HB 123 — An Act relating to disclosure of health care services and price information; and providing for an effective date.

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123(HSS)123(JUD) 01 "An Act relating to disclosure of health care services and price information;

(a) A health care provider shall annually compile a list, including a 08 brief description in plain language that an individual with no medical training can 09 understand, of the 2510 health care services most commonly performed by the health 10 care provider in the state in the previous calendar year from each of the six sections of 11 Category I, Current Procedural Terminology, adopted by the American Medical 12 Association and, for each of those services, 11 state 1213 (1) the procedure code;

1314 (2) the undiscounted price;

14and 15 (3) any facility fees;fees.

and16 15(b) (4)A health care facility in the paymentstate rateshall establishedannually undercompile ASa 47.05list, andincluding ASa 47.0717 forbrief thedescription 16in plain language that an individual with no medical assistancetraining program.can 18 understand, of the 10 health care services most commonly performed at the health care 19 facility in the previous calendar year from each of the six sections of Category I, 20 Current Procedural Terminology, adopted by the American Medical Association and, 21 for each of those services, state 22 (1) the procedure code;

1723 (b)(2) A health care facility in the stateundiscounted shallprice; annually compile a list, including a 18 brief description in plain language that an individual with no medical training can 19 understand, of the 50 health care services most commonly performed at the health care 20 facility in the previous calendar year and, for each of those services, state 21 (1) the procedure code;

22and (2)24 the(3) undiscountedany price;facility fees.

2325 (3)(c) anyIf, in the annual reporting period under this section, fewer than the number 26 of health care services described under (a) or (b) of this section are performed by a 27 health care provider or at a health care facility fees;in the state, the provider or facility shall 28 include in the list required under this section all of the health care services performed 29 by the provider or at the facility from each of the six sections described under (a) or 30 (b) of this section.

31 (d) A health care provider who provides health care services at a health care facility in a group practice is not required to compile and 24publish (4)a list under (a) and 02 (e) of this section if 03 (1) the paymenthealth ratecare establishedfacility underwhere ASthe 47.05provider is in a group practice 04 compiles and ASpublishes 47.07a forlist thein 25compliance medicalwith assistance(b) program.and (e) of this section;

26and (c)05 If(2) a health care provider performs fewer than 25 health care services in the 27prices stateand orfees fewerthat than 50 health care services are performed at a health care facility in the 28 state in the annual reporting period under this section, the health care provider orcharges 29are healthreflected care facility shall include in the list required06 undercompiled (a)and orpublished (b) of this section all 30 of the health care services performed by the health care provider or at the health care 31 facility.

(d)07 (e) A health care provider whoand provides health care servicesfacility atshall apublish healththe carelists 0208 facilitycompiled inunder a(a) groupand practice(b) isof notthis requiredsection toby compileJanuary and31 publisheach ayear list09 under(1) (a)by andproviding 03the (e)list ofto thisthe sectiondepartment iffor 04entry (1)in the healthdepartment's care10 facilitydatabase whereunder theAS provider18.15.360 isalong inwith athe groupname practice 05 compiles and publisheslocation aof listthe inhealth compliancecare with11 (b)provider andor (e)health ofcare thisfacility; section;

and12 06 (2) theby pricesposting anda feescopy thatof the providerlist charges13 are(A) reflected in thea listfont 07not compiledsmaller andthan published20 bypoints; the health care facility.

0814 (e)(B) A health care provider and health care facility shall publish the lists 09 compiled under (a) and (b) of this section by January 31 each year 10 (1) by providing the list to the department for entry in thea department'sconspicuous 11public databasereception underarea ASat 18.15.360 along with the namehealth andcare location15 ofprovider's theoffice or health care 12facility providerwhere orthe healthservices careare facility;performed;

1316 (2)(C) bythat postingincludes athe copyaddress offor the listdepartment's 14Internet (A)17 inwebsite; a font not smaller than 20 points;

1518 (B)(D) inthat amay conspicuousinclude publica receptionstatement areaexplaining atthat the health19 careundiscounted 16price provider'smay officebe higher or healthlower carethan facilitythe whereamount an individual 20 actually pays for the health care services aredescribed performed;in the list;

1721 (C)(E) that includes thea addressstatement forsubstantially thesimilar department'sto Internetthe 1822 website;following:

19"You (D)will thatbe mayprovided includewith aan statementestimate explainingof that the 20anticipated undiscountedcharges price23 may be higher or lower than the amount an individual 21 actually pays for theyour healthnonemergency care servicesupon describedrequest. in the list;

22Please (E)do thatnot includeshesitate a statement substantially similar to theask 23for following:24 information.";

"Youand will25 be(F) providedthat withlists anany estimatehealth ofcare insurers with which the anticipatedhealth chargescare 2426 forprovider youror nonemergencyhealth care uponfacility request.has a contract to provide health care services as 27 an in-network preferred provider;

Pleaseand do28 not(3) hesitateif tothe askhealth forcare 25provider information.";or health care facility has an Internet 29 website, by posting the list on the website.

