Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 128 Eighth Substitute (2017GS)

Sponsor

Rep. Webb, R. C.

Final action

Governor Signed 3/24/2017

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• defines terms;
• modifies the circumstances under which a health care provider may make a report to a credit bureau or use the services of a collection agency against an insured;
• addresses administrative penalties for a health care provider who fails to comply with the provisions of this bill; and
• makes technical and conforming changes.

Every vote on this bill

Bill text

HEALTH CARE DEBT COLLECTION AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: R. Curt Webb
Senate Sponsor: 
Curtis S. Bramble
LONG TITLE
General Description:
This bill modifies and enacts provisions related to health care claims practices.
Highlighted Provisions:
This bill:
▸ defines terms;
▸ modifies the circumstances under which a health care provider may make a report to
a credit bureau or use the services of a collection agency against an insured;
▸ addresses administrative penalties for a health care provider who fails to comply with
the provisions of this bill; and
▸ makes technical and conforming changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
31A-26-301.5
, as last amended by Laws of Utah 2016, Chapter 124
62A-2-112
, as last amended by Laws of Utah 2016, Chapter 211
ENACTS:
26-21-11.1
, Utah Code Annotated 1953
58-1-508
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-21-11.1
 is enacted to read:
 26-21-11.1.
Failure to follow certain health care claims practices -- Penalties.
(1) The department may assess a fine of up to $500 per violation against a health care
facility that violates Subsection 
31A-26-301.5
(4).
(2) The department shall waive the fine described in Subsection (1) if:
(a) the health care facility demonstrates to the department that the health care facility
mitigated and reversed any damage to the insured caused by the health care facility's violation;
or
(b) the insured does not pay the full amount due on the bill that is the subject of the
violation, including any interest, fees, costs, and expenses, within 120 days after the day on
which the health care facility makes a report to a credit bureau or uses the services of a
collection agency in violation of Subsection 
31A-26-301.5
(4).
Section 2. Section 
31A-26-301.5
 is amended to read:
31A-26-301.5.
Health care claims practices.
(1) As used in this section:
(a) "Health care provider" means:
(i) a health care facility as defined in Section 
26-21-2
; or
(ii) a person licensed to provide health care services under:
(A) Title 58, Occupations and Professions; or
(B) Title 62A, Chapter 2, Licensure of Programs and Facilities.
(b) "Text message" means a real time or near real time message that consists of text and
is transmitted to a device identified by a telephone number.
[
(1)
] 
(2)
 Except as provided in Section 
31A-8-407
, an insured retains ultimate
responsibility for paying for health care services the insured receives. If a service is covered by
one or more individual or group health insurance policies, all insurers covering the insured have
the responsibility to pay valid health care claims in a timely manner according to the terms and
limits specified in the policies.
[
(2) (a)
] 
(3)
 [
Except as provided in Section 
31A-22-610.1
, a
] 
A
 health care provider
may
:
(a) except as provided in Section 
31A-22-610.1
,
 bill and collect for any deductible,
copayment, or uncovered service[
.
]
; and
(b) [
A health care provider may
] bill an insured for services covered by health insurance
policies or [
may
] otherwise notify the insured of the expenses covered by the policies. 
[
However, a
]
(4) (a) Except as provided in Subsection (4)(c), a health care
 provider may not make
any report to a credit bureau[
,
] 
or
 use the services of a collection agency[
, or use methods other
than routine billing or notification until the later of
] 
unless the health care provider
:
(i) 
(A) after
 the expiration of the time afforded to an insurer under Section
31A-26-301.6
 to determine [
its
] 
the insurer's
 obligation to pay or deny the claim without
penalty[
; or
] 
, sends a notice described in Subsection (4)(b) to the insured by certified mail with
return receipt requested, priority mail, or text message; and
(B) makes the report to a credit bureau or uses the services of a collection agency after
the date stated in the notice in accordance with Subsection (4)(b)(ii)(A); or
(ii) 
(A)
 in the case of 
a
 Medicare [
beneficiaries or retirees
] 
beneficiary or retiree
years of age or older, [
days from
] 
after
 the date Medicare determines [
its
] 
Medicare's
 liability
for the claim[
.
] 
, sends a notice described in Subsection (4)(b) to the insured by certified mail
with return receipt requested, priority mail, or text message; and
(B) makes the report to a credit bureau or uses the services of a collection agency after
the date stated in the notice in accordance with Subsection (4)(b)(ii)(B).
(b) A notice described in Subsection (4)(a) shall state:
(i) the amount that the insured owes;
