2020 -- S 2228 | |
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LC003501 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2020 | |
____________ | |
A N A C T | |
RELATING TO INSURANCE -- UNANTICIPATED OUT-OF-NETWORK BILLS FOR | |
HEALTH CARE SERVICES | |
| |
Introduced By: Senators Archambault, Satchell, Euer, Nesselbush, and Lombardo | |
Date Introduced: February 04, 2020 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended |
2 | by adding thereto the following chapter: |
3 | CHAPTER 82 |
4 | UNANTICIPATED OUT-OF-NETWORK BILLS FOR HEALTH CARE SERVICES |
5 | 27-82-1. Applicability. |
6 | Notwithstanding any provisions to the contrary contained in §§ 27-18-76, 27-19-66, 27- |
7 | 20-62 and 27-41-79, this chapter shall govern any unanticipated out-of-network bills for health |
8 | care services as further provided for by the provisions of this chapter; provided, however, this |
9 | chapter shall not apply to health care services, including emergency services, where health care |
10 | provider fees are subject to schedules or other monetary limitations under any other law, |
11 | including the workers' compensation law, and shall not preempt any such law. |
12 | 27-82-2. Definitions. |
13 | For the purposes of this chapter: |
14 | (1) "Alternative dispute resolution entity" means a qualified third-party claim dispute |
15 | resolution entity, which is independent of the disputing parties and is prepared to resolve disputes |
16 | pursuant to this chapter. |
17 | (2) "Anticipated out-of-network care" means non-emergency services received by a |
18 | patient when the patient voluntarily consents in writing to receive health care services from an |
| |
1 | out-of-network health care provider prior to the provision of such services. |
2 | (3) "Cost-sharing" means a copayment, coinsurance, deductible or similar charge. |
3 | (4) "Emergency medical condition" means a medical or behavioral condition that |
4 | manifests itself by acute symptoms of sufficient severity, including severe pain, such that a |
5 | prudent layperson, possessing an average knowledge of medicine and health, could reasonably |
6 | expect the absence of immediate medical attention to result in a condition: |
7 | (i) Placing the health of the individual, or with respect to a pregnant woman her unborn |
8 | child, in serious jeopardy, or in the case of a behavioral condition, placing the health of the |
9 | individual or others in serious jeopardy; |
10 | (ii) Constituting a serious impairment to bodily functions; or |
11 | (iii) Constituting a serious dysfunction of any bodily organ or part. |
12 | (5) "Emergency services" means, with respect to an emergency medical condition: |
13 | (i) A medical screening examination (as required under § 1867 of the Social Security Act, |
14 | 42 U.S.C. § 1395dd) that is within the capability of the emergency department of a health care |
15 | facility, including ancillary services routinely available to the emergency department to evaluate |
16 | such emergency medical condition; and |
17 | (ii) Such further clinical and medical examination and treatment, to the extent they are |
18 | within the capabilities of the staff and facilities available at the health care facility, as are required |
19 | under § 1867 of the Social Security Act (42 U.S.C. § 1395dd) to stabilize the patient; |
20 | (6) "Health care facility" or "facility" means any institution, place, building, or agency, or |
21 | portion thereof, engaged in providing health care services. This includes, but is not limited to, |
22 | hospitals; ambulatory surgical or treatment centers; clinics; skilled nursing centers; residential |
23 | treatment centers; an inpatient, outpatient or residential drug and alcohol treatment facility; |
24 | outpatient surgery or care centers; diagnostic, laboratory and imaging centers; and specialized |
25 | care centers, such as birthing centers, cancer-treatment centers and psychiatric care centers. |
26 | (7) "Health care plan" or "plan" means health insurance coverage and a group health plan, |
27 | defined pursuant to §§ 27-18-1.1, 27-19-1, 27-20-1 and 27-41-2 and any contract between the |
28 | Rhode Island Medicaid program and any health insurance carrier, as defined under chapters 18, |
29 | 19, 20, and 41 of title 27. |
30 | (8) "Health care professional" or "professional" means a physician or other health care |
31 | practitioner licensed, accredited or certified to perform specified health care services consistent |
32 | with state law. |
33 | (9) "Health care provider" or "provider" means a health care professional or a health care |
34 | facility. |
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1 | (10) "Health care services" means services for the diagnosis, prevention, treatment, cure |
2 | or relief of a medical or behavioral condition, illness, injury or disease. |
3 | (11) "Health insurance carrier" or "carrier" means an insurer licensed to write accident |
4 | and sickness insurance policies pursuant to chapter 18 of title 27; a nonprofit hospital service |
5 | corporation licensed to write insurance policies pursuant to chapter 19 of title 27; a nonprofit |
6 | medical service corporation licensed to write insurance policies pursuant to chapter 20 of title 27; |
7 | a health maintenance organization licensed to write insurance policies pursuant to chapter 41 of |
