Bill Text: MI HB4460 | 2019-2020 | 100th Legislature | Engrossed
Bill Title: Health: other; charges by nonparticipating providers; regulate under certain circumstances. Amends 1978 PA 368 (MCL 333.1101 - 333.25211) by adding sec. 24509 to art. 18. TIE BAR WITH: HB 4459'19, HB 4990'19, HB 4991'19
Spectrum: Bipartisan Bill
Status: (Passed) 2020-10-28 - Assigned Pa 235'20 With Immediate Effect [HB4460 Detail]
Download: Michigan-2019-HB4460-Engrossed.html
Substitute For
HOUSE BILL NO. 4460
A bill to amend 1978 PA 368, entitled
"Public health code,"
(MCL 333.1101 to 333.25211) by adding section 24509 to article 18.
The people of the state of michigan enact:
Sec. 24509. (1) Subject to subsection (2), a nonparticipating provider who is providing a health care service to a nonemergency patient shall provide the disclosure described in subsection (3) to the nonemergency patient at the earliest of the following:
(a) If the health
care service was scheduled and is being provided in a health facility described
in section 24502(7)(a), (b), (c), (e), or (f), at least 14 days before
providing the health care service or, if the health care service will be
provided within 14 days after scheduling the health care service, within 14
days.
(b) If the health care service is being provided in a health facility described in section 24502(7)(d), at the time of the nonparticipating provider's first contact with the nonemergency patient regarding the health care service.
(c) During 1 of the following:
(i) A presurgical consultation for the health care service.
(ii) A scheduling or intake call for the health care service.
(iii) A preoperative review for the health care service.
(iv) Any other contact occurring before a health care service that is similar to a contact described in subparagraph (i), (ii), or (iii).
(2) A nonparticipating provider shall not provide the disclosure described in subsection (3) to a nonemergency patient at the time of the nonemergency patient's admittance to a health facility described in section 24502(7)(a), (b), (c), (e), or (f), or at the time of preparing the nonemergency patient for a surgery or another medical procedure.
(3) The disclosure required under subsection (1) must be in not less than 12-point type and in substantially the following form:
"Your health benefit plan may or may not provide coverage for all of the health care services you are scheduled to receive or the providers providing those services. You may be responsible for the costs of the services that are not covered by your health benefit plan.
The nonparticipating provider must provide a good-faith estimate of the cost of the health care services to be provided. A good-faith estimate does not take into account unforeseen circumstances, which may affect the cost of the health care services provided.
You also have a right to request that the health care services be performed by a provider that participates with your health benefit plan, and may contact your insurer to arrange for those services to be provided at a lower cost and to receive information on in-network providers who can perform the health care services that you need.
I have received, read, and understand this disclosure.
__________________________________________________ _________
(Patient or patient's representative's signature) (Date)
__________________________________________________
(Type or print name of patient or patient's representative)".
(4) A nonparticipating provider shall do all of the following:
(a) Complete the disclosure described in subsection (3) and, after completing the disclosure, obtain on the disclosure the signature of the nonemergency patient, or that patient's representative, acknowledging that the nonemergency patient, or that patient's representative, has received, has read, and understands the disclosure.
(b) Retain a copy of the disclosure required under this section for not less than 7 years.
(c) Provide the nonemergency patient or that patient's representative with a good-faith estimate of the cost of the health care services to be provided to the nonemergency patient.
(5) Except as otherwise provided in section 24513, a nonparticipating provider who fails to provide the disclosure as required under this section shall accept, and the nonemergency patient's insurer shall pay to the nonemergency patient or the nonparticipating provider, as payment in full, the greater of the following:
(a) Subject to section 24510, the average amount negotiated by the nonemergency patient's insurer for the region and provider specialty, excluding any in-network coinsurance, copayments, or deductibles.
(b) One hundred
and fifty percent of the Medicare fee for service fee schedule for the health
care service provided, excluding any in-network coinsurance, copayments, or
deductibles.
Enacting section 1. This amendatory act does not take effect unless all of the following bills of the 100th Legislature are enacted into law:
(a) House Bill No. 4459.
(b) House Bill No. 4990.
(c) House Bill No. 4991.
