Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 116 First Substitute (2022GS)

Sponsor

Rep. Winder, M.

Final action

House/ filed 3/4/2022

Outcome

Failed / filed without passage

Summary

What it does

• This bill:
• prohibits a health care provider from seeking payment for a medical service or procedure from an individual or health benefit plan under certain circumstances; and
• makes technical changes.

Every vote on this bill

Bill text

This document includes House Committee Amendments incorporated into the bill on Wed, Jan 26, 2022 at 7:49 AM by pflowers.
MEDICAL BILLING AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Mike Winder
Senate Sponsor: 
 Luz Escamilla
LONG TITLE
General Description:
This bill limits when a health care provider may seek payment for a medical service or
procedure from an individual or a health benefit plan.
Highlighted Provisions:
This bill:
▸ prohibits a health care provider from seeking payment for a medical service or
procedure from an individual or health benefit plan under certain circumstances;
and
▸ makes technical changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
13-11-4
, as last amended by Laws of Utah 2021, Chapters 138 and 154
31A-26-301.5
, as last amended by Laws of Utah 2018, Chapter 203
ENACTS:
13-59-202
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
13-11-4
 is amended to read:
13-11-4.
Deceptive act or practice by supplier.
(1) A deceptive act or practice by a supplier in connection with a consumer transaction
violates this chapter whether it occurs before, during, or after the transaction.
(2) Without limiting the scope of Subsection (1), a supplier commits a deceptive act or
practice if the supplier knowingly or intentionally:
(a) indicates that the subject of a consumer transaction has sponsorship, approval,
performance characteristics, accessories, uses, or benefits, if [
it has not
] 
the subject of the
consumer transaction does not
;
(b) indicates that the subject of a consumer transaction is of a particular standard,
quality, grade, style, or model, if [
it is not
] 
the subject of the consumer transaction is not
;
(c) indicates that the subject of a consumer transaction
:
(i)
 is new[
,
] or unused, if [
it is not, or
] 
the subject of the consumer transaction is not; or
(ii)
 has been used to an extent that is materially different from [
the fact
] 
the extent to
which the subject of the consumer transaction has actually been used
;
(d) indicates that the subject of a consumer transaction is available to the consumer for
a reason that does not exist, including any of the following reasons falsely used in an
advertisement:
(i) "going out of business";
(ii) "bankruptcy sale";
(iii) "lost our lease";
(iv) "building coming down";
(v) "forced out of business";
(vi) "final days";
(vii) "liquidation sale";
(viii) "fire sale";
(ix) "quitting business"; or
(x) an expression similar to any of the expressions in Subsections (2)(d)(i) through
(ix);
(e) indicates that the subject of a consumer transaction has been supplied in accordance
with a previous representation, if [
it
] 
the subject of the consumer transaction
 has not;
(f) indicates that the subject of a consumer transaction will be supplied in greater
quantity than the supplier intends;
(g) indicates that replacement or repair is needed, if [
it
] 
replacement or repair
 is not
needed
;
(h) indicates that a specific price advantage exists, if [
it
] 
the specific price advantage
does not 
exist
;
(i) indicates that the supplier has a sponsorship, approval, or affiliation the supplier
does not have;
(j) (i) indicates that a consumer transaction involves or does not involve a warranty, a
disclaimer of warranties, particular warranty terms, or other rights, remedies, or obligations, if
the representation is false; or
(ii) fails to honor a warranty or a particular warranty term;
(k) indicates that the consumer will receive a rebate, discount, or other benefit as an
inducement for entering into a consumer transaction in return for giving the supplier the names
of prospective consumers or otherwise helping the supplier to enter into other consumer
transactions, if receipt of the benefit is contingent on an event occurring after the consumer
enters into the transaction;
(l) after receipt of payment for goods or services, fails to ship the goods or furnish the
services within the time advertised or otherwise represented or, if no specific time is advertised
or represented, fails to ship the goods or furnish the services within 30 days, unless within the
applicable time period the supplier provides the buyer with the option to:
(i) cancel the sales agreement and receive a refund of all previous payments to the
supplier if the refund is mailed or delivered to the buyer within 10 business days after the day
