Introduced Version






HOUSE BILL No. 1716

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 16-18-2; IC 16-21-10.

Synopsis: Disclosure of hospital health care costs. Requires hospitals and ambulatory outpatient surgical centers to: (1) provide billing information to patients and the public; (2) establish an appeal procedure for disputed patient bills; and (3) establish programs that provide reduced cost of care to eligible individuals and alternative payment options to other individuals. Requires the state department of health to investigate violations of these requirements and specifies action that may be taken by the state department for a violation.

Effective: July 1, 2005.





Ripley




    January 19, 2005, read first time and referred to Committee on Public Health.







Introduced

First Regular Session 114th General Assembly (2005)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional provision adopted), the text of the new provision will appear in this style type. Also, the word NEW will appear in that style type in the introductory clause of each SECTION that adds a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts between statutes enacted by the 2004 Regular Session of the General Assembly.

HOUSE BILL No. 1716



    A BILL FOR AN ACT to amend the Indiana Code concerning health.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 16-18-2-52.3; (05)IN1716.1.1. -->     SECTION 1. IC 16-18-2-52.3 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 52.3. "Charge master", for purposes of IC 16-21-10, has the meaning set forth in IC 16-21-10-1.
SOURCE: IC 16-18-2-122; (05)IN1716.1.2. -->     SECTION 2. IC 16-18-2-122 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 122. "Facility" refers to the following:
        (1)
For purposes of IC 16-21-10, has the meaning set forth in IC 16-21-10-2.
        (2) For purposes of
IC 16-41-11, has the meaning set forth in IC 16-41-11-2.
SOURCE: IC 16-21-10; (05)IN1716.1.3. -->     SECTION 3. IC 16-21-10 IS ADDED TO THE INDIANA CODE AS A NEW CHAPTER TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]:
     Chapter 10. Disclosure of the Cost of Services
    Sec. 1. As used in this chapter, "charge master" means a

uniform schedule of charges published by a facility as the facility's gross billed charge for a given service or treatment, regardless of payor type.
    Sec. 2. As used in this chapter, "facility" refers to the following:
        (1) A hospital licensed under IC 16-21-2.
        (2) An ambulatory outpatient surgical center licensed under IC 16-21-2.
    Sec. 3. (a) A facility shall establish a program that reduces the cost of a service provided by the facility for a patient who:
        (1) has an income of not more than two hundred fifty percent (250%) of the federal income poverty level; and
        (2) does not:
            (A) have insurance coverage; or
            (B) qualify for coverage under:
                (i) Medicaid under IC 12-15;
                (ii) the federal Medicare program (42 U.S.C. 1395 et seq.);
                (iii) an association policy under IC 27-8-10; or
                (iv) any other state or federal assistance program that provides coverage for health care services.
    (b) A facility shall establish a program that creates a method of payment that allows a patient who has an income of more than two hundred fifty percent (250%) of the federal income poverty level to pay for services rendered by the facility in a manner other than a lump sum basis or a delayed basis.
    Sec. 4. A facility shall provide a patient described in section 3(a)(2) of this chapter with information on the facility's program established under section 3 of this chapter:
        (1) before the patient is admitted to the facility for a nonemergency service; or
        (2) as soon as reasonably practicable if the patient is admitted to the facility for an emergency service.
    Sec. 5. A facility shall implement procedures for a patient described in section 3(a)(2) of this chapter to apply for the program established under section 3 of this chapter. The facility shall design an application form for the program in a manner that encourages a patient to participate in the program.
    Sec. 6. (a) A facility shall make the following available to the public on the facility's Internet web site:
        (1) A copy of the facility's program established under section 3 of this chapter.
        (2) The facility's current charge master with a comparison of

the amount of reimbursement for the services under the federal Medicare program.
    (b) A facility shall provide a hard copy of the information required under subsection (a) upon request.
    Sec. 7. (a) A facility shall conspicuously post a sign:
        (1) in the area in which patients are admitted;
        (2) in the reception area that is open to the public; and
        (3) in the billing office;
to notify patients of the facility's program established under section 3 of this chapter and to inform the patient that the patient may have a copy of the program upon request.
    (b) A facility shall file a quarterly report with the state department indicating the following concerning the program described in section 3(a) of this chapter:
        (1) The number of patients that applied for the program.
        (2) The number of patients that were approved to participate in the program.
    Sec. 8. (a) A facility may not require a patient or a patient's representative to do the following:
        (1) Enter into an agreement that requires the patient to be financially liable for an unspecified amount for the provision of services by the facility.
        (2) Waive the patient's right to appeal charges billed to the patient by the facility.
    (b) A facility may require the patient or a patient's representative to make a financial commitment for nonemergency services if the facility provides the patient or the patient's representative with an estimate of the charges that:
        (1) the facility;
        (2) a contractor of the facility; or
        (3) a physician licensed under IC 25-22.5 who provides services at the facility;
generally charges for the services needed to treat the patient's condition.
    (c) The facility shall notify the patient or the patient's representative of any changes in an estimate provided under subsection (b) in a timely manner.
    (d) If the facility revises the estimated charges provided under subsection (b) by the lesser of either:
        (1) twenty percent (20%); or
        (2) one thousand dollars ($1,000);
of the original estimate, the financial commitment entered into by

