Chapter 419
2024 -- H 7702 SUBSTITUTE A AS AMENDED
Enacted 06/28/2024

A N   A C T
RELATING TO HEALTH AND SAFETY -- LICENSING OF HEALTHCARE FACILITIES

Introduced By: Representatives Speakman, Donovan, McGaw, Henries, Fogarty, Handy, Shallcross Smith, Bennett, Stewart, and Giraldo

Date Introduced: February 23, 2024

It is enacted by the General Assembly as follows:
     SECTION 1. Chapter 23-17 of the General Laws entitled "Licensing of Healthcare
Facilities" is hereby amended by adding thereto the following section:
     23-17-67. Hospital determinations for Medicare and Medicaid for uninsured patients.
     (a) All hospitals shall screen each uninsured patient, upon the uninsured patient's
agreement, at the earliest reasonable moment for potential eligibility for both:
     (1) Public health insurance programs; and
     (2) Any financial assistance offered by the hospital.
     (b) All screening activities, including initial screenings and all follow-up assistance, shall
be provided in compliance with § 23-17-54.
     (c) If a patient declines or fails to respond to the screening described in subsection (a) of
this section, the hospital shall document in the patient's record the patient's decision to decline or
failure to respond to the screening, confirming the date and method by which the patient declined
or failed to respond.
     (d) If a patient does not decline the screening described in subsection (a) of this section, a
hospital shall screen an uninsured patient at the earliest reasonable moment.
     (e) If a patient does not submit to screening, financial assistance application, or reasonable
payment plan documentation within thirty (30) days after a request, the hospital shall document the
lack of received documentation, confirming the date that the screening took place and that the
thirty-(30)day (30) timeline for responding to the hospital's request has lapsed; provided, however,
that it may be reopened within ninety (90) days after the date of discharge, date of service, or
completion of the screening.
     (f) If the screening indicates that the patient may be eligible for a public health insurance
program, the hospital shall provide information to the patient about how the patient can apply for
the public health insurance program, including, but not limited to, referral to healthcare navigators
who provide free and unbiased eligibility and enrollment assistance, including healthcare
navigators at federally qualified health centers; local, state, or federal government agencies; or any
other resources that the state recognizes as designed to assist uninsured individuals in obtaining
health coverage.
     (g) If the uninsured patient's application for a public health insurance program is approved,
the hospital shall bill the insuring entity and shall not pursue the patient for any aspect of the bill,
except for any required copayment, coinsurance, or other similar payment for which the patient is
responsible under the insurance. If the uninsured patient's application for public health insurance is
denied, the hospital shall again offer to screen the uninsured patient for hospital financial assistance,
and the timeline for applying for financial assistance under this section shall begin again.
     (h) A hospital shall offer to screen an insured patient for hospital financial assistance under
this section if the patient requests financial assistance screening,; if the hospital is contacted in
response to a bill,; if the hospital learns information that suggests an inability to pay,; or if the
circumstances otherwise suggest the patient's inability to pay.
     (i)(1) Each hospital shall post a sign with the following notice: "You may be eligible for
financial assistance under the terms and conditions the hospital offers to qualified patients. For
more information contact [hospital financial assistance representative]".
     (2) The sign under subsection (i)(1) of this subsectionsection shall be posted, either by
physical or electronic means, in accordance with § 23-17-54.
      (3) Each hospital that has a website shall post a notice in a prominent place on its website
that financial assistance is available at the hospital, a description of the financial assistance
application process, and a copy of the financial assistance application.
     (4) Within one hundred eighty (180) days after the effective date of this section, each
hospital shall make available information regarding financial assistance from the hospital in the
form of either a brochure, an application for financial assistance, or other written or electronic
material in the emergency room, hospital admission, and registration area.
     (j)(1) The executive office of health and human services is responsible for administering
and ensuring compliance with this section, including the development of any rules and regulations
necessary for the implementation and enforcement of this section.
     (2) The executive office of health and human services shall develop and implement a
process for receiving and handling complaints from individuals or hospitals regarding possible
violations of this section.
     (3) The attorney general may conduct any investigation deemed necessary regarding
possible violations of this section by any hospital including, without limitation, the issuance of
subpoenas to:
     (i) Require the hospital to file a statement or report or answer interrogatories in writing as
to all information relevant to the alleged violations;
     (ii) Examine under oath any person who possesses knowledge or information directly
related to the alleged violations; and
