1     
HEALTH CARE DEBT COLLECTION AMENDMENTS

2     
2017 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: R. Curt Webb

5     
Senate Sponsor: Curtis S. Bramble

6     

7     LONG TITLE
8     General Description:
9          This bill modifies and enacts provisions related to health care claims practices.
10     Highlighted Provisions:
11          This bill:
12          ▸     defines terms;
13          ▸     modifies the circumstances under which a health care provider may make a report to
14     a credit bureau or use the services of a collection agency against an insured;
15          ▸     addresses administrative penalties for a health care provider who fails to comply with
16     the provisions of this bill; and
17          ▸     makes technical and conforming changes.
18     Money Appropriated in this Bill:
19          None
20     Other Special Clauses:
21          None
22     Utah Code Sections Affected:
23     AMENDS:
24          31A-26-301.5, as last amended by Laws of Utah 2016, Chapter 124
25          62A-2-112, as last amended by Laws of Utah 2016, Chapter 211
26     ENACTS:
27          26-21-11.1, Utah Code Annotated 1953
28          58-1-508, Utah Code Annotated 1953
29     

30     Be it enacted by the Legislature of the state of Utah:
31          Section 1. Section 26-21-11.1 is enacted to read:
32          26-21-11.1. Failure to follow certain health care claims practices -- Penalties.
33          (1) The department may assess a fine of up to $500 per violation against a health care
34     facility that violates Subsection 31A-26-301.5(4).
35          (2) The department shall waive the fine described in Subsection (1) if:
36          (a) the health care facility demonstrates to the department that the health care facility
37     mitigated and reversed any damage to the insured caused by the health care facility's violation;
38     or
39          (b) the insured does not pay the full amount due on the bill that is the subject of the
40     violation, including any interest, fees, costs, and expenses, within 120 days after the day on
41     which the health care facility makes a report to a credit bureau or uses the services of a
42     collection agency in violation of Subsection 31A-26-301.5(4).
43          Section 2. Section 31A-26-301.5 is amended to read:
44          31A-26-301.5. Health care claims practices.
45          (1) As used in this section:
46          (a) "Health care provider" means:
47          (i) a health care facility as defined in Section 26-21-2; or
48          (ii) a person licensed to provide health care services under:
49          (A) Title 58, Occupations and Professions; or
50          (B) Title 62A, Chapter 2, Licensure of Programs and Facilities.
51          (b) "Text message" means a real time or near real time message that consists of text and
52     is transmitted to a device identified by a telephone number.
53          [(1)] (2) Except as provided in Section 31A-8-407, an insured retains ultimate
54     responsibility for paying for health care services the insured receives. If a service is covered by
55     one or more individual or group health insurance policies, all insurers covering the insured have
56     the responsibility to pay valid health care claims in a timely manner according to the terms and
57     limits specified in the policies.
58          [(2) (a)] (3) [Except as provided in Section 31A-22-610.1, a] A health care provider
59     may:
60          (a) except as provided in Section 31A-22-610.1, bill and collect for any deductible,
61     copayment, or uncovered service[.]; and
62          (b) [A health care provider may] bill an insured for services covered by health insurance
63     policies or [may] otherwise notify the insured of the expenses covered by the policies.
64     [However, a]
65          (4) (a) Except as provided in Subsection (4)(c), a health care provider may not make
66     any report to a credit bureau[,] or use the services of a collection agency[, or use methods other
67     than routine billing or notification until the later of] unless the health care provider:
68          (i) (A) after the expiration of the time afforded to an insurer under Section
69     31A-26-301.6 to determine [its] the insurer's obligation to pay or deny the claim without
70     penalty[; or] , sends a notice described in Subsection (4)(b) to the insured by certified mail with
71     return receipt requested, priority mail, or text message; and
72          (B) makes the report to a credit bureau or uses the services of a collection agency after
73     the date stated in the notice in accordance with Subsection (4)(b)(ii)(A); or
74          (ii) (A) in the case of a Medicare [beneficiaries or retirees] beneficiary or retiree 65
75     years of age or older, [60 days from] after the date Medicare determines [its] Medicare's liability
76     for the claim[.] , sends a notice described in Subsection (4)(b) to the insured by certified mail
77     with return receipt requested, priority mail, or text message; and
78          (B) makes the report to a credit bureau or uses the services of a collection agency after
79     the date stated in the notice in accordance with Subsection (4)(b)(ii)(B).
80          (b) A notice described in Subsection (4)(a) shall state:
81          (i) the amount that the insured owes;
82          (ii) the date by which the insured must pay the amount owed that is:
83          (A) at least 45 days after the day on which the health care provider sends the notice; or
84          (B) if the insured is a Medicare beneficiary or retiree 65 years of age or older, at least
