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.
January 19, 2005, read first time and referred to Committee on Public Health.
A BILL FOR AN ACT to amend the Indiana Code concerning
uniform schedule of charges published by a facility as the facility's
gross billed charge for a given service or treatment, regardless of
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
(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: