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Second Substitute H.B. 279

Representative David Ure proposes the following substitute bill:


             1     
PATIENT ACCESS TO HEALTH CARE

             2     
2006 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: David Ure

             5     
Senate Sponsor: ____________

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill enacts the Health Care Organizations Practices Act.
             10      Highlighted Provisions:
             11          This bill:
             12          .    defines terms;
             13          .    requires a hospital to give at least the same discount to any uninsured patient, that
             14      the hospital gives to an affiliated health care insurer;
             15          .    requires a hospital to disclose discounts it provides to an affiliated health care
             16      insurer to the commissioner of the Department of Insurance;
             17          .    requires a hospital to certify to the licensing authority in the Department of Health
             18      that it is in compliance with this act; and
             19          .    provides for penalties for a violation of the act.
             20      Monies Appropriated in this Bill:
             21          None
             22      Other Special Clauses:
             23          This bill takes effect on July 1, 2006.
             24      Utah Code Sections Affected:
             25      ENACTS:


             26          13-5b-101, Utah Code Annotated 1953
             27          13-5b-102, Utah Code Annotated 1953
             28          13-5b-201, Utah Code Annotated 1953
             29          13-5b-301, Utah Code Annotated 1953
             30     
             31      Be it enacted by the Legislature of the state of Utah:
             32          Section 1. Section 13-5b-101 is enacted to read:
             33     
CHAPTER 5b. HEALTH CARE ORGANIZATION PRACTICES ACT

             34     
Part 1. General Provisions

             35          13-5b-101. Title -- Liberally construed.
             36          (1) This chapter is known as the "Health Care Organization Practices Act."
             37          (2) This chapter shall be liberally construed.
             38          Section 2. Section 13-5b-102 is enacted to read:
             39          13-5b-102. Definitions.
             40          As used in this chapter:
             41          (1) "Affiliated" means two or more persons that:
             42          (a) directly or indirectly, through one or more intermediaries, control, are controlled by,
             43      or are under common control; or
             44          (b) when one person owns at least 20% of the other person.
             45          (2) "Discount" means any mechanism that has the effect in whole or in part of reducing
             46      the actual fee paid to or ultimately received by a hospital for a service in comparison to the
             47      price charged for the same service to any other person, including:
             48          (a) any fee reduction from charges;
             49          (b) any rebates;
             50          (c) half backs; or
             51          (d) internal transfers.
             52          (3) "Health care insurer" means:
             53          (a) a health maintenance organization as defined in Section 31A-8-101 ; or
             54          (b) an insurer offering accident and health insurance as defined in Section 31A-1-301 .
             55          (4) "Hospital" means a:
             56          (a) "general acute hospital" as defined in Section 26-21-2 ; or


             57          (b) "specialty hospital" as defined in Section 26-21-2 .
             58          (5) "Uninsured patient" means any natural person who:
             59          (a) as a result of a diagnosis, illness, or injury, needs treatment from a hospital or
             60      physician's employed by the hospital; and
             61          (b) does not have accident and health insurance coverage; or
             62          (c) has accident and health insurance coverage that is a high deductible plan such as a
             63      Health Care Savings Account.
             64          Section 3. Section 13-5b-201 is enacted to read:
             65     
Part 2. Organization Practices

             66          13-5b-201. Discounts.
             67          (1) A hospital, a physician employed by a hospital, or a physician under an exclusive
             68      contract with a hospital shall give any uninsured patient who obtains services from the hospital
             69      or physician at least the greatest discount the hospital or physician provides to a patient who:
             70          (a) is an enrollee of a health care insurer who is affiliated with the hospital; and
             71          (b) receives the same services.
             72          (2) The requirements of Subsection (1):
             73          (a) are effective July 1, 2006 for uninsured individuals; and
             74          (b) do not apply to a hospital that is not affiliated with a health care insurer.
             75          (3) (a) Beginning July 1, 2006, a hospital shall provide to the commissioner of the
             76      Insurance Department timely and accurate information on the hospital's, employed physician's
             77      or, physician's under exclusive contract discount for a service that is given to an affiliated
             78      health care insurer.
             79          (b) A hospital subject to this chapter, and licensed under Title 26, Chapter 21, Health
             80      Care Facility Licensing, and Inspection Act, shall, at the time of any license renewal, certify to
             81      the licensing authority in the Department of Health that the hospital is in compliance with the
             82      requirements of this chapter.
             83          Section 4. Section 13-5b-301 is enacted to read:
             84     
Part 3. Penalties

             85          13-5b-301. Penalties -- Private right of action.
             86          In addition to other penalties provided for under Title 13, Chapter 5, Unfair Practices
             87      Act and Title 76, Chapter 10, Part 9, Trade and Commerce, a hospital or organization that


             88      knowingly or with conscious disregard violates this chapter is subject to a private right of
             89      action under which a person injured by a violation of this chapter may receive:
             90          (1) treble damages;
             91          (2) costs of litigation;
             92          (3) attorney's fees; and
             93          (4) contractual damages that are otherwise available.
             94          Section 5. Effective date.
             95          This bill takes effect on July 1, 2006.


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