85     60 days after the day on which the health care provider sends the notice;
86          (iii) that if the insured fails to timely pay the amount owed, the health care provider may
87     make a report to a credit bureau or use the services of a collection agency; and
88          (iv) that each action described in Subsection (4)(b)(iii) may negatively impact the
89     insured's credit score.
90          (c) A health care provider satisfies the requirements described in Subsections (4)(a) and
91     (b) if the health care provider complies with the provisions of 26 C.F.R. Sec. 1.501(r)-6.
92          [(c)] (5) Beginning October 31, 1992, all insurers covering the insured shall notify the
93     insured of payment and the amount of payment made to the health care provider.
94          [(d)] (6) A health care provider shall return to an insured any amount the insured
95     overpaid, including interest that begins accruing 90 days after the date of the overpayment, if:
96          [(i)] (a) the insured has multiple insurers with whom the health care provider has
97     contracts that cover the insured; and
98          [(ii)] (b) the health care provider becomes aware that the health care provider has
99     received, for any reason, payment for a claim in an amount greater than the health care
100     provider's contracted rate allows.
101          [(3)] (7) The commissioner shall make rules consistent with this chapter governing
102     disclosure to the insured of customary charges by health care providers on the explanation of
103     benefits as part of the claims payment process. These rules shall be limited to the form and
104     content of the disclosures on the explanation of benefits, and shall include:
105          (a) a requirement that the method of determination of any specifically referenced
106     customary charges and the range of the customary charges be disclosed; and
107          (b) a prohibition against an implication that the health care provider is charging
108     excessively if the health care provider is:
109          (i) a participating provider; and
110          (ii) prohibited from balance billing.
111          Section 3. Section 58-1-508 is enacted to read:
112          58-1-508. Failure to follow certain health care claims practices -- Penalties.
113          (1) As used in this section, "health care provider" means an individual who is licensed to
114     provide health care services under this title.
115          (2) The division may assess a fine of up to $500 per violation against a health care
116     provider who violates Subsection 31A-26-301.5(4).
117          (3) The division shall waive the fine described in Subsection (2) if:
118          (a) the health care provider demonstrates to the division that the health care provider
119     mitigated and reversed any damage to the insured caused by the health care provider's violation;
120     or
121          (b) the insured does not pay the full amount due on the bill that is the subject of the
122     violation, including any interest, fees, costs, and expenses, within 120 days after the day on
123     which the health care provider makes a report to a credit bureau or uses the services of a
124     collection agency in violation of Subsection 31A-26-301.5(4).
125          Section 4. Section 62A-2-112 is amended to read:
126          62A-2-112. Violations -- Penalties.
127          (1) As used in this section, "health care provider" means a person licensed to provide
128     health care services under this chapter.
129          [(1)] (2) The office may deny, place conditions on, suspend, or revoke a human services
130     license, if it finds, related to the human services program:
131          (a) that there has been a failure to comply with the rules established under this chapter;
132          (b) evidence of aiding, abetting, or permitting the commission of any illegal act; or
133          (c) evidence of conduct adverse to the standards required to provide services and
134     promote public trust, including aiding, abetting, or permitting the commission of abuse, neglect,
135     exploitation, harm, mistreatment, or fraud.
136          [(2)] (3) The office may restrict or prohibit new admissions to a human services
137     program, if it finds:
138          (a) that there has been a failure to comply with rules established under this chapter;
139          (b) evidence of aiding, abetting, or permitting the commission of any illegal act; or
140          (c) evidence of conduct adverse to the standards required to provide services and
141     promote public trust, including aiding, abetting, or permitting the commission of abuse, neglect,
142     exploitation, harm, mistreatment, or fraud.
143          (4) (a) The office may assess a fine of up to $500 per violation against a health care
144     provider who violates Subsection 31A-26-301.5(4).
145          (b) The office shall waive the fine described in Subsection (4)(a) if:
146          (i) the health care provider demonstrates to the office that the health care provider
147     mitigated and reversed any damage to the insured caused by the health care provider's violation;
148     or
149          (ii) the insured does not pay the full amount due on the bill that is the subject of the
150     violation, including any interest, fees, costs, and expenses, within 120 days after the day on
151     which the health care provider makes a report to a credit bureau or uses the services of a
152     collection agency in violation of Subsection 31A-26-301.5(4).