A BILL TO BE ENTITLED AN ACT TO AMEND THE PROVISIONS OF HOUSE BILL 834 RELATED TO HEALTH CARE COST REDUCTION AND TRANSPARENCY AND FAIR HEALTH CARE BILLING AND COLLECTIONS PRACTICES; AND TO ALLOW THE SPEAKER OF THE HOUSE AND PRESIDENT PRO TEMPORE OF THE SENATE, AS AGENTS OF THE STATE, TO JOINTLY INTERVENE ON BEHALF OF THE GENERAL ASSEMBLY IN ANY JUDICIAL PROCEEDING CHALLENGING A NORTH CAROLINA STATUTE OR A PROVISION OF THE NORTH CAROLINA CONSTITUTION.
Senate committee substitute makes the following changes to the 2nd edition.
Changes the long title.
Deletes proposed changes to GS 90-413.2, Purpose, and GS 90-413.9, Disclosure of prices for most common episodes of care.
Enacts new Article 1B, Transparency in Health Care Costs, in GS Chapter 131E. Provides that the intent of the Article is to improve transparency in health care costs by providing information to the public on the costs of the most frequently reported diagnostic related groups (DRG) for hospital inpatient care and the most common surgical procedures and imaging procedures in hospital outpatient settings and ambulatory surgical facilities. Requires the Department of Health and Human Services (DHHS) to make available on its website the most current price information it receives from hospitals and ambulatory surgical facilities; sets out minimum requirements for that information. Requires each hospital, beginning with the quarter ending March 31, 2014, to provide DHHS six specified pieces of information about the 100 most frequently reported admissions by DRG for inpatients, including the total amount of Medicare reimbursements, and the total amount of payments made by the State Health Plan for Teachers and State Employees. Requires the NC Medical Care Commission (Commission) to adopt rules to ensure implementation of this requirement by January 1, 2014, and specifies information to be included in the rules. Requires each hospital and ambulatory surgical facility to provide DHHS information on the total costs for the 20 most common surgical procedures and the 20 most common imaging procedures along with related codes. Requires the Commission to adopt rules to ensure implementation of this requirement by March 31, 2014, and specifies information to be included in the rules. The information required may be provided to a patient upon request. Requires a hospital or ambulatory surgical facility required to file a Schedule H, federal form 990, to provide the public with access to its financial assistance policy and its annual financial assistance costs. Requires the information to be reported to DHHS annually and to be reported on the DHHS website and at the organization's place of business.
Directs the Department of Health and Human Services (DHHS) to communicate, not later than July 1, 2013, the requirements of Section 2 of the act to all hospitals licensed pursuant to Article 5 of GS 131E and Article 2 of GS 122C, as well as to all ambulatory surgical facilities licensed pursuant to Part 4 of Article 6 of GS 131E.
Amends GS 131E-97.3, providing that competitive health care information does not include the information that hospitals and ambulatory surgical facilities are required to report under GS 131E-214.6.
Amends GS 131E-99, excluding information a hospital or an ambulatory surgical facility is required to report under GS 131E-214.6 from the confidentiality requirements for health care contracts.
Enacts new GS 131E-273, Certain charges/payments prohibited, providing that it is unlawful for any provider of health care services to charge or accept payment for a health care procedure that was not actually performed or supplied.
Deletes Section 9 of the previous edition, which proposed a new section, GS 131E-91.3, Duplicate charges for certain radiology services prohibited.
Amends GS 131E-91, Fair billing and collections practices for hospitals and ambulatory surgical facilities, making organizational changes. Provides that a hospital or ambulatory surgical facility has 45 (was, 60) days from the time notice of overpayment is received to refund an overpayment resulting from specified circumstances. Amends GS 131E-91(d)(5), providing that for debts arising from the provision of care by a hospital or ambulatory surgical facility, the doctrine of necessaries as it existed at common law will apply equally to both spouses, with specified exceptions. Provides further rules or regulations regarding debt owed to a hospital or ambulatory surgical facility. Also provides that hospitals or ambulatory surgical facilities that provide care to a minor cannot execute or force the sale of the principal residence of the custodial parent for a judgment obtained for the outstanding debt until the minor is either no longer residing with the parent or until the minor reaches the age of majority, whichever occurs first.
Repeals Article 2A of GS 131E, Garnishment for Debts Owed Public Hospitals.
Amends Part VI of the act, renaming it Governance of Entities to Manage Care and Control Costs Statewide, establishing that the governance of entities contracting with the state to provide centralized care coordination, cost containment, or management of care on a statewide basis for the Medicaid program is of significant importance. Further finds that the public has a profound interest in ensuring the quality of internal governance in regards to this contracting. As such, DHHS will not enter into a new contract with an entity to provide cost containment or management of care on a statewide basis for the Medicaid program unless the entity adheres to certain specified governance provisions.
Amends the enactment clause, providing that Sections 4 and 5 of this act become effective January 1, 2014. Section 6 of this act becomes effective December 1, 2013, and applies to health care procedures and services rendered on or after that date. Section 7 of this act becomes effective January 1, 2014, and applies to tax refunds determined by the Department of Revenue on or after that date. Section 8 of this act becomes effective October 1, 2013, and applies to hospital and ambulatory surgical facility billings and collections practices occurring on or after that date. The remainder of this act is effective when it becomes law.
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