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H.B. 11

             1     

INMATE HEALTH INSURANCE AMENDMENTS

             2     
2011 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Paul Ray

             5     
Senate Sponsor: ____________

             6     
             7      LONG TITLE
             8      Committee Note:
             9          The Judiciary, Law Enforcement, and Criminal Justice Interim Committee
             10      recommended this bill.
             11      General Description:
             12          This bill modifies the Institutions Code and other code provisions regarding health care
             13      for inmates by modifying provisions concerning coverage by a person's private health
             14      and dental policies while the person is an inmate or while the person is in the custody of
             15      the Department of Corrections or a county jail, and also addresses coordination of
             16      benefits and exemptions.
             17      Highlighted Provisions:
             18          This bill:
             19          .    provides that, if an insured is otherwise eligible for health or dental benefits under a
             20      policy, an insurer may not exclude coverage for an insured who is:
             21              .    an inmate housed in a correctional facility;
             22              .    an offender in the custody of the Department of Corrections; or
             23              .    an inmate housed in a county jail;
             24          .    requires a health or dental insurer to coordinate benefits for an insured who is:
             25              .    an inmate housed in a correctional facility;
             26              .    an offender in the custody of the Department of Corrections; or
             27              .    an inmate housed in a county jail;


             28          .    requires a person who has health or dental insurance coverage, upon entering into
             29      the custody of the department or county sheriff, to use that coverage as primary
             30      payer for health and dental costs while in custody; and
             31          .    provides exemptions regarding coverage by an inmate's health or dental insurance
             32      policy for:
             33              .    incidents of inmate self harm;
             34              .    injuries sustained by the inmate as a result of an act of physical violence
             35      committed either upon or by the inmate; or
             36              .    situations where the department or sheriff has reason to believe, based on a
             37      medical evaluation of the inmate, that the inmate sought the health or dental
             38      care knowing that an underlying medical or dental need did not exist.
             39      Money Appropriated in this Bill:
             40          None
             41      Other Special Clauses:
             42          This bill takes effect on July 1, 2011.
             43      Utah Code Sections Affected:
             44      AMENDS:
             45          31A-22-613, as last amended by Laws of Utah 2005, Chapter 78
             46          31A-22-619, as last amended by Laws of Utah 2010, Chapter 285
             47          64-13-30 (Effective 07/01/11), as last amended by Laws of Utah 2010, Chapter 386
             48     
             49      Be it enacted by the Legislature of the state of Utah:
             50          Section 1. Section 31A-22-613 is amended to read:
             51           31A-22-613. Permitted provisions for accident and health insurance policies.
             52          The following provisions may be contained in an accident [and], health, and dental
             53      insurance policy, but if they are in that policy, they shall conform to at least the minimum
             54      requirements for the policyholder in this section.
             55          (1) Any provision respecting change of occupation may provide only for a lower
             56      maximum benefit payment and for reduction of loss payments proportionate to the change in
             57      appropriate premium rates, if the change is to a higher rated occupation, and this provision
             58      shall provide for retroactive reduction of premium rates from the date of change of occupation


             59      or the last policy anniversary date, whichever is the more recent, if the change is to a lower
             60      rated occupation.
             61          (2) Section 31A-22-405 applies to misstatement of age in accident and health policies,
             62      with the appropriate modifications of terminology.
             63          (3) (a) Any policy which contains a provision establishing, as an age limit or otherwise,
             64      a date after which the coverage provided by the policy is not effective, and if that date falls
             65      within a period for which a premium is accepted by the insurer or if the insurer accepts a
             66      premium after that date, the coverage provided by the policy continues in force, subject to any
             67      right of cancellation, until the end of the period for which the premium was accepted.
             68          (b) This Subsection (3) does not apply if the acceptance of premium would not have
             69      occurred but for a misstatement of age by the insured.
             70          (4) (a) (i) If an insured is otherwise eligible for maternity benefits, a policy may not
             71      contain language which requires an insured to obtain any additional preauthorization or
             72      preapproval for customary and reasonable maternity care expenses or for the delivery of the
             73      child after an initial preauthorization or preapproval has been obtained from the insurer for
             74      prenatal care.
             75          (ii) A requirement for notice of admission for delivery is not a requirement for
             76      preauthorization or preapproval, however, the maternity benefit may not be denied or
             77      diminished for failure to provide admission notice. The policy may not require the provision of
             78      admission notice by only the insured patient.
             79          (b) This Subsection (4) does not prohibit an insurer from:
             80          (i) requiring a referral before maternity care can be obtained;
             81          (ii) specifying a group of providers or a particular location from which an insured is
             82      required to obtain maternity care; or
             83          (iii) limiting reimbursement for maternity expenses and benefits in accordance with the
             84      terms and conditions of the insurance contract so long as [such] the terms do not conflict with
             85      Subsection (4)(a).
             86          (5) An insurer may only represent that a policy:
             87          (a) offers a vision benefit if the policy:
             88          (i) charges a premium for the benefit; and
             89          (ii) provides reimbursement for materials or services provided under the policy; and


             90          (b) covers laser vision correction, whether photorefractive keratectomy, laser assisted
             91      in-situ keratomelusis, or related procedure, if the policy:
             92          (i) charges a premium for the benefit; and
             93          (ii) the procedure is at least a partially covered benefit.
             94          (6) If an insured is otherwise eligible for benefits under a health or dental policy, the
             95      insurer may not exclude coverage if the insured is an:

