SB 451 — AN ACT PROTECTING PATIENTS FROM UNREASONABLE MEDICAL BILLS.

General Assembly   CommitteeSubstitute Bill No.

451 January Session, 2017   LCO*_____SB00451PH____032817____* No.AN ACT PROTECTING PATIENTS FROM UNREASONABLE MEDICAL BILLS.

5606   *05606SB00451PH_* Referred to Committee on PUBLIC HEALTH   Introduced by:

  (PH)   AN ACT PROTECTING PATIENTS FROM UNREASONABLE MEDICAL BILLS.

(b) If a hospital or health system charges a facility fee (1) utilizing a current procedural terminology evaluation and management (CPT E/M) code for outpatient services provided at a hospital-based facility, [where a professional fee is also expected to be charged,]charged] or (2) for any outpatient services provided at a hospital-based facility located off-site from the hospital campus, the hospital or health system shall provide the patient with a written notice that includes the following information:

(1)[(1)] (A) That the hospital-based facility is part of a hospital or health system and that the hospital or health system charges a facility fee that is in addition to and separate from the professional fee charged by the provider;

(2)[(2) (A)(A)] (B) (i) The amount of the patient's potential financial liability, including any facility fee likely to be charged, and [, where professional medical services are provided by an affiliated provider,] any professional fee likely to be charged, or, if the exact type and extent of the professional medical services needed are not known or the terms of a patient's health insurance coverage are not known with reasonable certainty, an estimate of the patient's financial liability based on typical or average charges for visits to the hospital-based facility, including the facility fee, [(B)] provided if a range is given for the facility fee likely to be charged, the high number in the range shall be no greater than one hundred fifty per cent of the low number in the range, (B)(ii) a statement that the patient's actual financial liability will depend on the professional medical services actually provided to the patient, and (C)[(C)] (iii) an explanation that the patient may incur financial liability that is greater than the patient would incur if the professional medical services were not provided by a hospital-based facility;

and (3)[(3)] (C) That a patient covered by a health insurance policy should contact the health insurer for additional information regarding the hospital's or health system's charges and fees, including the patient's potential financial liability, if any, for such charges and fees.

[(e)] (f) The written notice described in subsections (b)(b), [to (d)](d), andinclusive, (e)(h) [,to inclusive,](j)] and [(h)(e) toand (j)] (i) to (k), inclusive, of this section shall be in plain language and in a form that may be reasonably understood by a patient who does not possess special knowledge regarding hospital or health system facility fee charges.

[(k)] (l) Notwithstanding the provisions of this section, [on and after January 1, 2017,] no hospital, health system or hospital-based facility shall collect a facility fee for (1) outpatient health care services that use a current procedural terminology evaluation and management (CPT E/M) code and are provided at a hospital-based facility located off-site from a hospital campus, other than a hospital emergency department, [located off-site from a hospital campus] operated as a provider-based entity, as defined in 42 CFR 413.65, that is authorized under Medicare rules to bill for emergency procedures, or (2) outpatient health care services, other than those provided in an emergency department located off-site from a hospital campus, and operated as a provider-based entity, as defined in 42 CFR 413.65, that is authorized under Medicare rules to bill for emergency procedures, received by a patient who is uninsured of more than the Medicare rate.

Section 1 October 1, 2017 19a-508c Statement of Purpose:Legislative Commissioners:

ToIn protectSection patients1(b), fromsubdivision unreasonabledesignators medical(1) bills.to (3), inclusive, were bracketed and changed to subparagraph designators (A) to (C), inclusive for accuracy;

[Proposedin deletionsSection are(1)(b)(2)(B), enclosedsubparagraph indesignators brackets.(A) to (C), inclusive, were bracketed and changed to clause designators (i) to (iii), inclusive, for accuracy;

Proposedand additionsin areSection indicated1(l)(1), by"management underline,code" exceptwas thatchanged whento the"management entire(CPT textE/M) ofcode" afor billinternal orconsistency. resolution or a section of a bill or resolution is new, it is not underlined.] Co-Sponsors:

SEN.PH Joint Favorable Subst.

LOONEY,-LCO 11th  Dist.;

SEN.

FASANO, 34th Dist.

S.B.

451