and30 26(f) (F)The thatdepartment shall annually compile the lists anyprovided under (a) and (b) 31 of this section by health care insurersservice withand, whichwhere therelevant, health care 27 provider orand health care facility hasname aand contractlocation, topost providethe healthinformation careon servicesthe asdepartment's 2802 anInternet in-networkwebsite, preferredand provider;enter the information in the database maintained under 03 AS 18.15.360.

and04 29(g) (3)If ifa patient who is receiving nonemergency health care services requests an 05 estimate from a health care provider, health care facility, or health care insurer of the 06 reasonably anticipated charges for treating the patient's specific condition, the health 07 care providerprovider, health care facility, or health care facilityinsurer has08 an(1) Internetshall 30provide website,a bygood postingfaith estimate before the listnonemergency onhealth 09 care services are provided and not later than 10 business days after receiving the website.10 request;

3111 (f)(2) The department shall annuallyprovide compile the listsestimate providedin underwhichever (a) and (b) of this section by health care service and, where relevant, health care provider and 02 health care facility name and location, post the informationfollowing onformats the12 department's 03 Internet website, and enter the informationpatient inrequests: the database maintained under 04 AS 18.15.360.

05 (g) If a patient who is receiving nonemergency health care services requests an 06 estimate from a health care provider, health care facility, or health care insurer of the 07 reasonably anticipated charges for treating the patient's specific condition, the health 08 care provider or health care facility, or health care insurer 09 (1) shall provide a good faith estimate before the nonemergency health 10 care services are provided and not later than 10 business days after receiving the 11 request;

12 (2) shall provide the estimate in whichever of the following formats 13 the patient requests:

if the estimate is 1413 provided orally, the health care provider, health care facility, or health care insurer 1514 shall keep a record of the estimate;

1615 (3) is not required to disclose the charges for the total anticipated 1716 course of treatment for the patient, but if the estimate does not include charges for the 1817 total anticipated course of treatment, the estimate must include a statement explaining 1918 that the estimate only includes charges for a portion of the total anticipated course of 2019 treatment;

and 2120 (4) may provide an estimate that includes a reasonable range of 2221 charges for anticipated health care services if the charges for the services will vary 2322 significantly in response to conditions that the health care provider, health care 2423 facility, or health care insurer cannot reasonably assess before the services are 2524 provided.

2625 (h) A good faith estimate requiredprovided by a health care provider or health care 26 facility under (g)(1)(g) of this section must include 27 (1) a brief description in plain language that an individual with no 28 medical training can understand of the health care services, products, procedures, and 29 supplies that are included in the estimate;

18 (i) A health care provider,provider or health care facility,facility that provides a good faith 19 estimate to a patient under (g) and (h) of this section or a health care insurer that 1920 provides a good faith estimate to a patient under (g) and (h) of this section is not liable 20 for 21 damages or other relief if the estimate differs from the amount actually charged to 21 the 22 patient.

2223 (j) The requirement for a health care facility to provide a good faith estimate 2324 of reasonably anticipated charges for nonemergency health care services under 2425 (e)(2)(E), (g), and (h) of this section does not apply to a health care facility that is an 2526 emergency department.

2627 (k) A health care provider or a health care facility that fails to comply with the 2728 requirements of (a) - (e), (g), andor (h) of this section or a health care insurer that fails to 2829 comply with the requirements of (g) and (h) of this section is liable for a civil penalty 29 not to 30 exceed $10,000 for each violation.

The department may impose a penalty, 3031 (1) for failure to comply with (a) - (e) of this section, of not more than 31 $100 for each day of noncompliance after March 31;

or 02 (2) for failure to provide a good faith estimate under (g) andor (h) of this 0203 section, of not more than $100 for each day of noncompliance.

0304 (l) A health care provider, health care facility, or health care insurer penalized 0405 under (k) of this section is entitled to a hearing conducted by the office of 0506 administrative hearings under AS 44.64.

0607 (m) A municipality may not enact or enforce an ordinance that is inconsistent 0708 with or imposes health care price or fee disclosure requirements in addition to the 0809 requirements under this section or regulations adopted under this section.

0910 (n) In this section, 1011 (1) "department" means the Department of Health and Social Services;

1112 (2) "facility fee" means a charge or fee billed by a health care provider 1213 or health care facility that is in addition to fees billed for a health care provider's 1314 professional services and is intended to cover building, electronic medical records 1415 system, billing, and other administrative and operational expenses;

1516 (3) "health care facility" means a private, municipal, or state hospital, 1617 psychiatric hospital, emergency department, independent diagnostic testing facility, 1718 residential psychiatric treatment center as defined in AS 47.32.900, kidney disease 1819 treatment center (including freestanding hemodialysis units), the offices of private 1920 physicians or dentists whether in individual or group practice, ambulatory surgical 2021 center as defined in AS 47.32.900, free-standing birth center as defined in 2122 AS 47.32.900, and rural health clinic as defined in AS 47.32.900;