Bill
Number: S.B. 1441
Lesko
Floor Amendment
Reference
to: FINANCE Committee amendment
Amendment
drafted by: Leg Council
FLOOR
AMENDMENT EXPLANATION
- Specifies that a health care, laboratory or durable medical
equipment service (service) provided in a network facility by a
non-contracted provider must meet one of the following requirements in
order to qualify as a surprise out-of-network bill:
a)
the bill was for a service that was provided in the case
of an emergency;
b)
the bill was not for a service that was provided in the
case of an emergency and the provider did not provide the enrollee within a
reasonable amount of time before the enrollee received the service a written
disclosure containing the following information:
i)
notice that a provider is not contracted with the
enrollee's insurance network;
ii) the
estimated total cost to be billed by the provider; and
iii) notice
that if the enrollee or their authorized representative signs the disclosure,
the enrollee may have waived any rights to dispute resolution of the surprise
out-of-network bill; or
c)
the bill was not for a service that was provided in the
case of an emergency and the enrollee received the disclosure, but they or
their authorized representative chose not to sign that disclosure.
- Specifies that an enrollee may not seek arbitration of a bill if
they or their authorized representative signed the provider's written
disclosure and the amount actually billed to the enrollee is less than or
equal to the estimated total cost provided in the disclosure.
- Requires the enrollee to participate in an informal settlement
teleconference (teleconference) after making the request for arbitration
of a surprise out-of-network bill and gives the enrollee the option of
participating in the arbitration. The provider and insurer must still
participate in both the teleconference and the arbitration.
- Specifies that if either the insurer or provider fails to
participate in the teleconference, then the other party may notify the
Department of Insurance to immediately initiate arbitration with the
nonparticipating party being required to pay the total cost of
arbitration.
- Requires the enrollee, before the arbitration occurs, to agree in
writing to pay the health care provider:
a)
the total amount of the enrollee's cost sharing that is
due for the services that are the subject of the surprise out-of-network bill;
and
b)
any amount received from the enrollee's health insurer
as payment for the out-of-network services that were provided by the health
care provider.
- Changes the period of time in which the arbitration must be
conducted from within 180 days to within 120 days.
- Prohibits the provider from issuing any additional balance bill to
the enrollee relating to the service that was the subject of the
teleconference or arbitration after the claim is resolved.
8. Adds a
delayed effective date of January 1, 2019.
- Makes technical
changes.
Page 2, line
8, after "provider" insert "or its billing company or authorized representative"
Lines 9 and
10, strike ", or its billing company,"
Line 21,
after "enrollee's" insert "applicable"
Strike lines
27 through 31, insert:
"8. "health care provider" means a person who is
licensed, registered or certified as a health care professional under title 32
or a laboratory or durable medical equipment provider that furnishes services
to a patient in a network facility and that separately bills the patient for
the services."
Line 32,
after the comma insert "group disability insurer,"
Page 3, line
5, after "service" insert ",
a laboratory service"
Line 6,
strike "if the"
Strike lines
7 through 11, insert "and that meets one of the
requirements listed in section 20‑3113."
Line 17,
strike "Health care providers" insert "Surprise out‑of‑network
bill; requirements"; strike "; requirements"
Strike lines
18 through 31, insert:
"A bill for a health care service, a laboratory service or durable
medical equipment that was provided in a network facility by a health care
provider that is not a contracted provider must meet one of the following
requirements to qualify as a surprise out‑of‑network bill:
1. The
bill was for a health care service, a laboratory service or durable medical
equipment that was provided in the case of an emergency, including under
circumstances described by section 20‑2803, subsection A.
2. The
bill was not for a health care service, a laboratory service or durable medical
equipment that was provided in the case of an emergency and the health care
provider did not provide to the enrollee within a reasonable amount of time
before the enrollee received the services a written disclosure that contained
the following information:
(a) Notice
that the health care provider is not a contracted provider.
(b) The
estimated total cost to be billed by the health care provider.
(c) Notice
that if the enrollee or the enrollee's authorized representative signs the
disclosure, the enrollee may have waived any rights to dispute resolution under
this article.
3. The
bill was not for a health care service, a laboratory service or durable medical
equipment that was provided in the case of an emergency and the enrollee
received the disclosure prescribed in paragraph 2 of this section, but the
enrollee or the enrollee's authorized representative chose not to sign the
disclosure."
Page 3, line
32, strike "Mandatory" insert "Settlement
teleconference;"
Page 4, line
1, strike "application" insert "deduction"; after "requirements"
insert "and the insurer's allowable reimbursement";
strike "including the"
Line 2,
strike "amount unpaid by the health insurer,"
Line 5,
after the comma insert "the enrollee shall participate in
an informal settlement teleconference and may participate in the arbitration.";
after "in" insert "the
informal settlement teleconference and"
Between
lines 6 and 7, insert:
"C. An enrollee may not seek arbitration of a bill if the
enrollee or the enrollee's authorized representative signed the disclosure
prescribed in section 20‑3113, paragraph 2 and the amount actually billed
to the enrollee is less than or equal to the estimated total cost provided in
the disclosure."
Line 9,
after "arbitration" insert "procedure"
Page 4, line
11, strike "may" insert "shall"
Line 13,
after the period insert "Department staff may not serve as
arbitrators."
Line 18,
strike "appoint an arbitrator and shall"
Line 19,
after the first "the" insert "request.
D. In
an effort to settle the surprise out-of-network bill before arbitration, the
department shall arrange an informal settlement teleconference within thirty
days after the department receives the request for arbitration. If the dispute
is not settled in the teleconference, the parties shall notify the department.
E. If either the health insurer or health care
provider fails to participate in the teleconference, the other party may notify
the department to immediately initiate arbitration and the nonparticipating
party shall be required to pay the total cost of the arbitration.
F. On receipt of notice that the dispute has not
settled or that a party has failed to participate in the teleconference, the
Department shall appoint an arbitrator and shall notify the parties of the"
Reletter to
conform
Strike lines
25 through 32, insert:
"G. Before the arbitration, the enrollee shall agree in
writing to pay the health care provider the total amount of the enrollee's cost
sharing that is due for the services that are the subject of the surprise out‑of‑network
bill and any amount received from the enrollee's health insurer as payment for
the out‑of‑network services that were provided by the health care
provider."
Reletter to
conform
Lines 33 and
34, strike "that is not settled through the informal
settlement conference"
Page 5, line
28, strike "eighty" insert "twenty"
Line 35,
after "provider" insert "or
its billing company or authorized representative"
Page 6, line
9, after "remit" insert "its
portion of"
Line 10,
strike "conference" insert "teleconference"
Line 14,
after "requirements" insert ", and the health care provider may not issue, either directly or
through its billing company, any additional balance bill to the enrollee
related to the health care service, laboratory service or durable medical
equipment that was the subject of the informal settlement teleconference or
arbitration"
Line 15,
after "agree" insert "or
unless required by subsection E of this section"
Line 16,
strike the period insert ", and the enrollee is not
responsible for any portion of the cost of the arbitration."
Line 19,
strike "adjustment" insert "adjudication"
Between
lines 19 and 20, insert:
"Sec. 3. Effective date
This act is
effective from and after December 31, 2018."
Amend title
to conform