H.B. 134

1

PATIENT ACCESS REFORM
2 2012 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Melvin R. Brown
5 Senate Sponsor: ____________
6
7 LONG TITLE
8 General Description:
9 This bill renames the Integrated Health System Fair Practices Act as the Health System
10 Fair Practices Act and prohibits a hospital from using discounts to restrict patient access
11 to other health care facilities.
12 Highlighted Provisions:
13 This bill:
14 . renames the chapter as Health System Fair Practices Act;
15 . amends definitions;
16 . regulates the use of hospital discounts as a mechanism to control competition from
17 other health care facilities; and
18 . provides a remedy for a violation of the chapter.
19 Money Appropriated in this Bill:
20 None
21 Other Special Clauses:
22 None
23 Utah Code Sections Affected:
24 AMENDS:
25 13-5b-101, as enacted by Laws of Utah 2007, Chapter 172
26 13-5b-102, as enacted by Laws of Utah 2007, Chapter 172
27 13-5b-103, as enacted by Laws of Utah 2007, Chapter 172

28 ENACTS:
29 13-5b-104, 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 amended to read:
33 CHAPTER 5b. HEALTH SYSTEM FAIR PRACTICES ACT
34 13-5b-101. Title.
35 This chapter is known as the "[Integrated] Health System Fair Practices Act."
36 Section 2. Section 13-5b-102 is amended to read:
37 13-5b-102. Definitions.
38 For purposes of this chapter:
39 (1) "Affiliate" means an organization that directly or indirectly through one or more
40 intermediaries controls, is controlled by, or is under common control with another
41 organization.
42 (2) "Competing facility" means a health care facility that offers one or more of the
43 health care services that a hospital also offers within the insurer's same geographic services
44 area as defined in Section 31A-3-103 .
45 (3) "Health care facility" means:
46 (a) an "ambulatory surgical facility" as defined in Section 26-21-2 ;
47 (b) a "specialty hospital" as defined in Section 26-21-2 ;
48 (c) an "end stage renal disease facility" as defined in Section 26-21-2 ; or
49 (d) a medical imaging center.
50 (4) "Health insurer" means:
51 (a) an entity licensed under Title 31A, Insurance Code, to sell health care insurance as
52 defined in Section 31A-1-301 ; and
53 (b) an entity that is not licensed under Title 31A, Insurance Code that offers to provide
54 a health care benefit or payment of incurred health care expenses.
55 (5) "Hospital" means a general acute care hospital as defined in Section 26-21-2 .
56 [(2)] (6) "Integrated health system" means an organization that directly, or through an
57 affiliate or subsidiary:
58 (a) owns and operates one or more hospitals in the state; and

59 (b) offers health insurance to residents of the state.
60 [(3)] (7) "Subsidiary" means an affiliate controlled:
61 (a) by a specified person;
62 (b) directly or indirectly; and
63 (c) through one or more intermediaries.
64 Section 3. Section 13-5b-103 is amended to read:
65 13-5b-103. Contract negotiation standards -- Health facility discounts to insurers.
66 (1) An integrated health system shall prohibit any employee or independent contractor
67 of any division, subsidiary, or affiliate engaged in the business of health insurance from
68 negotiating contracts on behalf of the integrated health care system's health care facilities,
69 subject to licensing under Title 26, Chapter 21, Health Care Facility Licensing and Inspection
70 Act, with any other licensed health insurer in the state.
71 (2) An integrated health system shall prohibit the disclosure of contract pricing terms
72 between the integrated health care system's health care facilities and other health insurers with
73 the integrated health care system's divisions, subsidiaries, or affiliates which are engaged in the
74 business of health insurance.
75 (3) (a) Except as provided in Subsections (3)(b) and (c), and beginning with a contract
76 negotiated with a health care insurer on or after May 8, 2012, a hospital may not offer to
77 provide a service for the enrollees of a health care insurer at a discount that is different from
78 the discount it offers to any other health care insurer with whom it contracts.
79 (b) If a health care insurer includes a competing facility on its provider panel, a
80 hospital may offer the insurer a different discount only for the particular services that are
81 offered by both the hospital and the competing facility. The hospital may not offer a discount
82 different from Subsection (3)(a) for the services that are not offered at a competing facility.
83 (c) Subsections (3)(a) and (b) do not prohibit a hospital from offering a different
84 discount to different health insurers when that discount is based on the volume of patients the
85 insurer may bring to the hospital for a service which the competing facility does not provide.
86 Section 4. Section 13-5b-104 is enacted to read:
87 13-5b-104. Injunctive relief -- Damages.
88 Any person or the state may maintain an action to enjoin a continuance of any act in
89 violation of this chapter, and, if injured by the act, for the recovery of damages. If the court

90 finds that the defendant is violating or has violated any of the provisions of this chapter, the
91 court shall enjoin the defendant from a continuance of the violation. It is not necessary that
92 actual damages to the plaintiff be alleged or proved. In addition to injunctive relief, the
93 plaintiff is entitled to recover from the defendant three times the amount of the actual damages
94 sustained or $2,000, whichever is greater, plus court costs, and attorney fees.




Legislative Review Note
as of 2-1-12 12:56 PM

Office of Legislative Research and General Counsel