8 | title 27. |
9 | (12) "In-network," when it refers to cost-sharing amounts and benefits, means such |
10 | amounts and benefits included in a health care plan. |
11 | (13) "In-network health care professional" means a health care professional and "in- |
12 | network health-care provider" means a health care provider who has a contract with the health |
13 | care plan that provides health care services to the plan's insured. |
14 | (14) "Insured patient" or "insured" means a patient covered under a health care plan. |
15 | (15) "Out-of-network" refers to situations when health care providers or health care |
16 | professionals do not have a contract with a particular health care plan to provide health care |
17 | services to the insured. |
18 | (16) "Out-of-network health care professional" means a health care professional and "out- |
19 | of-network health care provider" means a health care provider who does not have a contract with |
20 | the health care plan that provides health care services to the plan's insured. |
21 | (17) "Patient" means a person who receives health care services, including emergency |
22 | services. |
23 | (18) "Unanticipated out-of-network care" means emergency services or health care |
24 | services rendered by an out-of-network health care provider for a patient in situations when the |
25 | insured did not have the ability or control to select such services from an in-network health care |
26 | provider. Such unanticipated out-of-network care may include health care services rendered by an |
27 | out-of-network health care provider at the request of an in-network health care provider. |
28 | (19) "Uninsured patient" or "uninsured" means a patient not covered under a health care |
29 | plan. |
30 | 27-82-3. Anticipated out-of-network care provided by out-of-network providers. |
31 | (a) Health insurance carriers shall provide up-to-date information for patients about |
32 | providers, pursuant to § 27-18.8-3(c)(4). |
33 | (b) Health care professionals who are not participants in health care plans shall post a |
34 | notice pursuant to § 5-37-22. |
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1 | (c) An insured patient shall make every reasonable effort to confirm before receiving |
2 | health care services that each health care provider from whom the insured may receive non- |
3 | emergency care is an in-network provider. It is the insured's responsibility to review with their |
4 | health insurance carrier whether their health care plan offers any out-of-network benefit coverage |
5 | and to inquire about potential payment the insured may be required to cover for out-of-network |
6 | health care services. |
7 | (d) For scheduled, non-emergency, facility-based procedures or surgery, any patient may |
8 | obtain from their health insurance carrier information about the insured's out-of-network benefits |
9 | and payment obligations and may obtain from their out-of-network health care professional a |
10 | written estimate, provided in good faith and with reasonable effort, of the cost for out-of-network |
11 | health care services. The patient may further request that such estimates include the potential |
12 | payment amount for which the patient may be liable and any amount that might be covered by the |
13 | health insurance carrier. |
14 | 27-82-4. Written estimates for health care services for uninsured patients. |
15 | Uninsured patients may obtain a written estimate from a health care professional for |
16 | health care services, pursuant to § 27-82-3(d). |
17 | 27-82-5. Out-of-network professional billing and payment of unanticipated out-of- |
18 | network care. |
19 | (a) No health insurance carrier shall require prior authorization for rendering emergency |
20 | services to an insured. |
21 | (b) The office of the health insurance commissioner shall provide on its website a list of |
22 | resources available to consumers, including its own consumer protection unit, the attorney |
23 | general's office consumer protection unit and the department of health's Rhode Island Board of |
24 | Medical Licensure & Discipline. |
25 | (c) Nothing in this subsection shall be construed to prohibit a patient's health insurance |
26 | carrier and out-of-network health care professional from reaching agreement with each other |
27 | about the payment for professional services. |
28 | (d) With respect to a bill for unanticipated out-of-network care: |
29 | (1) No health insurance carrier shall impose a coinsurance, copayment, deductible or |
30 | other out-of-pocket expense that is greater than the coinsurance, copayment, deductible or other |
31 | out-of-pocket expense that would be imposed for such health care services if such services were |
32 | rendered by an in-network health care provider. |
33 | (2) No out-of-network health care provider may seek or accept any payment from a |
34 | patient for unanticipated out-of-network care for services subject to this section, except for |
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1 | copayments, deductibles, or other cost-sharing payments at in-network rates that are specifically |
2 | permitted under the patient's arrangements with their health insurance carrier; |
3 | (3) The out-of-network health care professional shall send notice to the insured of the |