the patient or the patient's representative is void.
    Sec. 9. A facility may not provide nonemergency services to a patient until the facility has provided the patient with written notice advising the patient of the availability of the facility's charge master from the state department as required by section 13 of this chapter.
    Sec. 10. If an unanticipated complication or an unforeseen circumstance occurs in the nonemergency treatment of a patient, the facility may charge the patient or a third party payor for the additional services or supplies resulting from the complication or unforeseen circumstance if the charges are itemized on the patient's billing statement.
    Sec. 11. (a) A facility shall provide a patient with the following information concerning a service received by the patient at the facility:
        (1) The cost for each service provided to the patient.
        (2) The amount of reimbursement for the service under the federal Medicare program, including any cost sharing requirement.
    (b) Subsection (a)(2) does not include supplemental payments required under the federal Medicare program.
    Sec. 12. A facility may not condition the provision of services to an individual on a waiver of the patient's rights under this chapter.
    Sec. 13. (a) A facility shall file the following with the state department not later than forty-five (45) days after each calendar quarter:
        (1) A copy of the facility's current charge master containing pricing information on each service provided by the facility.
        (2) The facility's billing policy concerning the facility's charge master.
        (3) Information concerning any changes in the facility's gross revenue due to a change in the charge master during the previous twelve (12) months.
        (4) The expected amount that would be reimbursed under the federal Medicare program for a service listed on the facility's charge master, including cost sharing required under the federal Medicare program, but excluding any supplemental payment required under the federal Medicare program.
    (b) The state department shall publish information on the state department's Internet web site concerning the reports filed under subsection (a).
    (c) Beginning March 1, 2006, the state department shall

annually issue a report to legislative council in an electronic format under IC 5-14-6 and to the governor that includes the following information:
        (1) The number of individuals who applied to participate in a program established under section 3(a) of this chapter.
        (2) The number of investigations conducted by the state department for violations of this chapter.
        (3) The number of violations confirmed by the state department.
        (4) The name of a facility that has violated this chapter and the actions taken by the state department against the facility as allowed under section 14(a) of this chapter.
    (d) The state department shall make the report required under subsection (c) available to the public upon request and without charge.
    Sec. 14. (a) The state department may take the following action against a facility that violates this chapter:
        (1) Suspend the facility's license.
        (2) Revoke the facility's license.
        (3) Fine the facility not more than five thousand dollars ($5,000) for each violation.
    (b) An individual may file with the state department a complaint alleging that a facility has violated this chapter. The state department shall investigate the complaint and report the state department's findings to the complainant and any action that will be taken under subsection (a).
    Sec. 15. (a) An individual who receives services from a facility has the right to appeal any charges billed by:
        (1) the facility;
        (2) a contractor of the facility; or
        (3) a physician licensed under IC 25-22.5 who provides services at the facility.
    (b) A facility's billing statement must notify the individual of the individual's right to appeal a charge on the statement. The notice on the billing statement must meet the following conditions:
        (1) Be in at least 12 point type.
        (2) Be in bold faced type.
        (3) Be in capitalized letters.
        (4) Be conspicuously displayed at the bottom of the billing statement.
    Sec. 16. (a) A facility shall establish an independent method for reviewing billing that includes the following:


        (1) The review of the charges by an individual who was not involved in the initial billing of the patient.
        (2) A written decision with a clear explanation of the grounds for the decision concerning the billing appeal not later than thirty (30) days after the facility receives the request for appeal.
    (b) A facility shall maintain a record of the following regarding a billing appeal filed under this chapter:
        (1) The name of the patient or the patient's representative who requested the appeal.
        (2) The basis for the appeal.
        (3) The total amount of billing charges.
        (4) The amount of billing charges under appeal.
        (5) The disposition of the appeal and the basis for the disposition.
    Sec. 17. A facility shall annually report to the state department the following information concerning appeals at the facility:
        (1) The number of appeals filed in the calendar year.
        (2) The total amount of billing charges subject to appeal.
        (3) A summary of the disposition of each appeal.