Bill Summary – FastDemocracy

Enrolled Copy                                                                             S.B. 155
                              MEDICAL BILLING AMENDMENTS
                                          2020 GENERAL SESSION
                                             STATE OF UTAH
                                       Chief Sponsor: Karen Mayne
                                House Sponsor: Timothy D. Hawkes
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 LONG TITLE
 General Description:
         This bill enacts provisions related to balance billing for certain health care services.
 Highlighted Provisions:
         This bill:
         < requires health care facilities and health care providers who engage in balance
 billing for certain health care services to submit a report to the Insurance
 Department;
         < requires an insurer to provide certain information regarding reimbursement for
 emergency services to the Insurance Department;
         < specifies the information that must be reported by a health care provider, a health
 care facility, or a health insurer;
         < creates a reporting requirement; and
         < creates a sunset date.
 Money Appropriated in this Bill:
         None
 Other Special Clauses:
         None
 Utah Code Sections Affected:
 AMENDS:
         26-21-27, as enacted by Laws of Utah 2010, Chapter 68
         58-1-508, as last amended by Laws of Utah 2018, Chapter 203
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         63G-2-305, as last amended by Laws of Utah 2019, Chapters 128, 193, 244, and 277
         63I-2-231, as last amended by Laws of Utah 2019, Chapter 55
 ENACTS:
         31A-22-653, Utah Code Annotated 1953
33
 Be it enacted by the Legislature of the state of Utah:
         Section 1. Section 26-21-27 is amended to read:
         26-21-27. Reporting certain health care facility charges.
         (1) Beginning January 1, 2011, a health care facility licensed under this chapter shall,
 when requested by a consumer:
         [(1)] (a) make a list of prices charged by the facility available for the consumer that
 includes the facility's:
         [(a)] (i) in-patient procedures;
         [(b)] (ii) out-patient procedures;
         [(c)] (iii) the 50 most commonly prescribed drugs in the facility;
         [(d)] (iv) imaging services; and
         [(e)] (v) implants; and
         [(2)] (b) provide the consumer with information regarding any discounts the facility
 provides for:
         [(a)] (i) charges for services not covered by insurance; or
         [(b)] (ii) prompt payment of billed charges.
         (2) A health care provider that is subject to the reporting requirement in Section
 31A-22-653 shall submit information to the Insurance Department in accordance with Section
 31A-22-653.
         Section 2. Section 31A-22-653 is enacted to read:
         31A-22-653. Emergency service balance billing report -- Rulemaking -- Immunity
 -- Reporting requirement.
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        (1) As used in this section:
        (a) (i) "Balance billing" means the practice of a qualified provider billing an enrollee of
 a health benefit plan who is a Utah resident for the difference between the qualified provider's
 charge and the insurer's allowed amount.
        (ii) "Balance billing" does not include a qualified provider billing an enrollee of a
 health benefit plan for cost sharing, including copayments, coinsurance, and deductibles,
 required under the enrollee's health benefit plan.
        (b) "Emergency service" means:
        (i) emergency services as defined in 29 C.F.R. Sec. 2590.715-2719A(b)(4)(ii); and
        (ii) services related to emergency services under Subsection (1)(b)(i) that:
        (A) are provided by a qualified provider after the condition of the enrollee of a health
 benefit plan is no longer considered an emergency medical condition as defined in Section
 31A-22-627; and
        (B) stabilize as defined in 42 U.S.C. Sec. 1395dd(e)(3), improve, or resolve the
 condition of the enrollee of a health benefit plan.
        (c) "Qualified provider" means a person who:
        (i) provides an emergency service from July 1, 2020, through June 30, 2021; and
        (ii) (A) is licensed to provide health care services under Title 58, Occupations and
 Professions; or
        (B) is a health care facility as defined in Section 26-21-2.
        (d) "Reporting period" means the period beginning July 1, 2020, and ending on June
 30, 2021.
        (2) On or before January 4, 2022, a qualified provider that engages in balance billing
 during the reporting period shall submit a report to the commissioner that describes:
        (a) during the reporting period and aggregated by payer, the percentage of episodes of
 care for an emergency service provided to a Utah resident who is an enrollee of a health benefit
 plan offered by an insurer for which the qualified provider was out-of-network for which the
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 qualified provider engaged in balance billing; and
        (b) the specialty or subspecialty of the qualified provider, as identified by the qualified
 provider.
