2019 -- H 5556

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LC001808

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO INSURANCE -- HEALTH CARE ACCESSIBILITY AND QUALITY

ASSURANCE ACT

     Introduced By: Representatives Donovan, Canario, Tanzi, Carson, and Casimiro

     Date Introduced: February 27, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

     SECTION 1. Chapter 27-18.8 of the General Laws entitled "Health Care Accessibility

and Quality Assurance Act" is hereby amended by adding thereto the following section:

     27-18.8-11. Development of common summary of payments forms.

     (a) The commissioner shall develop a common summary of payments form to be used by

all carriers in the state of Rhode Island and provided to health care consumers with respect to

provider claims submitted to a payer. The common summary of payments form shall be written in

an easily readable and understandable format showing the consumer’s responsibility, if any, for

payment of any portion of a health care provider claim. The office shall allow the development

and use of forms that may be exchanged securely through electronic means. Carriers shall not be

obligated to issue a common summary of payments form for provider claims that consist solely of

requests for copayment.

     (b)(1) Carriers shall issue common summary of payments forms at the member level for

each insured member. Carriers may establish a standard method of delivery of common summary

of payments forms. All carriers shall permit the following individuals to choose, in writing, an

alternative method of receiving the common summary of payments form:

     (i) A subscriber who is legally authorized to consent to care for the insured member;

     (ii) An insured member who is legally authorized to consent to that member’s own care;

or

     (iii) Another party who has the exclusive legal authorization to consent to care for the

insured member.

     (2) The alternative methods of receiving the common summary of payments form shall

include, but not be limited to:

     (i) Sending a paper form to the address of the subscriber;

     (ii) Sending a paper form to the address of the insured member;

     (iii) Sending a paper form to any alternate address upon request of the insured member;

or

     (iv) Allowing the subscriber, the insured member or both to access the form through

electronic means; provided, however, that such access is provided in compliance with any

applicable state and federal laws and regulations pertaining to data privacy and security.

     (c) All carriers shall also permit an individual not authorized under subsection (b) of this

section but who is legally authorized to consent to care for an insured member to request, and

shall accommodate a reasonable request by such individual to receive, the forms on behalf of the

member through any of the alternative methods enumerated in subsection (b) of this section;

provided that, the individual clearly states in writing that the disclosure of all or part of the

information could endanger the individual or the insured member. Upon receipt of such request,

carriers shall not inquire as to the reasons for, or otherwise seek to confirm, the endangerment.

     (d) The preferred method of receipt selected pursuant to subsection (b) of this section

shall be valid until the insured member submits a request in writing for a different method;

provided, however, that a carrier shall not be requested to maintain more than one alternate

address for a member. Carriers shall comply with an insured member’s request pursuant to this

subsection not later than three (3) business days after receipt of the request.

     (e) Carriers shall not specify or describe sensitive health care services in a common

summary of payments form. The commissioner shall define sensitive health care services for the

purposes of this section. In determining that definition, the commissioner shall consider the

recommendations of the National Committee on Vital and Health Statistics and similar

regulations in other states and shall consult with experts in fields including, but not limited to,

infectious disease, reproductive and sexual health, domestic violence and sexual assault, and

mental health and substance abuse disorders.

     (f) In the event that the insured member has no liability for payment for any procedure or

service, carriers shall permit all insured members who are legally authorized to consent to care, or

parties legally authorized to consent to care for the insured member, to request suppression of

common summary of payments forms for a specific service or procedure, in which case the

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common summary of payments forms shall be not issued; provided, however, that the insured

member clearly makes the request orally or in writing. The carrier may request verification of the

request in writing following an oral request. A carrier shall not require an explanation as to the

basis for an insured member’s request to suppress the common summary of payments forms,

unless otherwise requested by law or court order.

     (g) The insured member’s ability to request the preferred method of receipt pursuant to

subsection (b) of this section and to request suppression of the common summary of payments

forms pursuant to subsection (f) of this section shall be communicated in plain language and in

clear and conspicuous manner in evidence of coverage documents, member privacy

communications, and on every common summary of payments form and shall be conspicuously

displayed on the carrier’s members website and online portals for individual members.

     (h) The commissioner shall issue guidance as necessary to implement and enforce this

section, which shall include requirements for reasonable reporting by carriers to the

commissioner regarding compliance and the number and type of complaints received regarding

noncompliance with this section.

     (i) The commissioner, in collaboration with the office of the health insurance

commissioner, shall develop and implement a plan to educate providers and consumers regarding

the rights of insured members and the responsibilities of carriers to promote compliance with this

section. The plan shall include, but not be limited to, staff training and other education for

hospitals, community health centers, school-based health centers, physicians, nurses and other

licensed health care professionals, as well as administrative staff including, but not limited to:

     (1) All staff involved in patient registration and confidentiality education; and

     (2) Billing staff involved in processing insurance claims. The plan shall be developed in

consultation with groups representing health care insurers, providers and consumers, including

consumer organizations concerned with the provision of sensitive health care services.

     (j) Nothing in this section shall supersede any general or special law related to the

informed consent of minors.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- HEALTH CARE ACCESSIBILITY AND QUALITY

ASSURANCE ACT

***

     This act would provide for the development of a common summary of payments forms,

to be used by all health insurance carriers and to be provided to health care consumers, providing

the consumer with their responsibility for payment, if any, of any portion of a health care provider

claim.

     This act would take effect upon passage.

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LC001808

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