilities;
          (c)       establish the information to be reported and verified to ensure a hospital operating as a
  nonprofit health care facility is complying with charity care and community benefit standards; and
          (d)       establish penalties for failing to comply with 50-5-106 and this section. The penalties may be in
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68th Legislature 2023                                                                                                HB 45.1
  addition to the penalties provided for in 50-5-112."
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          Section 4. Section 50-5-245, MCA, is amended to read:
          "50-5-245.    Department to license specialty hospitals -- standards -- rulemaking -- moratorium.
  (1) Subject to subsection (4), the department shall license specialty hospitals using the requirements for
  licensure of hospitals and the procedure provided for in parts 1 and 2 of this chapter.
          (2)      Prior to approving an application under this section, the department shall adopt rules that are
  necessary to implement and administer this section.
          (3)      Notwithstanding the requirements of subsection (1), the department may not accept an
  application or issue a license for a specialty hospital before July 1, 2009.
          (4)      A health care facility licensed by the department and in existence on May 8, 2007, may not
  change its licensure status in order to qualify for licensure as a specialty hospital unless the health care facility
  is licensed as a hospital and the hospital is not subject to the provisions of 50-5-246 and subsections (5)
  through (9) of this section.
          (5)      A specialty hospital meets the 24-hour emergency care requirements for a hospital, as defined
  in 50-5-101, if it has an agreement with a hospital in the area served by the specialty hospital stating that the
  hospital will provide 24-hour emergency care to patients of the specialty hospital.
          (6)      A specialty hospital applying for a license must have:
          (a)      a charity care policy meeting the provisions of 50-5-121 and, if applicable, subsection (9) of this
  section if the hospital will be operating as a nonprofit health care facility or meeting the provisions of subsection
  (9) of this section, if applicable; and
          (b)      a joint venture relationship with a hospital; or
          (c)      a signed statement from a nonprofit hospital operating as a nonprofit health care facility in the
  community acknowledging that the hospital declined a bona fide, good faith opportunity to participate in a joint
  venture with the applicant.
          (7)      A specialty hospital owned by physicians and proposed as a joint venture with a nonprofit
  hospital operating as a nonprofit health care facility in the community may be licensed if:
          (a)      the majority of partnering physicians hold active privileges with the joint venture hospital; and
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68th Legislature 2023                                                                                                HB 45.1
          (b)      the partnering hospital holds an ownership interest of at least 50%.
          (8)      This section does not prohibit physicians who are partners in a specialty hospital that is
  proposed as a joint venture from managing the specialty hospital.
          (9)      The charity care policy for a specialty hospital applying as a joint venture with a nonprofit
  hospital operating as a nonprofit health care facility in the community must be the same as the policy used by
  the nonprofit hospital."
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          NEW SECTION. Section 5.         Transition. (1) The department of public health and human services may
  not require the submission of the charity care report and community benefit report required under [this act] until
  the department has adopted rules specifying the information to be reported.
          (2)      A hospital charity care policy required under [this act] may comply with only federal charity care
  standards until the department of public health and human services has adopted rules specifying state
  standards for the policy.
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Statutes affected: 
HB0045_1.pdf: 50-5-106, 50-5-112, 50-5-121, 50-5-245
HB0045_2.pdf: 50-5-106, 50-5-112, 50-5-121, 50-5-245
HB0045_X.pdf: 50-5-106, 50-5-112, 50-5-121, 50-5-245
Amended: 50-5-106, 50-5-112, 50-5-121, 50-5-245
Introduced: 50-5-106, 50-5-112, 50-5-121, 50-5-245