Bill Text: DE HB439 | 2015-2016 | 148th General Assembly | Draft

Delaware House Bill 439 (Prior Session Legislation)

Draft

Bill Title: An Act To Amend Title 18 Of The Delaware Code Relating To Health Insurance.

Sponsorship: Strong Partisan Bill (Democrat 10-1)

Status: (Enrolled - Dead) 2016-07-01 - HS 1 for HB 439 - Passed by Senate. Votes: Passed 20 YES 0 NO 0 NOT VOTING 1 ABSENT 0 VACANT [HB439 Detail]

Download: Delaware-2015-HB439-Draft.html

SPONSOR:

Rep. B. Short & Sen. Blevins

Reps. Bolden, Heffernan, Keeley, Kowalko, Viola;Sens. Ennis, Hall-Long, Hocker, Peterson

HOUSE OF REPRESENTATIVES

148th GENERAL ASSEMBLY

HOUSE BILL NO. 439

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO HEALTH INSURANCE.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1. Amend Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§3371. Network Disclosure and Transparency.

(a)This section applies to every policy or contract of health insurance which is delivered or issued for delivery in this State, including each policy or contract issued by a health service corporation, which provides medical, major medical, or similar comprehensive-type coverage, and which designates network physicians or providers (hereinafter referred to collectively as "network providers").However, this section applies only to items, services or conditions for which coverage is provided by those policies or contracts (hereinafter referred to as "covered services").

(b) For purposes of this section "facility-based provider" means a provider who provides health care services to patients who are in an in-patient or ambulatory facility, including services such as pathology, anesthesiology, or radiology.

(c) For purposes of this section "health care provider" means any provider who provides health care services to patients who are not in a facility based setting.

(d) Non-emergency out-of-network services.

(1) At the time a facility-based provider schedules a procedure or seeks prior authorization from a health carrier for the provision of non-emergency covered services to an insured person, the facility shall provide the insured person with a timely, written out-of-network disclosure that states the following:

a. That discloses whether the facility is a participating or out-of-network facility;

b. That certain facility-based providers may be called upon to render care to the covered person during the course of treatment;

c. That those facility-based providers may not have a contract with the covered person's health carrier and are therefore considered to be out-of-network;

d. That the services therefore will be provided on an out-of-network basis, which may result in additional charges for which the covered person may be responsible, and a statement that these charges are in addition to any coinsurance, deductibles and copayments applicable under the person's health insurance contract;

e. A listing of those facility based providers who may be called upon to render care to the covered person during the course of treatment, and a statement that the covered person should contact their health carrier to determine the provider's network status;

f. Notification that an estimate of the range of charges for any out-of-networks services for which the covered person may be responsible may be obtained from the out-of-network provider;

g. The notification shall contain a written consent, signed by the covered person:(i) acknowledging a provider may be a non-network provider; (ii) acknowledging that the services provided by the non-network provider may not be covered by the insured's policy; and (iii) affirmatively electing to obtain the services and agreeing to accept and pay the charges for the out-of-network services;

h. That the covered person may contact the covered person's health carrier for additional assistance or may rely on whatever other rights and remedies may be available under state or federal law; and

i. If the facility and all facility-based providers participate in the covered person's network, this disclosure shall not be required.

(2) Prior to the delivery of non-emergency covered services to an insured person, an out-of-network health care provider shall provide the insured person with a timely, written out-of-network disclosure that states the following:

a. That the health care provider is an out-of-network provider and the services therefore will be provided on an out-of-network basis;

b. That out-of-network services may result in additional charges for which the covered person may be responsible, and a statement that these charges are in addition to any coinsurance, deductibles and copayments applicable under the person's health insurance contract;

c. Notification that an estimate of the range of charges for any out-of-networks services for which the covered person may be responsible may be obtained from the out-of-network provider;

d. The notification shall contain a written consent, signed by the covered person:(i) acknowledging a provider may be a non-network provider; (ii) acknowledging that the services provided by the non-network provider may not be covered by the insured's policy; and (iii) affirmatively electing to obtain the services and agreeing to accept and pay the charges for the out-of-network services; and

e. That the covered person may contact the covered person's health carrier for additional assistance or may rely on whatever other rights and remedies may be available under state or federal law.

(3)If a facility-based provider or a health care provider fails to provide such disclosures to the insured person, the facility and the out-of-network provider may not balance bill the insured person for health care services not covered by the insured's health insurance contract.

(4) This balance billing prohibition shall not prevent the operation of policy provisions involving coinsurance, deductibles and copayments payable under the insured health insurance contract.

(5) In the event a facility-based provider or a health care provider fails to provide such disclosures to the insured person and the provider of services and insurer cannot agree on the appropriate rate of reimbursement, the provider shall be entitled to those charges and rates allowed by the Insurance Commissioner or the Commissioner's designee following arbitration of the dispute.The Insurance Commissioner shall adopt regulations concerning the arbitration of such disputes.

(6) This section shall not apply to those out-of-network services provided pursuant to Section 3348 and 3349 of this Chapter.

(e) Health insurers shall be required to maintain accurate and complete provider directories, to update provider directories frequently, to audit the accuracy and completeness of such directories and make the directories easily accessible to the covered person in a variety of formats.The Insurance Commissioner shall adopt regulations concerning the provisions of this subsection (e).

Section 2.Amend Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as show by underling as follows:

§3571S. Network Disclosure and Transparency.

(a) This section applies to every policy or contract of health insurance which is delivered or issued for delivery in this State, including each policy or contract issued by a health service corporation, which provides medical, major medical, or similar comprehensive-type coverage, and which designates network physicians or providers (hereinafter referred to collectively as "network providers").However, this section applies only to items, services or conditions for which coverage is provided by those policies or contracts (hereinafter referred to as "covered services").

(c) For purposes of this section "health care provider" means any provider who provides health care services to patients who are not in a facility based setting.

(d) Non-emergency out-of-network services.

a.That discloses whether the facility is a participating or out-of-network facility;