on which the seller receives written notification from the buyer of the buyer's intent to cancel
the sales agreement and receive the refund; or
(ii) extend the shipping date to a specific date proposed by the supplier;
(m) except as provided in Subsection (3)(b), fails to furnish a notice meeting the
requirements of Subsection (3)(a) of the purchaser's right to cancel a direct solicitation sale
within three business days of the time of purchase if:
(i) the sale is made other than at the supplier's established place of business pursuant to
the supplier's personal contact, whether through mail, electronic mail, facsimile transmission,
telephone, or any other form of direct solicitation; and
(ii) the sale price exceeds $25;
(n) promotes, offers, or grants participation in a pyramid scheme as defined under Title
76, Chapter 6a, Pyramid Scheme Act;
(o) represents that the funds or property conveyed in response to a charitable
solicitation will be donated or used for a particular purpose or will be donated to or used by a
particular organization, if the representation is false;
(p) if a consumer indicates the consumer's intention of making a claim for a motor
vehicle repair against the consumer's motor vehicle insurance policy:
(i) commences the repair without first giving the consumer oral and written notice of:
(A) the total estimated cost of the repair; and
(B) the total dollar amount the consumer is responsible to pay for the repair, which
dollar amount may not exceed the applicable deductible or other copay arrangement in the
consumer's insurance policy; or
(ii) requests or collects from a consumer an amount that exceeds the dollar amount a
consumer was initially told the consumer was responsible to pay as an insurance deductible or
other copay arrangement for a motor vehicle repair under Subsection (2)(p)(i), even if that
amount is less than the full amount the motor vehicle insurance policy requires the insured to
pay as a deductible or other copay arrangement, unless:
(A) the consumer's insurance company denies that coverage exists for the repair, in
which case, the full amount of the repair may be charged and collected from the consumer; or
(B) the consumer misstates, before the repair is commenced, the amount of money the
insurance policy requires the consumer to pay as a deductible or other copay arrangement, in
which case, the supplier may charge and collect from the consumer an amount that does not
exceed the amount the insurance policy requires the consumer to pay as a deductible or other
copay arrangement;
(q) includes in any contract, receipt, or other written documentation of a consumer
transaction, or any addendum to any contract, receipt, or other written documentation of a
consumer transaction, any confession of judgment or any waiver of any of the rights to which a
consumer is entitled under this chapter;
(r) charges a consumer for a consumer transaction or a portion of a consumer
transaction that has not previously been agreed to by the consumer;
(s) solicits or enters into a consumer transaction with a person who lacks the mental
ability to comprehend the nature and consequences of:
(i) the consumer transaction; or
(ii) the person's ability to benefit from the consumer transaction;
(t) solicits for the sale of a product or service by providing a consumer with an
unsolicited check or negotiable instrument the presentment or negotiation of which obligates
the consumer to purchase a product or service, unless the supplier is:
(i) a depository institution under Section 
7-1-103
;
(ii) an affiliate of a depository institution; or
(iii) an entity regulated under Title 7, Financial Institutions Act;
(u) sends an unsolicited mailing to a person that appears to be a billing, statement, or
request for payment for a product or service the person has not ordered or used, or that implies
that the mailing requests payment for an ongoing product or service the person has not received
or requested;
(v) issues a gift certificate, instrument, or other record in exchange for payment to
provide the bearer, upon presentation, goods or services in a specified amount without printing
in a readable manner on the gift certificate, instrument, packaging, or record any expiration
date or information concerning a fee to be charged and deducted from the balance of the gift
certificate, instrument, or other record;
(w) misrepresents the geographical origin or location of the supplier's business;
(x) fails to comply with the restrictions of Section 
15-10-201
 on automatic renewal
provisions;
(y) violates Section 
13-59-201
or Section 
13-59-202
; or
(z) fails to comply with the restrictions of Subsection 
13-54-202
(2).
(3) (a) The notice required by Subsection (2)(m) shall:
(i) be a conspicuous statement written in dark bold with at least 12-point type on the