        (3) On or before January 1, 2022, an insurer shall submit a report to the commissioner
 that describes, for enrollees of a health benefit plan who are Utah residents:
        (a) whether the insurer provided a reimbursement directly to the enrollee of a health
 benefit plan during the reporting period for emergency services not performed by a network
 qualified provider; and
        (b) during the reporting period, the percentage of emergency department claims
 received from all qualified providers for enrollees of a health benefit plan who are Utah
 residents that were provided by an out-of-network qualified provider.
        (4) Information submitted to the commissioner under this section is a protected record
 under Title 63G, Chapter 2, Government Records Access and Management Act.
        (5) A qualified provider is immune from any civil liability for the disclosure of
 information to the commissioner in accordance with this section.
        (6) On or before July 1, 2022, the commissioner shall provide a written report to the
 Business and Labor Interim Committee and the Health and Human Services Interim Committee
 regarding:
        (a) the information received under this section; and
        (b) in collaboration with the Air Ambulance Committee created in Section 26-1-7,
 information regarding the amount charged by air medical transport providers that engage in
 balance billing.
        Section 3. Section 58-1-508 is amended to read:
        58-1-508. Failure to follow certain health care claims practices and reporting
 requirements -- Penalties.
        (1) As used in this section, "health care provider" means an individual who is licensed
 to provide health care services under this title.
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        Enrolled Copy                                                                           S.B. 155
         (2) The division may assess a fine of up to $500 per violation against a health care
 provider that violates Section 31A-26-313.
         (3) The division shall waive the fine described in Subsection (2) if:
         (a) the health care provider demonstrates to the division that the health care provider
 mitigated and reversed any damage to the insured caused by the health care provider or third
 party's violation; or
         (b) the insured does not pay the full amount due on the bill that is the subject of the
 violation, including any interest, fees, costs, and expenses, within 120 days after the day on
 which the health care provider or third party makes a report to a credit bureau or takes an action
 in violation of Section 31A-26-313.
         (4) A health care provider that is subject to the reporting requirement in Section
 31A-22-653 shall submit information to the Insurance Department in accordance with Section
 31A-22-653.
         Section 4. Section 63G-2-305 is amended to read:
         63G-2-305. Protected records.
         The following records are protected if properly classified by a governmental entity:
         (1) trade secrets as defined in Section 13-24-2 if the person submitting the trade secret
 has provided the governmental entity with the information specified in Section 63G-2-309;
         (2) commercial information or nonindividual financial information obtained from a
 person if:
         (a) disclosure of the information could reasonably be expected to result in unfair
 competitive injury to the person submitting the information or would impair the ability of the
 governmental entity to obtain necessary information in the future;
         (b) the person submitting the information has a greater interest in prohibiting access
 than the public in obtaining access; and
         (c) the person submitting the information has provided the governmental entity with
 the information specified in Section 63G-2-309;
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        (3) commercial or financial information acquired or prepared by a governmental entity
 to the extent that disclosure would lead to financial speculations in currencies, securities, or
 commodities that will interfere with a planned transaction by the governmental entity or cause
 substantial financial injury to the governmental entity or state economy;
        (4) records, the disclosure of which could cause commercial injury to, or confer a
 competitive advantage upon a potential or actual competitor of, a commercial project entity as
 defined in Subsection 11-13-103(4);
        (5) test questions and answers to be used in future license, certification, registration,
 employment, or academic examinations;
        (6) records, the disclosure of which would impair governmental procurement
 proceedings or give an unfair advantage to any person proposing to enter into a contract or
 agreement with a governmental entity, except, subject to Subsections (1) and (2), that this
 Subsection (6) does not restrict the right of a person to have access to, after the contract or
 grant has been awarded and signed by all parties:
        (a) a bid, proposal, application, or other information submitted to or by a governmental
 entity in response to:
        (i) an invitation for bids;
        (ii) a request for proposals;
        (iii) a request for quotes;
        (iv) a grant; or
        (v) other similar document; or
        (b) an unsolicited proposal, as defined in Section 63G-6a-712;
        (7) information submitted to or by a governmental entity in response to a request for
 information, except, subject to Subsections (1) and (2), that this Subsection (7) does not restrict
 the right of a person to have access to the information, after:
        (a) a contract directly relating to the subject of the request for information has been
