Bill Text: OR HB2181 | 2013 | Regular Session | Introduced

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Bill Title: Relating to payment for trauma system hospital services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [HB2181 Detail]

Download: Oregon-2013-HB2181-Introduced.html

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     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 985

                         House Bill 2181

Sponsored by Representative BOONE (Presession filed.)

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.

  Requires insurer offering health insurance to have adequate
network of trauma system hospitals in insurer's network of
providers. Requires insurer to reimburse for services provided by
out-of-network trauma system hospital at specified rate. Provides
that health care providers must accept reimbursement as payment
in full and may not bill insured for balance. Specifies that a
provider that institutes suit to collect balance must pay
reasonable costs and attorney fees incurred by patient to defend
action.

                        A BILL FOR AN ACT
Relating to payment for trauma system hospital services.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + Section 2 of this 2013 Act is added to and made
a part of the Insurance Code. + }
  SECTION 2.  { + (1) As used in this section:
  (a) 'Emergency medical condition' has the meaning given that
term in ORS 743A.012.
  (b) 'Trauma system hospital' means a hospital designated by the
Oregon Health Authority as a trauma system hospital under ORS
431.609.
  (2) Any insurer that offers a policy or certificate of health
insurance that covers inpatient hospital services for a resident
of this state must contract with a sufficient number of trauma
system hospitals, with sufficient geographic distribution, to
ensure that, to the greatest extent practicable, each insured has
access to an in-network trauma system hospital that is located
within a reasonable travel distance from where the insured
resides.
  (3) If it is medically necessary for an insured to be admitted
to a trauma system hospital to be stabilized for an emergency
medical condition and the hospital or a health care provider
serving the insured at the hospital is not in the insurer's
provider network, the insurer must reimburse the hospital and the
health care provider by paying, at a minimum, the maximum
allowable charge that the insurer pays for each service if
provided in an in-network hospital or by an in-network
provider. + }
  SECTION 3.  { + (1) A hospital and any other provider that is
reimbursed by an insurer for services provided at a trauma system
hospital under section 2 (3) of this 2013 Act must accept the
insurer's payment as payment in full and may not bill the insured
for the difference between the hospital's usual and customary
charge and the amount paid by the insurer in accordance with
section 2 (3) of this 2013 Act.
  (2) If a hospital or other provider or an assignee of a
provider institutes an action to recover an amount billed in
violation of subsection (1) of this section, the action shall be
dismissed and the court shall award the defendant reasonable
costs and attorney fees incurred in defending the action. + }
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