→
Previous
Latest
FILED SENATE GENERAL ASSEMBLY OF NORTH CAROLINA Mar 30, 2021 S.B.
GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2021 S 1 SENATE BILL 415 Short Title:
415 SESSION 2021 PRINCIPAL CLERK S D SENATE BILL DRS35129-MR-39 Short Title:
A BILL TO BE ENTITLED AN ACT TO PROVIDE GREATER TRANSPARENCY IN HEALTH CARE SERVICES BILLING AND TO REDUCE BILLING THAT COMES AS A SURPRISE TO THE PATIENT.
Rules and Operations of the Senate March 31, 2021 A BILL TO BE ENTITLED AN ACT TO PROVIDE GREATER TRANSPARENCY IN HEALTH CARE SERVICES BILLING AND TO REDUCE BILLING THAT COMES AS A SURPRISE TO THE PATIENT.
58-3-223, unless contracting health careproviders ableto meet healthneeds oftheinsuredare reasonably available to the insured without unreasonable delay.
58-3-223, unless contractinghealth careproviders ableto meet healthneeds oftheinsuredare reasonablyavailable to the insured without unreasonable delay.
Nothing herein shall require an insurer to make any direct payment to a health *DRS35129-MR-39* General Assembly Of North Carolina Session 2021 care provider.
Nothing herein shall require an insurer to make any direct payment to a health *S415-v-1* General Assembly Of North Carolina Session 2021 care provider.
(c) Benchmark Amount Calculation.
(c) BenchmarkAmount Calculation.
Article 11B of Chapter 131E of theGeneral Statutes reads as rewritten:
Article 11B of Chapter 131E of the General Statutes reads as rewritten:
– A facility that is licensed under this Chapter or Chapter 122C of the General Statutes or under the licensing laws of another state for the provision of the same services in the ordinary course of business Page 2 DRS35129-MR-39 General Assembly Of North Carolina Session 2021 or practice as would require the facility to be licensed under this Chapter or Chapter 122C of the General Statutes were the facility located in this State.
– A facility that is licensed under this Chapter or Chapter 122C of the General Statutes or under the licensing laws of another state for the provision of the same services in the ordinary course of business Page 2 Senate Bill 415-First Edition General Assembly Of North Carolina Session 2021 or practice as would require the facility to be licensed under this Chapter or Chapter 122C of the General Statutes were the facility located in this State.
The nonparticipating health care providers shall be identified in the written disclosure using the individual's health care provider's name and practice nameas used on theapplicablehealthservices facilityorhealthcareprovider's credentials or name badge.
The nonparticipating health care providers shall be identified in the written disclosure using the individual's health care provider's name and practice nameas used on theapplicablehealthservices facilityorhealth careprovider's credentials or name badge.
(5) Text, using a bold or other distinguishable font, that states that certain consumer protections available to the insured individual when services are rendered by a health services facility or health care provider participating in theinsurer'shealthcareprovidernetworkmay not beapplicablewhenservices are rendered by a nonparticipating health services facility or health care provider.
(5) Text, using a bold or other distinguishable font, that states that certain consumer protections available to the insured individual when services are rendered by a health services facility or health care provider participating in theinsurer'shealthcareprovidernetworkmaynot beapplicablewhenservices are rendered by a nonparticipating health services facility or health care provider.
(2) The insurer, the insured individual, and any third party, individually or collectively, havenolegal obligationto pay morethan thebenchmarkamount, DRS35129-MR-39 Page 3 General Assembly Of North Carolina Session 2021 as calculated under G.S.
(2) The insurer, the insured individual, and any third party, individually or collectively, havenolegal obligationto paymorethanthebenchmarkamount, Senate Bill 415-First Edition Page 3 General Assembly Of North Carolina Session 2021 as calculated under G.S.
(3) Payment by the insurer, the insured individual, or any third party, individually or collectively, of the benchmark amount calculated under G.S.
(3) Payment bythe insurer, the insured individual, or anythird party, individually or collectively, of the benchmark amount calculated under G.S.
An insurer's, insured individual's, or any third party's total payment, individually or collectively, of the benchmark amount shall foreclose the health services facility or the health care provider from collecting any additional amount from the insured or any third Page 4 DRS35129-MR-39 General Assembly Of North Carolina Session 2021 party, including the insurer, individually or collectively.
An insurer's, insured individual's, or any third party's total payment, individually or collectively, of the benchmark amount shall foreclose the health services facility or the health care provider from collecting any additional amount from the insured or any third Page 4 Senate Bill 415-First Edition General Assembly Of North Carolina Session 2021 party, including the insurer, individually or collectively.
– A health services facility must require through its contracts with health care providers that do not participate in an insurer's health care provider network that the nonparticipating health care providers comply with the requirements of this section.
– A health services facilitymust require through its contracts with health care providers that do not participate in an insurer's health care provider network that the nonparticipating health care providers comply with the requirements of this section.
58-3-225, an insurer may recover overpayments made to any health care provider or health services facility under this section by making demands for refunds from the insured individual, the health care provider, or the health services facility, as applicable.
58-3-225, an insurer may recover overpayments made to anyhealth care provider or health services facility under this section by making demands for refunds from the insured individual, the health care provider, or the health services facility, as applicable.
Chapter 90 of the General Statutes is amended by adding a new Article to read:
Chapter 90 of the General Statutes is amended byadding a new Article to read:
DRS35129-MR-39 Page 5 General Assembly Of North Carolina Session 2021 (b) Reasonable Payments.
Senate Bill 415-First Edition Page 5 General Assembly Of North Carolina Session 2021 (b) Reasonable Payments.
An insurer's, insured individual's, or third party's total payment, individually or collectively, of the benchmark amount shall foreclose the health care provider from collecting any additional amount from the insurer, insured, or any third party, individually or collectively.
An insurer's, insured individual's, or third party's total payment, individually or collectively, of the benchmark amount shall foreclose the health care provider from collecting any additional amount from the insurer, insured, or any third party, individuallyor collectively.
"(a) It is the intent of this Article Part to improve transparency in health care costs by providing information to thepubliconthecosts of themost frequently reporteddiagnosticrelated groups (DRGs) forhospital inpatientcare andthe most commonsurgical procedures and imaging procedures provided in hospital outpatient settings and ambulatory surgical facilities." SECTION 4.(b) G.S.
"(a) It is the intent of this Article Part to improve transparency in health care costs by providinginformation to thepubliconthecosts of themost frequentlyreporteddiagnostic related groups (DRGs) forhospital inpatientcare andthe most common surgical procedures and imaging procedures provided in hospital outpatient settings and ambulatory surgical facilities." SECTION 4.(b) G.S.
Page 6 DRS35129-MR-39
Page 6 Senate Bill 415-First Edition
⬇ Download PDF