             96          (a) inmate housed in a correctional facility as defined in Section 64-13-1 ;
             97          (b) offender in the custody of the Department of Corrections; or
             98          (c) inmate housed in a county jail.
             99          Section 2. Section 31A-22-619 is amended to read:
             100           31A-22-619. Coordination of benefits.
             101          (1) The commissioner shall:
             102          (a) adopt rules concerning the coordination of benefits between accident and health
             103      insurance policies;
             104          (b) publish a coordination of benefits guide;
             105          (c) post the coordination of benefits guide on the state insurance exchange; and
             106          (d) work with the Health Data Authority, health care provider groups, and with state
             107      and national organizations that are developing uniform standards for the electronic exchange of
             108      health insurance claims to develop standardized language regarding coordination of benefits for
             109      the purpose of including the standardized language in an insurer's explanation of benefits.
             110          (2) Rules adopted by the commissioner under Subsection (1):
             111          (a) may not prohibit coordination of benefits with individual accident and health
             112      insurance policies;
             113          (b) shall apply equally to all accident and health insurance policies without regard to
             114      whether the policies are group or individual policies; [and]
             115          (c) shall include standardized language regarding the coordination of benefits process
             116      that shall be included in each insurer's accident and health insurance policy[.]; and
             117          (d) shall require a health or dental insurer to coordinate benefits for an insured who is
             118      an:

             119          (i) inmate housed in a correctional facility as defined in Section 64-13-1 ;
             120          (ii) offender in the custody of the Department of Corrections; or


             121          (iii) inmate housed in a county jail.
             122          Section 3. Section 64-13-30 (Effective 07/01/11) is amended to read:
             123           64-13-30 (Effective 07/01/11). Expenses incurred by offenders -- Payment to
             124      department or county jail -- Medical care expenses and copayments.
             125          (1) (a) The department shall establish and collect from each offender on a work release
             126      program the reasonable costs of the offender's maintenance, transportation, and incidental
             127      expenses incurred by the department on behalf of the offender.
             128          (b) Priority shall be given to restitution and family support obligations.
             129          (c) The offender's reimbursement to the department for the cost of obtaining the
             130      offender's DNA specimen under Section 53-10-404 is the next priority after Subsection (1)(b).
             131          (2) The department, under its rules, may advance funds to any offender as necessary to
             132      establish the offender in a work release program.
             133          (3) (a) The department or county jail may require an inmate to make a copayment for
             134      medical and dental services provided by the department or county jail.
             135          (b) For services provided while in the custody of the department, the copayment by the
             136      inmate is $5 for primary medical care, $5 for dental care, and $2 for prescription medication.
             137          (c) For services provided outside of a prison facility while in the custody of the
             138      department, the [offender] inmate is responsible for 10% of the costs associated with hospital
             139      care with a cap on an inmate's share of hospital care expenses not to exceed $2,000 per fiscal
             140      year.
             141          (4) (a) An inmate who has assets exceeding $200,000, as determined by the department
             142      upon entry into the department's custody, is responsible [to pay] for paying the costs of all
             143      medical and dental care up to 20% of the inmate's total determined asset value.
             144          (b) After an inmate has received medical and dental care equal to 20% of the inmate's
             145      total asset value, the inmate is subject to the copayments provided in Subsection (3).
             146          (5) The department shall turn over to the Office of State Debt Collection any debt
             147      under this section that is unpaid at the time the offender is released from parole.
             148          (6) An inmate may not be denied medical treatment if the inmate is unable to pay for
             149      the treatment because of inadequate financial resources.
             150          (7) (a) An inmate who, upon entering into the department's custody, has medical
             151      insurance or dental insurance coverage shall use that coverage as the primary payer for medical


             152      and dental costs incurred while in the custody of the department or county sheriff, except as
             153      limited under Subsection (7)(b).

             154          (b) Any insurance policy held by an inmate for medical or dental care is not required
             155      under Subsection (7)(a) to provide coverage for:

             156          (i) incidents involving the self harm of the inmate;
             157          (ii) injuries sustained by the inmate as a result of an act of physical violence committed
             158      either upon or by the inmate; or

             159          (iii) situations where the department or sheriff has reason to believe, based on a
             160      medical evaluation of the inmate, that the inmate sought the medical or dental care knowing
             161      that an underlying medical or dental need did not exist.

             162          [(7)] (8) When an offender in the custody of the department receives medical care that
             163      is provided outside of a prison facility, the department shall pay the costs:
             164          (a) at the contracted rate; or
             165          (b) (i) if there is no contract between the department and a health care facility that
             166      establishes a fee schedule for medical services rendered, expenses shall be at the noncapitated
             167      state Medicaid rate in effect at the time the service was provided; and
             168          (ii) if there is no contract between the department and a health care provider that
             169      establishes a fee schedule for medical services rendered, expenses shall be 65% of the amount
             170      that would be paid under the Public Employees' Benefit and Insurance Program, created in
             171      Section 49-20-103 .
             172          [(8)] (9) Expenses described in Subsection [(7)] (8) are a cost to the department only to
             173      the extent that they exceed an offender's private insurance that is in effect at the time of the
             174      service and that covers those expenses.
             175          [(9)] (10) (a) The Public Employees' Benefit and Insurance Program shall provide
             176      information to the department that enables the department to calculate the amount to be paid to
             177      a health care provider under Subsection [(7)] (8)(b).
             178          (b) The department shall ensure that information provided under Subsection [(9)]
             179      (10)(a) is confidential.
             180          Section 4. Effective date.
             181          This bill takes effect on July 1, 2011.





Legislative Review Note
    as of 6-24-10 11:21 AM


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