(ii) the date by which the insured must pay the amount owed that is:
(A) at least 45 days after the day on which the health care provider sends the notice; or
(B) if the insured is a Medicare beneficiary or retiree 65 years of age or older, at least
days after the day on which the health care provider sends the notice;
(iii) that if the insured fails to timely pay the amount owed, the health care provider may
make a report to a credit bureau or use the services of a collection agency; and
(iv) that each action described in Subsection (4)(b)(iii) may negatively impact the
insured's credit score.
(c) A health care provider satisfies the requirements described in Subsections (4)(a) and
(b) if the health care provider complies with the provisions of 26 C.F.R. Sec. 1.501(r)-6.
[
(c)
] 
(5)
 Beginning October 31, 1992, all insurers covering the insured shall notify the
insured of payment and the amount of payment made to the 
health care
 provider.
[
(d)
] 
(6)
 A health care provider shall return to an insured any amount the insured
overpaid, including interest that begins accruing 90 days after the date of the overpayment, if:
[
(i)
] 
(a)
 the insured has multiple insurers with whom the health care provider has
contracts that cover the insured; and
[
(ii)
] 
(b)
 the health care provider becomes aware that the 
health care
 provider has
received, for any reason, payment for a claim in an amount greater than the 
health care
provider's contracted rate allows.
[
(3)
] 
(7)
 The commissioner shall make rules consistent with this chapter governing
disclosure to the insured of customary charges by health care providers on the explanation of
benefits as part of the claims payment process. These rules shall be limited to the form and
content of the disclosures on the explanation of benefits, and shall include:
(a) a requirement that the method of determination of any specifically referenced
customary charges and the range of the customary charges be disclosed; and
(b) a prohibition against an implication that the 
health care
 provider is charging
excessively if the 
health care
 provider is:
(i) a participating provider; and
(ii) prohibited from balance billing.
Section 3. Section 
58-1-508
 is enacted to read:
 58-1-508.
Failure to follow certain health care claims practices -- Penalties.
(1) As used in this section, "health care provider" means an individual who is licensed to
provide health care services under this title.
(2) The division may assess a fine of up to $500 per violation against a health care
provider who violates Subsection 
31A-26-301.5
(4).
(3) The division shall waive the fine described in Subsection (2) if:
(a) the health care provider demonstrates to the division that the health care provider
mitigated and reversed any damage to the insured caused by the health care provider's violation;
or
(b) the insured does not pay the full amount due on the bill that is the subject of the
violation, including any interest, fees, costs, and expenses, within 120 days after the day on
which the health care provider makes a report to a credit bureau or uses the services of a
collection agency in violation of Subsection 
31A-26-301.5
(4).
Section 4. Section 
62A-2-112
 is amended to read:
62A-2-112.
Violations -- Penalties.
(1) As used in this section, "health care provider" means a person licensed to provide
health care services under this chapter.
[
(1)
] 
(2)
 The office may deny, place conditions on, suspend, or revoke a human services
license, if it finds, related to the human services program:
(a) that there has been a failure to comply with the rules established under this chapter;
(b) evidence of aiding, abetting, or permitting the commission of any illegal act; or
(c) evidence of conduct adverse to the standards required to provide services and
promote public trust, including aiding, abetting, or permitting the commission of abuse, neglect,
exploitation, harm, mistreatment, or fraud.
[
(2)
] 
(3)
 The office may restrict or prohibit new admissions to a human services
program, if it finds:
(a) that there has been a failure to comply with rules established under this chapter;
(b) evidence of aiding, abetting, or permitting the commission of any illegal act; or
(c) evidence of conduct adverse to the standards required to provide services and
promote public trust, including aiding, abetting, or permitting the commission of abuse, neglect,
exploitation, harm, mistreatment, or fraud.
(4) (a) The office may assess a fine of up to $500 per violation against a health care
provider who violates Subsection 
31A-26-301.5
(4).
(b) The office shall waive the fine described in Subsection (4)(a) if:
(i) the health care provider demonstrates to the office that the health care provider
mitigated and reversed any damage to the insured caused by the health care provider's violation;
or
(ii) the insured does not pay the full amount due on the bill that is the subject of the
violation, including any interest, fees, costs, and expenses, within 120 days after the day on
which the health care provider makes a report to a credit bureau or uses the services of a
collection agency in violation of Subsection 
31A-26-301.5
(4).