4 | provider's out-of-network charges for the health care services provided and shall ask for the |
5 | insured's health insurance information; provided, however, that this initial communication from |
6 | the out-of-network professional to the insured shall include a notice in twelve (12) point bold type |
7 | stating that the communication is not a bill for unanticipated out-of-network care and that the |
8 | insured shall not pay until they are informed by their health insurance carrier of any applicable |
9 | cost sharing. |
10 | (4) The insured and/or the out-of-network health care professional shall then submit the |
11 | professional's out-of-network charges as a claim to the insured's health insurance carrier. Such |
12 | charges shall be determined by the health care professional in accordance with statutory standards |
13 | of professional conduct, pursuant to chapter 37 of title 5. The health insurance carrier can request |
14 | the Rhode Island department of health to make a determination whether the professional's billed |
15 | charges comply with statutory standards, pursuant to § 5-37-5.1(16). The department of health |
16 | shall respond with an advisory opinion before either party seeks arbitration for the unanticipated |
17 | out-of-network charges. |
18 | (5) Upon receipt of a claim from the insured and/or the out-of-network health care |
19 | professional for such out-of-network care, the health insurance carrier shall furnish to the out-of- |
20 | network professional a statement of the applicable in-network cost-sharing amounts owed at the |
21 | time of payment by the insured to the professional for the unanticipated out-of-network care. |
22 | (6) Within the time allowed pursuant to § 27-20-47(a), a health insurance carrier that has |
23 | received an out-of-network claim from an insured and/or an out-of-network health care |
24 | professional shall pay the insured the out-of-network charges billed, minus any amount of cost- |
25 | sharing owed to the health care professional by the insured, or the health insurance carrier shall |
26 | dispute the charges. If the health insurance carrier disputes the charges, the health insurance |
27 | carrier and the health care professional may attempt to negotiate a payment that is acceptable to |
28 | both parties. |
29 | (7) If there is no dispute over the charges at the end of the timeframe identified in § 27- |
30 | 20-47(a), the out-of-network health care professional shall bill the insured for the applicable in- |
31 | network cost-sharing amounts owed by the insured to the professional for the unanticipated out- |
32 | of-network care. The insured shall only pay the health care professional the deductibles and cost- |
33 | sharing amounts that would correspond with deductible and cost-sharing amounts as described |
34 | within this subsection that would be owed if the health insurance carrier were to pay the median |
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1 | in-network rate for such health care services. When a health insurance carrier pays an insured the |
2 | out-of-network charges billed, minus any amount of cost-sharing owed to the health care |
3 | professional by the insured, that payment from the health insurance carrier shall be sent with a |
4 | notice in twelve (12) point bold type stating that the insured is obligated to pay the out-of- |
5 | network professional the full amount of such payment from the health insurance carrier, within |
6 | thirty (30) calendar days of receipt. This notice shall also inform the patient that they are |
7 | responsible for paying the out-of-network professional all applicable cost-sharing amounts. |
8 | (8) The out-of-network professional shall not bill the patient while the claim is in |
9 | negotiation, dispute, mediation or arbitration. If the health insurance carrier and health care |
10 | professional reach a settlement for payment, that amount shall take into consideration the |
11 | insured's cost-sharing amount and shall constitute payment in full for the health care services |
12 | rendered. |
13 | (9) The health insurance carrier shall pay any settlement to the insured. With such |
14 | payment, the health insurance carrier shall send a notice to the insured, of the insured's obligation |
15 | to pay the health care professional, pursuant to § 27-82-5(7). |
16 | (10) In no case shall a health insurance carrier or professional go back to the patient |
17 | seeking additional payment. However, the patient shall be responsible for paying the out-of- |
18 | network professional any applicable cost-sharing amounts that would have been due to an in- |
19 | network professional for such services. Such applicable cost-sharing amounts shall be treated by |
20 | health insurance carriers as though they were paid to an in-network professional for purposes |
21 | related to the insured's deductibles and annual out-of-pocket maximums. |
22 | (11) If the out-of-network professional has received more than the in-network cost- |
23 | sharing amount from the insured for services subject to this section, the out-of-network |
24 | professional shall refund any overpayment to the insured within thirty (30) calendar days after |
25 | receiving payment from the insured or from the health insurance carrier. An out-of-network |
