This document includes House Floor Amendments incorporated into the bill on Tue, Feb 1, 2022 at 12:06 PM by lfindlay.
Representative Mike Winder proposes the following substitute bill:


1     
MEDICAL BILLING AMENDMENTS

2     
2022 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Mike Winder

5     
Senate Sponsor: Luz Escamilla

6     

7     LONG TITLE
8     General Description:
9          This bill limits when a health care provider may seek payment for a medical service or
10     procedure from an individual or a health benefit plan.
11     Highlighted Provisions:
12          This bill:
13          ▸     prohibits a health care provider from seeking payment for a medical service or
14     procedure from an individual or health benefit plan under certain circumstances;
15     and
16          ▸     makes technical changes.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          13-11-4, as last amended by Laws of Utah 2021, Chapters 138 and 154
24          31A-26-301.5, as last amended by Laws of Utah 2018, Chapter 203
25     ENACTS:
26          13-59-202, Utah Code Annotated 1953
27     

28     Be it enacted by the Legislature of the state of Utah:
29          Section 1. Section 13-11-4 is amended to read:
30          13-11-4. Deceptive act or practice by supplier.
31          (1) A deceptive act or practice by a supplier in connection with a consumer transaction
32     violates this chapter whether it occurs before, during, or after the transaction.
33          (2) Without limiting the scope of Subsection (1), a supplier commits a deceptive act or
34     practice if the supplier knowingly or intentionally:
35          (a) indicates that the subject of a consumer transaction has sponsorship, approval,
36     performance characteristics, accessories, uses, or benefits, if [it has not] the subject of the
37     consumer transaction does not;
38          (b) indicates that the subject of a consumer transaction is of a particular standard,
39     quality, grade, style, or model, if [it is not] the subject of the consumer transaction is not;
40          (c) indicates that the subject of a consumer transaction:
41          (i) is new[,] or unused, if [it is not, or] the subject of the consumer transaction is not; or
42          (ii) has been used to an extent that is materially different from [the fact] the extent to
43     which the subject of the consumer transaction has actually been used;
44          (d) indicates that the subject of a consumer transaction is available to the consumer for
45     a reason that does not exist, including any of the following reasons falsely used in an
46     advertisement:
47          (i) "going out of business";
48          (ii) "bankruptcy sale";
49          (iii) "lost our lease";
50          (iv) "building coming down";
51          (v) "forced out of business";
52          (vi) "final days";
53          (vii) "liquidation sale";
54          (viii) "fire sale";
55          (ix) "quitting business"; or
56          (x) an expression similar to any of the expressions in Subsections (2)(d)(i) through
57     (ix);
58          (e) indicates that the subject of a consumer transaction has been supplied in accordance
59     with a previous representation, if [it] the subject of the consumer transaction has not;
60          (f) indicates that the subject of a consumer transaction will be supplied in greater
61     quantity than the supplier intends;
62          (g) indicates that replacement or repair is needed, if [it] replacement or repair is not
63     needed;
64          (h) indicates that a specific price advantage exists, if [it] the specific price advantage
65     does not exist;
66          (i) indicates that the supplier has a sponsorship, approval, or affiliation the supplier
67     does not have;
68          (j) (i) indicates that a consumer transaction involves or does not involve a warranty, a
69     disclaimer of warranties, particular warranty terms, or other rights, remedies, or obligations, if
70     the representation is false; or
71          (ii) fails to honor a warranty or a particular warranty term;
72          (k) indicates that the consumer will receive a rebate, discount, or other benefit as an
73     inducement for entering into a consumer transaction in return for giving the supplier the names
74     of prospective consumers or otherwise helping the supplier to enter into other consumer
75     transactions, if receipt of the benefit is contingent on an event occurring after the consumer
76     enters into the transaction;
77          (l) after receipt of payment for goods or services, fails to ship the goods or furnish the
78     services within the time advertised or otherwise represented or, if no specific time is advertised
79     or represented, fails to ship the goods or furnish the services within 30 days, unless within the
80     applicable time period the supplier provides the buyer with the option to:
81          (i) cancel the sales agreement and receive a refund of all previous payments to the
82     supplier if the refund is mailed or delivered to the buyer within 10 business days after the day
83     on which the seller receives written notification from the buyer of the buyer's intent to cancel
84     the sales agreement and receive the refund; or
85          (ii) extend the shipping date to a specific date proposed by the supplier;
86          (m) except as provided in Subsection (3)(b), fails to furnish a notice meeting the
87     requirements of Subsection (3)(a) of the purchaser's right to cancel a direct solicitation sale
88     within three business days of the time of purchase if:
89          (i) the sale is made other than at the supplier's established place of business pursuant to
90     the supplier's personal contact, whether through mail, electronic mail, facsimile transmission,
91     telephone, or any other form of direct solicitation; and
92          (ii) the sale price exceeds $25;
93          (n) promotes, offers, or grants participation in a pyramid scheme as defined under Title
94     76, Chapter 6a, Pyramid Scheme Act;
95          (o) represents that the funds or property conveyed in response to a charitable
96     solicitation will be donated or used for a particular purpose or will be donated to or used by a
97     particular organization, if the representation is false;
98          (p) if a consumer indicates the consumer's intention of making a claim for a motor
99     vehicle repair against the consumer's motor vehicle insurance policy:
100          (i) commences the repair without first giving the consumer oral and written notice of:
101          (A) the total estimated cost of the repair; and
102          (B) the total dollar amount the consumer is responsible to pay for the repair, which
103     dollar amount may not exceed the applicable deductible or other copay arrangement in the
104     consumer's insurance policy; or
105          (ii) requests or collects from a consumer an amount that exceeds the dollar amount a
106     consumer was initially told the consumer was responsible to pay as an insurance deductible or
107     other copay arrangement for a motor vehicle repair under Subsection (2)(p)(i), even if that
108     amount is less than the full amount the motor vehicle insurance policy requires the insured to
109     pay as a deductible or other copay arrangement, unless:
110          (A) the consumer's insurance company denies that coverage exists for the repair, in
111     which case, the full amount of the repair may be charged and collected from the consumer; or
112          (B) the consumer misstates, before the repair is commenced, the amount of money the
113     insurance policy requires the consumer to pay as a deductible or other copay arrangement, in
114     which case, the supplier may charge and collect from the consumer an amount that does not
115     exceed the amount the insurance policy requires the consumer to pay as a deductible or other
116     copay arrangement;
117          (q) includes in any contract, receipt, or other written documentation of a consumer
118     transaction, or any addendum to any contract, receipt, or other written documentation of a
119     consumer transaction, any confession of judgment or any waiver of any of the rights to which a
120     consumer is entitled under this chapter;
121          (r) charges a consumer for a consumer transaction or a portion of a consumer
122     transaction that has not previously been agreed to by the consumer;
123          (s) solicits or enters into a consumer transaction with a person who lacks the mental
124     ability to comprehend the nature and consequences of:
125          (i) the consumer transaction; or
126          (ii) the person's ability to benefit from the consumer transaction;
127          (t) solicits for the sale of a product or service by providing a consumer with an
128     unsolicited check or negotiable instrument the presentment or negotiation of which obligates
129     the consumer to purchase a product or service, unless the supplier is:
130          (i) a depository institution under Section 7-1-103;
131          (ii) an affiliate of a depository institution; or
132          (iii) an entity regulated under Title 7, Financial Institutions Act;
133          (u) sends an unsolicited mailing to a person that appears to be a billing, statement, or
134     request for payment for a product or service the person has not ordered or used, or that implies
135     that the mailing requests payment for an ongoing product or service the person has not received
136     or requested;
137          (v) issues a gift certificate, instrument, or other record in exchange for payment to
138     provide the bearer, upon presentation, goods or services in a specified amount without printing
139     in a readable manner on the gift certificate, instrument, packaging, or record any expiration
140     date or information concerning a fee to be charged and deducted from the balance of the gift
141     certificate, instrument, or other record;
142          (w) misrepresents the geographical origin or location of the supplier's business;
143          (x) fails to comply with the restrictions of Section 15-10-201 on automatic renewal
144     provisions;
145          (y) violates Section 13-59-201 or Section 13-59-202; or
146          (z) fails to comply with the restrictions of Subsection 13-54-202(2).
147          (3) (a) The notice required by Subsection (2)(m) shall:
148          (i) be a conspicuous statement written in dark bold with at least 12-point type on the
149     first page of the purchase documentation; and
150          (ii) read as follows: "YOU, THE BUYER, MAY CANCEL THIS CONTRACT AT
151     ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (or time period
152     reflecting the supplier's cancellation policy but not less than three business days) AFTER THE
153     DATE OF THE TRANSACTION OR RECEIPT OF THE PRODUCT, WHICHEVER IS
154     LATER."
155          (b) A supplier is exempt from the requirements of Subsection (2)(m) if the supplier's
156     cancellation policy:
157          (i) is communicated to the buyer; and
158          (ii) offers greater rights to the buyer than Subsection (2)(m).
159          (4) (a) A gift certificate, instrument, or other record that does not print an expiration
