Representative R. Curt Webb proposes the following substitute bill:


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