HF 2599

as introduced - 93rd Legislature (2023 - 2024) Posted on 04/21/2023 02:20pm

A bill for an act
relating to health care; establishing requirements for hospitals to screen patients
for eligibility for health coverage or assistance; requiring an affidavit of expert
review before certain debt collection activities; limiting hospital charges for
uninsured treatments and services for certain patients; proposing coding for new
law in Minnesota Statutes, chapter 144.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [144.587] REQUIREMENTS FOR SCREENING FOR ELIGIBILITY
FOR HEALTH COVERAGE OR ASSISTANCE.
new text end

new text begin Subdivision 1. new text end

new text begin Definitions. new text end

new text begin (a) The terms defined in this subdivision apply to this section
and sections 144.588 to 144.589.
new text end

new text begin (b) "Charity care" means the provision of free or discounted care to a patient according
to a hospital's financial assistance policies.
new text end

new text begin (c) "Hospital" means a private, nonprofit, or municipal hospital licensed under sections
144.50 to 144.56.
new text end

new text begin (d) "Minnesota attorney general/hospital agreement" means the agreement between the
attorney general and certain Minnesota hospitals that is filed in Ramsey County District
Court and that establishes requirements for hospital litigation practices, garnishments, use
of collection agencies, central billing office practices, and practices for billing uninsured
patients.
new text end

new text begin (e) "Most favored insurer" means the nongovernmental third-party payor that provided
the most revenue to the provider during the previous calendar year.
new text end

new text begin (f) "Navigator" has the meaning given in section 62V.02, subdivision 9.
new text end

new text begin (g) "Premium tax credit" means a tax credit or premium subsidy under the federal Patient
Protection and Affordable Care Act, Public Law 111-148, as amended, including the federal
Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any
amendments to and federal guidance and regulations issued under these acts.
new text end

new text begin (h) "Presumptive eligibility" has the meaning given in section 256B.057, subdivision
12.
new text end

new text begin (i) "Revenue recapture" means the use of the procedures in chapter 270A to collect debt.
new text end

new text begin (j) "Uninsured service or treatment" means any service or treatment that is not covered
by: (1) a health plan, contract, or policy that provides health coverage to a patient; or (2)
any other type of insurance coverage, including but not limited to no-fault automobile
coverage, workers' compensation coverage, or liability coverage.
new text end

new text begin (k) "Unreasonable burden" includes requiring a patient to apply for enrollment in a state
or federal program for which the patient is obviously or categorically ineligible or has been
found to be ineligible in the previous 12 months.
new text end

new text begin Subd. 2. new text end

new text begin Screening. new text end

new text begin A hospital must screen a patient who is uninsured or whose insurance
coverage status is not known by the hospital for: eligibility for charity care from the hospital;
eligibility for state or federal public health care programs using presumptive eligibility or
another similar process; and eligibility for a premium tax credit. The hospital must attempt
to complete this screening process in person or by telephone within 30 days after the patient
receives services at the hospital or at the emergency department associated with the hospital.
new text end

new text begin Subd. 3. new text end

new text begin Charity care. new text end

new text begin (a) Upon completion of the screening process in subdivision 2,
the hospital must either assist the patient with applying for charity care and refer the patient
to the appropriate department in the hospital for follow-up or make a determination that the
patient is ineligible for charity care. A hospital may initiate one or more of the following
steps only after the hospital determines that the patient is ineligible for charity care and may
not initiate any of the following steps while the patient's application for charity care is
pending:
new text end

new text begin (1) offering to enroll or enrolling the patient in a payment plan;
new text end

new text begin (2) changing the terms of a patient's payment plan;
new text end

new text begin (3) offering the patient a loan or line of credit, application materials for a loan or line of
credit, or assistance with applying for a loan or line of credit, for the payment of medical
debt;
new text end

new text begin (4) referring a patient's debt for collections, including in-house collections, third-party
collections, revenue recapture, or any other process for the collection of debt;
new text end

new text begin (5) denying health care services to the patient or any member of the patient's household
because of outstanding medical debt, regardless of whether the services are deemed necessary
or may be available from another provider; or
new text end

new text begin (6) accepting a credit card payment of over $500 for the medical debt owed to the hospital.
new text end

new text begin (b) A hospital may not impose application procedures for charity care that place an
unreasonable burden on the individual patient, taking into account the individual patient's
physical, mental, intellectual, or sensory deficiencies or language barriers that may hinder
the patient's ability to comply with application procedures.
new text end

new text begin (c) When a hospital evaluates a patient's eligibility for charity care, hospital requests to
the responsible party for verification of assets or income shall be limited to:
new text end