26 | professional shall automatically include in their refund to the insured all interest that has accrued |
27 | pursuant to this section without requiring the insured to submit a request for the interest amount. |
28 | (12) If the parties reach no resolution within the timeframe identified in § 27-20-47(a), |
29 | either the professional or the health insurance carrier may notify the other that they dispute the |
30 | out-of-network charge or the proposed payment by the health insurance carrier. When a health |
31 | insurance carrier notifies an out-of-network professional that it disputes the out-of-network |
32 | charges, the carrier shall include in its dispute notice the following: the claim code, the claim |
33 | amount the carrier would pay to an in-network professional for the same health care services and |
34 | the carrier's complete contact information. |
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1 | (13) Within fourteen (14) calendar days after either party files a dispute notice, each party |
2 | (out-of-network professional and health insurance carrier) shall submit to the other its best and |
3 | final offer for the amount in dispute, with supporting documents, and they shall attempt to reach a |
4 | negotiated settlement. |
5 | (14) If the parties negotiate a settlement, the health insurance carrier shall pay the insured |
6 | the negotiated amount within thirty (30) calendar days. |
7 | (15) Once a year, by February 15, any health insurance carrier that has negotiated |
8 | payments with any out-of-network professional shall report to the office of the health insurance |
9 | commissioner the details about all settlements during the prior calendar year. That report shall |
10 | include: the claim codes in dispute, the date of each dispute notice, each professional's billed |
11 | charges, what the health insurance carrier would have paid for each service to an in-network |
12 | professional and to an out-of-network professional, the dates the parties reached settlements and |
13 | the settlement amounts for each case. Any information shall be provided as de-identified data. |
14 | This report shall also include the number of times the health insurance carrier has paid the billed |
15 | charges, without disputing the claim, for unanticipated out-of-network care. |
16 | (16) Either the health insurance carrier or the out-of-network professional may submit the |
17 | dispute regarding the professional's out-of-network charges to an alternative dispute resolution |
18 | entity, for the purpose of arbitrating the dispute, as provided for in § 27-82-6; provided, however, |
19 | that both parties first attempt to negotiate the dispute within fourteen (14) calendar days, in |
20 | accordance with the provisions of this subsection. |
21 | 27-82-6. Arbitrated dispute resolution for unanticipated out-of-network care. |
22 | (a) This chapter establishes an independent dispute resolution process for the purpose of |
23 | arbitrating payment disputes between a health insurance carrier and a health care professional for |
24 | unanticipated out-of-network care covered by this chapter. |
25 | (b)(1) Nothing in this section shall be construed to preclude the parties from reaching a |
26 | resolution of their dispute at any point before the arbitrator issues a final award. |
27 | (2)(i) The arbitrated dispute resolution process shall use the American Arbitration |
28 | Association as the alternative dispute resolution entity. However, if the American Arbitration |
29 | Association ceases to exist or ceases to be qualified or becomes unable to perform arbitrations in |
30 | connection with this section, the office of the health insurance commissioner shall specify a |
31 | similarly qualified organization. |
32 | (ii) Except as otherwise provided in this section, the arbitration shall follow the |
33 | procedures of the American Arbitration Association Healthcare Payor Provider Arbitration Rules, |
34 | Desk/Telephonic Track, with fees calculated under the Standard Fee Schedule and based on the |
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1 | monetary amount in dispute, calculated as the difference between the out-of-network |
2 | professional's best and final offer for out-of-network charges and the health insurance carrier's |
3 | best and final offer for out-of-network payment, as provided for in § 27-82-5(13). |
4 | (3) An arbitrator appointed to administer a dispute shall be impartial and independent of |
5 | the parties and shall perform the arbitrator's duties with diligence and in good faith. |
6 | (4) If either a health insurance carrier or an out-of-network professional submits the |
7 | dispute for resolution, the other party shall also participate in the process as provided in this |
8 | section. |
9 | (5) The award obtained through the resolution process shall be binding on both parties |
10 | and not appealable. The award shall be binding on the health insurance carrier and out-of-network |
11 | professional for any disputes between them involving the same claim code stated in the demand |
12 | for arbitration for a period of one year from the date of the award. |
13 | (6) A payment made by a health insurance carrier to an out-of-network professional |
14 | under an award obtained through the resolution process specified in this section, in addition to the |