     (iii) Examine any record, book, document, account, or paper necessary to investigate the
alleged violation.
     (4) If the attorney general determines that there is a reason to believe that any hospital has
violated this section, the attorney general may bring an action against the hospital to obtain
temporary, preliminary, or permanent injunctive relief for any act, policy, or practice by the hospital
that violates this section. Before bringing such an action, the attorney general may permit the
hospital to submit a correction plan for the attorney general's approval.
     SECTION 2. Joint Resolution. – AUTHORIZING THE SECRETARY OF THE
EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES TO DEVELOP A PILOT PLAN
FOR ESTABLISHING AN ACUTE HOSPITAL CARE AT HOME PROGRAM
     WHEREAS, During the COVID-19 pandemic, federal and state governments issued
waiver flexibilities that allowed hospitals to provide advanced level services to patients at home
under certain circumstances; and
     WHEREAS, The waiver flexibility is built on the success of previous acute care at home
models that have been tested over decades, showing that advanced care at home can be a safe,
effective way to provide care to patients that is associated with lower costs and better patient
outcome and satisfaction compared with inpatient hospitalization; and
     WHEREAS, As part of the omnibus spending bill that became law December 29, 2022,
the Centers for Medicare and Medicaid services extended, through December 31, 2024, the acute
hospital care at home initiative whereby individual hospitals may seek waivers to operate acute
care at home programs; and
     WHEREAS, The hospital at home model is an important component of the shift away from
institutionalized care and has been successful in allowing patients with particular conditions to
remain in their homes and avoid risks associated with inpatient admission and care.
     NOW THEREFORE BE IT RESOLVED,
     l. Notwithstanding any provision of law to the contrary, the Executive Office of Health and
Human Services executive office of health and human services shall establish a pilot program to
permit a hospital to provide acute care services to a covered person outside of the hospital's licensed
facility and within a private residence designated by the covered person. The pilot program shall
be established in a manner that is consistent with the provisions of the Acute Hospital Care at Home
Program, as authorized by the federal Centers for Medicare and Medicaid Services.
     2. Any hospital previously in receipt of a waiver to operate, or otherwise approved to
participate in the Centers for Medicare and Medicaid Services' Acute Hospital Care at Home
Program prior to the effective date of this resolution, shall be permitted to operate or to continue to
operate the program in the same manner as previously permitted under federal law, and shall be
integrated into the pilot program established pursuant to this resolution.
     3. The Medicaid program shall provide coverage and payment for acute hospital care
services delivered to a covered person through the program established pursuant to this resolution,
on the same basis as when services are delivered within the facilities of a hospital. Reimbursement
payments under this section shall be provided to the hospital, facility, or organization providing the
services or the individual practitioner who delivered the reimbursable services, or to the agency,
facility, or organization that employs or contracts with the individual practitioner who delivered
the reimbursable services, as appropriate, for a period of ninety (90) days following the expiration
of the program, at a rate no higher than current reimbursement rates to ensure the pilot program is
budget neutral.
     4. The pilot program shall be limited to any person participating in the program at the time
of the expiration of the program and shall continue for not more than ninety (90) days, provided
that the person is eligible for Medicaid. The pilot program shall not utilize more stringent utilization
management criteria than apply when those services are provided within the facilities of a hospital.
     5. The Secretary secretary of the Executive Office of Health and Human Services
executive office of health and human services shall apply for any Statestate plan amendments or
waivers as may be necessary to implement the provisions of this resolution and to secure federal
financial participation for Statestate Medicaid expenditures under the federal Medicaid program.
     6. The Secretary secretary of the Executive Office of Health and Human Services
executive office of health and human services shall adopt rules and regulations, in accordance
with the "Administrative Procedure Act," if necessary to effectuate the provisions of this resolution.
     7. The Secretary secretary of the Executive Office of Health and Human Services
executive office of health and human services may waive any state rules or regulations if
necessary to implement the provisions of this resolution.
     AND BE IT FURTHER RESOLVED, The pilot program shall become ineffective upon
the expiration of the federal program, and The Secretary secretary of the Executive Office of
Health and Human Services executive office of health and human services shall provide a report
to the Governor governor and the General Assembly general assembly regarding the cost of the
pilot program.
     SECTION 3. Section 1 of this act shall take effect on January 1, 2025, and Section 2 of this
act shall take effect on July 1, 2024.
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LC005103/SUB A/2
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