160     date in accordance with Subsection (2)(v) does not expire.
161          (b) A gift certificate, instrument, or other record that does not include printed
162     information concerning a fee to be charged and deducted from the balance of the gift
163     certificate, instrument, or other record is not subject to the charging and deduction of the fee.
164          (c) Subsections (2)(v) and (4)(b) do not apply to a gift certificate, instrument, or other
165     record useable at multiple, unaffiliated sellers of goods or services if an expiration date is
166     printed on the gift certificate, instrument, or other record.
167          Section 2. Section 13-59-202 is enacted to read:
168          13-59-202. Consumer medical billing safe harbor.
169          (1) As used in this section:
170          (a) "Billing period" means the period between the day of completion and the day that is
171     Ĥ→ [90] 120 ←Ĥ days after the day of completion.
172          (b) "Day of completion" means:
173          (i) the day a patient's service or procedure is completed; or
174          (ii) the anticipated day a service or procedure would have been completed if:
175          (A) upon completion of the service or procedure, the service or procedure would
176     normally be billed as global or bundled health care; and
177          (B) the service or procedure was not completed.
178          (c) "Insured patient" means a patient for whom a responsible party has provided proof
179     of coverage under a health benefit plan.
180          (d) "Patient" means an individual receiving the service or procedure.
181          (e) "Responsible party" means:
182          (i) the patient;
183          (ii) if the patient is a minor, the minor's parent or guardian; or
184          (iii) another individual designated by the patient.
185          (2) (a) For an insured patient, a health care provider or the health care provider's
186     representative may not, after the billing period expires:
187          (i) file a claim for the service or procedure with the patient's health benefit plan; or
188          (ii) attempt to collect payment for the service or procedure.
189          (b) Subsection (2)(a) does not apply if a health care provider can show the health care
190     provider or the health care provider's representative filed a claim with any health benefit plan
191     on record with the health care provider within the billing period.
192          (3) (a) For a patient who is not an insured patient, a health care provider or the health
193     care provider's representative may not attempt to collect payment for the service or procedure
194     after the billing period expires.
195          (b) Subsection (3)(a) does not apply if a health care provider can show the health care
196     provider or the health care provider's representative sent a bill to the responsible party's last
197     known mailing or email address within the billing period.
198          (4) This section does not apply to any claim submitted to or by:
199          (a) the state Medicaid program; or
200          (b) the Medicare program.
201          Section 3. Section 31A-26-301.5 is amended to read:
202          31A-26-301.5. Health care claims practices.
203          (1) (a) Except as provided in Section 31A-8-407, an insured retains ultimate
204     responsibility for paying for health care services the insured receives.
205          (b) If a health care service is covered by one or more individual or group health
206     insurance policies, all insurers covering the insured have the responsibility to pay valid health
207     care claims in a timely manner according to the terms and limits specified in the policies.
208          (2) [A] Subject to Section 13-59-202 and Section 31A-22-610.1, a health care provider
209     may:
210          [(a) except as provided in Section 31A-22-610.1,]
211          (a) bill and collect for any deductible, copayment, or uncovered service; and
212          (b) bill an insured for services covered by health insurance policies or otherwise notify
213     the insured of the expenses covered by the policies.
214          (3) [Beginning October 31, 1992, all ] All insurers covering the insured shall notify the
215     insured of payment and the amount of payment made to the health care provider.
216          (4) A health care provider shall return to an insured any amount the insured overpaid,
217     including interest that begins accruing 90 days after the date of the overpayment, if:
218          (a) the insured has multiple insurers with whom the health care provider has contracts
219     that cover the insured; and
220          (b) the health care provider becomes aware that the health care provider has received,
221     for any reason, payment for a claim in an amount greater than the health care provider's
222     contracted rate allows.
223          (5) (a) The commissioner shall make rules consistent with this chapter governing
224     disclosure to the insured of customary charges by health care providers on the explanation of
225     benefits as part of the claims payment process.
226          (b) These rules shall be limited to the form and content of the disclosures on the
227     explanation of benefits, and shall include:
228          (i) a requirement that the method of determination of any specifically referenced
229     customary charges and the range of the customary charges be disclosed; and
230          (ii) a prohibition against an implication that the health care provider is charging
231     excessively if the health care provider is:
232          (A) a participating provider; and
233          (B) prohibited from balance billing.