15 | applicable cost-sharing owed by the insured who received the health care service that is the |
16 | subject of the resolution process, shall constitute payment in full for the health care services |
17 | rendered. |
18 | (7) In all situations, the patient shall be held harmless. In no case shall a health insurance |
19 | carrier or professional go back to the patient seeking additional payment. However, the patient |
20 | shall be responsible for paying the out-of-network professional any applicable cost-sharing |
21 | amounts that would have been due to an in-network professional for such services. Such |
22 | applicable cost-sharing amounts shall be treated by health insurance carriers as though they were |
23 | paid to an in-network professional for purposes related to the insured's deductibles and annual |
24 | out-of-pocket maximums. |
25 | (c) Binding resolution process. |
26 | (1) The party initiating the process shall file a demand for arbitration with the alternative |
27 | dispute resolution entity, shall pay the applicable administrative filing fee, and simultaneously |
28 | send a copy of the demand to the other party. The initiating party shall include on the demand the |
29 | claim code, claim amount and complete contact information for both parties and shall transmit the |
30 | demand in accordance with the alternative dispute resolution entity's procedures. |
31 | (2) Within fourteen (14) calendar days after notice of the filing of the demand is sent by |
32 | the alternative dispute resolution entity, the parties named in the demand shall each submit their |
33 | best and final offer for the amount in dispute with supporting documents to each other and the |
34 | alternative dispute resolution entity. |
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1 | (i) During the fourteen (14) calendar day period after the notice of filing is sent, the |
2 | parties may negotiate a settlement. If a settlement is reached, both parties shall advise in writing |
3 | the alternative dispute resolution entity. |
4 | (ii) If, during the fourteen (14) calendar day period, the parties do not notify in writing |
5 | the alternative dispute resolution entity that a settlement was reached, an arbitrator shall be |
6 | appointed in accordance with the procedures established by the alternative dispute resolution |
7 | entity. |
8 | (3) Upon appointment of the arbitrator, the alternative dispute resolution entity shall |
9 | require the parties to deposit sums of money as the alternative dispute resolution entity deems |
10 | necessary to cover the expense of arbitration, including the arbitrator's fees, if any, render an |
11 | accounting to the parties and return any unexpended balance at the conclusion of the case. The |
12 | deposit for arbitrator's fees shall be split evenly between the parties. |
13 | (4) After the arbitrator is appointed, the alternative dispute resolution entity shall transmit |
14 | to the arbitrator the parties' previously submitted best and final offers with supporting documents. |
15 | (5) In making an award under this subsection, the arbitrator may consider the following |
16 | criteria including, but not limited to: |
17 | (i) The level of training, education and experience of the professional. |
18 | (ii) The professional's usual charge and usual payment for comparable health care |
19 | services provided in-network and out-of-network with respect to any health care plan. |
20 | (iii) The health insurance carrier's usual payment and fee schedules for comparable health |
21 | care services provided in the service area. |
22 | (iv) The propensity of the professional to be included in networks and the propensity of |
23 | the insurer to include professionals in networks. |
24 | (v) Payments made in prior disputes over unanticipated out-of-network care between the |
25 | professional and the insurer. |
26 | (vi) The circumstances and complexity of the particular case, including the time and |
27 | place of the health care service. |
28 | (vii) Any final award between the insurer and professional for the same claim code from |
29 | a period of one year prior. |
30 | (6) The arbitrator's award shall be a dollar amount between the two (2) amounts |
31 | submitted by the parties as their best and final offers and shall be binding on both parties. |
32 | (7) The arbitrator shall issue a final binding award in writing, within thirty (30) days after |
33 | the arbitrator has received the parties' best and final offers and supporting documents. The award |
34 | shall include the claim code for which the dispute was filed, the date of the written demand for |
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1 | arbitration, the date the award was communicated to the parties, the final offers from each party |
2 | and the award amount. Electronic copies of the final award shall be provided to both parties. |
3 | (8) The American Arbitration Association shall submit annually, by February 15, to the |
4 | office of the health insurance commissioner the number of total cases that were filed for |
5 | arbitration, the number of cases that were settled before an arbitrator issued an award and the |
6 | number of awards issued. This report shall further include the details that arbitrators include in |