 awarded and signed by all parties; or
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           (b) (i) a final determination is made not to enter into a contract that relates to the
 subject of the request for information; and
           (ii) at least two years have passed after the day on which the request for information is
 issued;
           (8) records that would identify real property or the appraisal or estimated value of real
 or personal property, including intellectual property, under consideration for public acquisition
 before any rights to the property are acquired unless:
           (a) public interest in obtaining access to the information is greater than or equal to the
 governmental entity's need to acquire the property on the best terms possible;
           (b) the information has already been disclosed to persons not employed by or under a
 duty of confidentiality to the entity;
           (c) in the case of records that would identify property, potential sellers of the described
 property have already learned of the governmental entity's plans to acquire the property;
           (d) in the case of records that would identify the appraisal or estimated value of
 property, the potential sellers have already learned of the governmental entity's estimated value
 of the property; or
           (e) the property under consideration for public acquisition is a single family residence
 and the governmental entity seeking to acquire the property has initiated negotiations to acquire
 the property as required under Section 78B-6-505;
           (9) records prepared in contemplation of sale, exchange, lease, rental, or other
 compensated transaction of real or personal property including intellectual property, which, if
 disclosed prior to completion of the transaction, would reveal the appraisal or estimated value
 of the subject property, unless:
           (a) the public interest in access is greater than or equal to the interests in restricting
 access, including the governmental entity's interest in maximizing the financial benefit of the
 transaction; or
           (b) when prepared by or on behalf of a governmental entity, appraisals or estimates of
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 the value of the subject property have already been disclosed to persons not employed by or
 under a duty of confidentiality to the entity;
        (10) records created or maintained for civil, criminal, or administrative enforcement
 purposes or audit purposes, or for discipline, licensing, certification, or registration purposes, if
 release of the records:
        (a) reasonably could be expected to interfere with investigations undertaken for
 enforcement, discipline, licensing, certification, or registration purposes;
        (b) reasonably could be expected to interfere with audits, disciplinary, or enforcement
 proceedings;
        (c) would create a danger of depriving a person of a right to a fair trial or impartial
 hearing;
        (d) reasonably could be expected to disclose the identity of a source who is not
 generally known outside of government and, in the case of a record compiled in the course of
 an investigation, disclose information furnished by a source not generally known outside of
 government if disclosure would compromise the source; or
        (e) reasonably could be expected to disclose investigative or audit techniques,
 procedures, policies, or orders not generally known outside of government if disclosure would
 interfere with enforcement or audit efforts;
        (11) records the disclosure of which would jeopardize the life or safety of an
 individual;
        (12) records the disclosure of which would jeopardize the security of governmental
 property, governmental programs, or governmental recordkeeping systems from damage, theft,
 or other appropriation or use contrary to law or public policy;
        (13) records that, if disclosed, would jeopardize the security or safety of a correctional
 facility, or records relating to incarceration, treatment, probation, or parole, that would interfere
 with the control and supervision of an offender's incarceration, treatment, probation, or parole;
        (14) records that, if disclosed, would reveal recommendations made to the Board of
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        Enrolled Copy                                                                             S.B. 155
 Pardons and Parole by an employee of or contractor for the Department of Corrections, the
 Board of Pardons and Parole, or the Department of Human Services that are based on the
 employee's or contractor's supervision, diagnosis, or treatment of any person within the board's
 jurisdiction;
         (15) records and audit workpapers that identify audit, collection, and operational
 procedures and methods used by the State Tax Commission, if disclosure would interfere with
 audits or collections;
         (16) records of a governmental audit agency relating to an ongoing or planned audit
 until the final audit is released;
         (17) records that are subject to the attorney client privilege;
         (18) records prepared for or by an attorney, consultant, surety, indemnitor, insurer,
 employee, or agent of a governmental entity for, or in anticipation of, litigation or a judicial,
 quasi-judicial, or administrative proceeding;
         (19) (a) (i) personal files of a state legislator, including personal correspondence to or
 from a member of the Legislature; and
         (ii) notwithstanding Subsection (19)(a)(i), correspondence that gives notice of
 legislative action or policy may not be classified as protected under this section; and
         (b) (i)