first page of the purchase documentation; and
(ii) read as follows: "YOU, THE BUYER, MAY CANCEL THIS CONTRACT AT
ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY (or time period
reflecting the supplier's cancellation policy but not less than three business days) AFTER THE
DATE OF THE TRANSACTION OR RECEIPT OF THE PRODUCT, WHICHEVER IS
LATER."
(b) A supplier is exempt from the requirements of Subsection (2)(m) if the supplier's
cancellation policy:
(i) is communicated to the buyer; and
(ii) offers greater rights to the buyer than Subsection (2)(m).
(4) (a) A gift certificate, instrument, or other record that does not print an expiration
date in accordance with Subsection (2)(v) does not expire.
(b) A gift certificate, instrument, or other record that does not include printed
information concerning a fee to be charged and deducted from the balance of the gift
certificate, instrument, or other record is not subject to the charging and deduction of the fee.
(c) Subsections (2)(v) and (4)(b) do not apply to a gift certificate, instrument, or other
record useable at multiple, unaffiliated sellers of goods or services if an expiration date is
printed on the gift certificate, instrument, or other record.
Section 2. Section 
13-59-202
 is enacted to read:
 13-59-202.
Consumer medical billing safe harbor.
(1) As used in this section:
(a) "Billing period" means the period between the day on which
Ĥ→ [
a patient receives a
service or procedure
] 
a patient's service or procedure is completed
 ←Ĥ
and the day that is 90
171a 
days after the day on which
Ĥ→ [
the patient receives the
service or procedure
] 
the patient's service or procedure is completed
 ←Ĥ
.
(b) "Insured patient" means a patient for whom a responsible party has provided proof
of coverage under a health benefit plan.
(c) "Patient" means an individual receiving the service or procedure.
(d) "Responsible party" means:
(i) the patient;
(ii) if the patient is a minor, the minor's parent or guardian; or
(iii) another individual designated by the patient.
(2) (a) For an insured patient, a health care provider or the health care provider's
representative may not, after the billing period expires:
(i) file a claim for the service or procedure with the patient's health benefit plan; or
(ii) attempt to collect payment for the service or procedure.
(b) Subsection (2)(a) does not apply if a health care provider can show the health care
provider or the health care provider's representative filed a claim with
Ĥ→ [
the patient's health
benefit plan
] 
any health benefit plan on record with the health care provider
 ←Ĥ
within the
186a 
billing period.
(3) (a) For a patient who is not an insured patient, a health care provider or the health
care provider's representative may not attempt to collect payment for the service or procedure
after the billing period expires.
(b) Subsection (3)(a) does not apply if a health care provider can show the health care
provider or the health care provider's representative sent a bill to the responsible party's last
known mailing or email address within the billing period.
192a 
Ĥ→ 
(4) This section does not apply to any claim submitted to or by the state Medicaid
192b 
program.
 ←Ĥ
Section 3. Section 
31A-26-301.5
 is amended to read:
31A-26-301.5.
Health care claims practices.
(1) (a) Except as provided in Section 
31A-8-407
, an insured retains ultimate
responsibility for paying for health care services the insured receives.
(b) If a health care 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
] 
Subject to Section 
13-59-202
 and Section 
31A-22-610.1
, a
 health care provider
may:
[
(a) except as provided in Section 
31A-22-610.1
,
]
(a)
 bill and collect for any deductible, copayment, or uncovered service; and
(b) bill an insured for services covered by health insurance policies or otherwise notify
the insured of the expenses covered by the policies.
(3) [
Beginning October 31, 1992, all 
] 
All
 insurers covering the insured shall notify the
insured of payment and the amount of payment made to the health care provider.
(4) 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:
(a) the insured has multiple insurers with whom the health care provider has contracts
that cover the insured; and
(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.
(5) (a) 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.
(b) These rules shall be limited to the form and content of the disclosures on the
explanation of benefits, and shall include:
(i) a requirement that the method of determination of any specifically referenced
customary charges and the range of the customary charges be disclosed; and
(ii) a prohibition against an implication that the health care provider is charging
excessively if the health care provider is:
(A) a participating provider; and
(B) prohibited from balance billing.