7 | final binding awards, pursuant to § 27-82-6(c)(7). Any information shall be provided as de- |
8 | identified data. |
9 | (d) Cost allocations. |
10 | (1) In the final award, the arbitrator shall determine which party is responsible for paying |
11 | all administrative fees, arbitrator compensation and expenses, including any reimbursement of the |
12 | initial filing fee that may be due to either party. |
13 | (2) A party that fails to pay all amounts due to the other party within thirty (30) days of |
14 | receiving the final award shall: |
15 | (i) Pay interest to the prevailing party. |
16 | (ii) Be subject to a penalty of one hundred dollars ($100) per day, payable to the |
17 | prevailing party, until all payments are made in full. |
18 | (e) Alternative dispute resolution entity records. |
19 | An alternative dispute resolution entity shall comply with the following: |
20 | (1) Maintain for eighteen (18) months after a case is closed, by calendar year, all in an |
21 | easily accessible and retrievable format, the following: |
22 | (i) The written demand filed by the initiating party establishing the date the alternative |
23 | dispute resolution entity received a request for dispute resolution. |
24 | (ii) Case-related materials that are made a part of the alternative dispute resolution |
25 | entity's electronic file. |
26 | (iii) The award. |
27 | (iv) The date the award was communicated to the parties. |
28 | (2) Document measures taken to appropriately safeguard the confidentiality of the |
29 | records and prevent unauthorized use and disclosures under applicable federal and state law. |
30 | (3) Report annually to the office of the health insurance commissioner by February 15 for |
31 | the prior calendar year's cases, with de-identified data, in the aggregate: |
32 | (i) The total number of demands for arbitrations received under this section. |
33 | (ii) The number of arbitrations withdrawn due to settlement before an arbitrator issued an |
34 | award. |
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1 | (iii) The total number of arbitrations concluded. |
2 | (iv) The breakdown of disposition for arbitrations concluded, with the details the |
3 | arbitrators include in final binding awards issued, pursuant to § 27-82-6(c)(7). Any information |
4 | shall be provided as de-identified data. |
5 | (4) Protect from disclosure, except as otherwise required by law, information specifically |
6 | identifying the insured who received the health care services that were the subject of an |
7 | arbitration decision. This information shall be protected and remain confidential in compliance |
8 | with all applicable federal and state laws and regulations and shall be confidential as nonpublic |
9 | personal health information. |
10 | (5) Report immediately to the office of the health insurance commissioner a change in its |
11 | status that would cause it to cease performing or being qualified to perform arbitrations under this |
12 | act. |
13 | 27-82-7. Data collection regarding payment disputes that arise after unanticipated |
14 | out-of-network care. |
15 | (a) By March 31 each year, the office of the health insurance commissioner shall |
16 | annually report to the president of the senate and to the speaker of the house of representatives, in |
17 | the aggregate: |
18 | (1) The detailed information the office has received from health insurance carriers about |
19 | the number of unanticipated out-of-network charges the carrier paid and the number of cases that |
20 | were in dispute in the prior calendar year, pursuant to § 27-82-5(d)(15). |
21 | (2) The detailed information the office has received from the American Arbitration |
22 | Association about how many cases were filed for arbitration and how such cases were resolved, |
23 | with the information provided by arbitrators in final binding awards, pursuant to § 27-82-6(c)(7) |
24 | and with the information provided pursuant to § 27-82-6(c)(8). |
25 | (b) Any information reported by the office of the health insurance commissioner shall be |
26 | provided as de-identified data. |
27 | (c) As a result of data collected in its annual reports, if the office of the health insurance |
28 | commissioner determines this statute has had a negative or inflationary impact on health |
29 | insurance premiums, has resulted in increased consumer complaints and/or has led to a reduction |
30 | of health care providers within health insurance networks, the commissioner may make |
31 | recommendations to the governor, the president of the senate and to the speaker of the house of |
32 | representatives regarding potential amendments to this statute. |
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1 | SECTION 2. This act shall take effect on January 1, 2021. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO INSURANCE -- UNANTICIPATED OUT-OF-NETWORK BILLS FOR | |
HEALTH CARE SERVICES | |
*** | |
1 | This act would provide a method for the reimbursement to out-of-network professionals |
2 | who provide unanticipated out-of-network care and would provide guidelines for what payment |
3 | out-of-network professionals may seek or accept from a patient for unanticipated out-of-network |
4 | care. |
5 | This act would take effect on January 1, 2021. |
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