Bill Summary for S 473 (2013-2014)

Summary date: 

Apr 25 2013

Bill Information:

View NCGA Bill Details2013-2014 Session
Senate Bill 473 (Public) Filed Wednesday, March 27, 2013
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.
Intro. by Rucho, Brown.

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Bill summary

Senate committee substitute makes the following changes to the 1st edition.

Amends proposed GS 90-413.9 to specify that the information published by NC Health Information Exchange (HIE) on its Internet web sitebe publishedin a conspicuous manner, and that the information be the most current information available. Adds new subsection (b), which declares that any data disclosed by a hospital or ambulatory surgical facility to the NC HIE under the Health Care Cost Reduction and Transparency Act of 2013 (Act) remains the sole property of the facilitysubmitting the data. Provides that any data or product derived from the data that was disclosed to NC HIE pursuant to the Actof 2013, including a consolidation or analysis of the data, remains the sole property of the state of North Carolina. Prohibits the NorthCarolina Community Care Networks., (CCNC), NC HIE, and all other entities thatreceive datadisclosed by a hospital or ambulatory surgical facility under the Act from disclosing, selling, or exchanging the data, or from engaging in any consolidation, analysis, or product derived from the data, for a fee or consideration of any type.

Amends new GS 131E-91.1 to clarify that the term "episode of care" includes services by health care providers employed by the hospital (was, affiliated with the hospital). Amends the definition for "health insurer" to provide that the term does not include self-insured plans and group heath plans as defined in section 607(1) of the Employee Retirement Income Security Act of 1974. Requires each hospital licensed under Article 5 of GS Chapter 131E to electronicallyprovide to NC HIE, beginning onMarch 31, 2014 and quarterly thereafter, (was, annually beginning on January 1, 2014), specific information regarding costs, payments, and reimbursementsfor the hospital's 50 most common episodes of care. Adds to the list of specified information required that the list must include the average negotiated settlement on the amount that will be charged to a patient andthat must be remitted in subdivision (1) of this subsection. Also clarifies that the total amount of Medicaid reimbursements for each episode of care includes claims and pro rata supplemental payments. Changes the required content of the rules adopted by the NC Medical Care Commission (Commission) to implement this section, providing that the rules must include (1) the 50 most common episodes of care on which the hospitals must report, and (2) specific categories by which hospitals are to be grouped for the purpose of disclosing this information to the public on the NC HIE Internet web site.

Amends GS 131E-91.2 to require that a hospital's posting of its policy on charity care, also include the amounts spent by the hospital on uncompensated care and bad debt in the preceding calendar year. Adds definitions for "bad debt" and "uncompensated care." Amends GS 131E-153.1(was, 131E-153.2) to providesubstantively similar provisions as they apply to ambulatory surgical facilities.

Amends GS 131E-153 (was, 131E-153.1) applying to the disclosure of prices for ambulatory surgical services. Modifies the definition for "episode of care" to include pharmaceuticals dispensed by the ambulatory surgical facility pharmacy or by a pharmacy owned or controlled by the ambulatory surgical facility. Requires that the rules adopted by the Commission include the 50 most common episodes of care on which the ambulatory surgical facilities must report.

Enacts new GS 131E-91.3 as new Part 4B of Article 5 of GS Chapter 131E (was, added as new section to Part 4A of GS Chapter 131E, Article 5). Adds a definition for "provider of radiology services." Defines provider of radiological services as a hospital, ambulatory surgical facility, a freestanding radiology services facility, or a physician's office that provides outpatient radiology services.Amends criteria for unlawful duplicate charges for outpatient imaging radiology services and extends the provisions to include providers of radiology services. Makes a conforming deletion ofnew GS 131E-153.3 having to do with prohibiting duplicate charges for certain radiology services from an ambulatory surgical facility or health care providers affiliated with the facility.

Deletes changes to GS 108A-121, definitions in Article 7, Hospital Provider Assessment Act,of GS Chapter 108A.

Amends GS 131E-91 to apply to fair billing and collections practices for hospitals and ambulatory surgical facilities. Includes provisions that require bills to be legible, easily understandable, and to included clear explanations when the use of medical codes and terms is unavoidable. Also identifies reasonable collection practices which hospitals and ambulatory surgical facilities must use. Prohibits the use of wage garnishment, a lien on a patient's primary residence, or a forced sale as a means of collecting an unpaid bill.

Enacts new GS 131E-147.1 (Fair billing and collections practices for ambulatory surgical facilities) providing that all ambulatory surgical facilities licensed under Part 4 of Article 6 of GS Chapter131E will be subject to the fair billing and collections practices as set out in GS 131E-91.

Amends GS 58-3-245, changing section name to Provider directories; cost tools for insured (was, Provider directories) and requires that health benefit plans that utilize a provider network must ensure that a patient is provided accurate and current information about each provider's network status through both the telephone system and any electronic or online system.Adds new GS 58-3-245(d), establishing that health care providers must provide patients or prospective patients, upon request, with information regarding that provider's network status with a particular health benefit plan.

Delineates governance changes for the North Carolina Community Care Networks, Inc. (CNCC), including changes in the composition of its board.Adds that those changes include ensuring that no member or immediate family member is a registered lobbyist or employed by an entity lobbying for a health care provider association.

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