new text begin (1) information that is reasonably necessary and readily available to determine eligibility;
and
new text end

new text begin (2) facts that are relevant to determine eligibility.
new text end

new text begin A hospital must not demand duplicate forms of verification of assets.
new text end

new text begin Subd. 4. new text end

new text begin Public health care program; premium tax credit. new text end

new text begin (a) If a patient is
presumptively eligible for a public health care program, the hospital must assist the patient
in completing an insurance affordability program application, help the patient schedule an
appointment with a navigator organization, or provide the patient with contact information
for the nearest available navigator services.
new text end

new text begin (b) If a patient is eligible for a premium tax credit, the hospital may schedule an
appointment for the patient with a navigator organization or provide the patient with contact
information for the nearest available navigator services.
new text end

new text begin Subd. 5. new text end

new text begin Patient may decline services. new text end

new text begin A patient may decline to participate in the
screening process, to apply for charity care, to complete an insurance affordability program
application, to schedule an appointment with a navigator organization, or to accept
information about navigator services.
new text end

new text begin Subd. 6. new text end

new text begin Notice. new text end

new text begin (a) A hospital must post notice of the availability of charity care from
the hospital in at least the following locations: (1) areas of the hospital where patients are
admitted or registered; (2) emergency departments; and (3) the portion of the hospital's
financial services or billing department that is accessible to patients. The posted notice must
be in all languages spoken by more than five percent of the population in the hospital's
service area.
new text end

new text begin (b) A hospital must make available on the hospital's website, the current version of the
hospital's charity care policy, a plain-language summary of the policy, and the hospital's
charity care application form. The summary and application form must be available in all
languages spoken by more than five percent of the population in the hospital's service area.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective November 1, 2023.
new text end

Sec. 2.

new text begin [144.588] CERTIFICATION OF EXPERT REVIEW.
new text end

new text begin Subdivision 1. new text end

new text begin Requirement; action to collect medical debt or garnish wages or bank
accounts. new text end

new text begin (a) In an action against a patient for collection of medical debt owed to a hospital
or for garnishment of the patient's wages or bank accounts to collect medical debt owed to
a hospital, the hospital must serve on the defendant with the summons and complaint an
affidavit of expert review certifying that the hospital:
new text end

new text begin (1) made all of the verifications required of the hospital in the most recent version of
the Minnesota attorney general/hospital agreement in order to collect the specific patient's
debt or to garnish the specific patient's wages or bank accounts; and
new text end

new text begin (2) unless the patient declined to participate, complied with the requirements in section
144.587 to conduct a patient screening and, as applicable, assist the patient in applying for
charity care, assist the patient with completing an insurance affordability program application,
or refer the patient to a navigator organization.
new text end

new text begin (b) The affidavit of expert review must be completed by a designated employee of the
hospital seeking to initiate the action or garnishment.
new text end

new text begin Subd. 2. new text end

new text begin Requirement; referral to third-party debt collection agency. new text end

new text begin (a) In order to
refer a patient's account to a third-party debt collection agency, a hospital must complete
an affidavit of expert review certifying that the hospital:
new text end

new text begin (1) confirmed the information required of the hospital in the most recent version of the
Minnesota attorney general/hospital agreement for referral of a specific patient's account
to a third-party debt collection agency; and
new text end

new text begin (2) unless the patient declined to participate, complied with the requirements in section
144.587 to conduct a patient screening and, as applicable, assist the patient in applying for
charity care, assist the patient with completing an insurance affordability program application,
or refer the patient to a navigator organization.
new text end

new text begin (b) The affidavit of expert review must be completed by a designated employee of the
hospital seeking to refer the patient's account to a third-party debt collection agency.
new text end

new text begin Subd. 3. new text end

new text begin Penalty for noncompliance. new text end

new text begin Failure to comply with subdivision 1 shall result,
upon motion, in mandatory dismissal with prejudice of the action to collect the medical
debt or to garnish the patient's wages or bank accounts. Failure to comply with subdivision
2 shall subject a hospital to a fine assessed by the commissioner of health.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective November 1, 2023.
new text end

Sec. 3.

new text begin [144.589] BILLING OF UNINSURED PATIENTS.
new text end

new text begin A hospital shall not charge a patient whose annual household income is less than $125,000
for any uninsured service or treatment in an amount that exceeds the total amount the
provider would be reimbursed for that service or treatment from its most favored insurer.
The total amount the provider would be reimbursed for that service or treatment from its
most favored insurer includes both the amount the provider would be reimbursed directly
from its most favored insurer, and the amount the provider would be reimbursed from the
insured's policyholder under any applicable co-payments, deductibles, and coinsurance.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective November 1, 2023.
new text end