SF 2673

2nd Engrossment - 93rd Legislature (2023 - 2024) Posted on 06/29/2023 04:32pm

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) "Insurance affordability program" has the meaning given in section 256B.02,
subdivision 19.
new text end

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

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

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

new text begin (h) "Uninsured service or treatment" means any service or treatment that is not covered
by:
new text end

new text begin (1) a health plan, contract, or policy that provides health coverage to a patient; or
new text end

new text begin (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 (i) "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) A hospital participating in the hospital presumptive eligibility
program under section 256B.057, subdivision 12, must determine whether a patient who is
uninsured or whose insurance coverage status is not known by the hospital is eligible for
hospital presumptive eligibility coverage.
new text end

new text begin (b) For any uninsured patient, including any patient the hospital determines is eligible
for hospital presumptive eligibility coverage, and for any patient whose insurance coverage
status is not known to the hospital, a hospital must:
new text end

new text begin (1) if it is a certified application counselor organization, schedule an appointment for
the patient with a certified application counselor to occur prior to discharge unless the
occurrence of the appointment would delay discharge;
new text end

new text begin (2) if the occurrence of the appointment under clause (1) would delay discharge or if
the hospital is not a certified application counselor organization, schedule prior to discharge
an appointment for the patient with a MNsure-certified navigator to occur after discharge
unless the scheduling of an appointment would delay discharge; or
new text end

new text begin (3) if the scheduling of an appointment under clause (2) would delay discharge or if the
patient declines the scheduling of an appointment under clause (1) or (2), provide the patient
with contact information for available MNsure-certified navigators who can meet the needs
of the patient.
new text end

new text begin (c) For any uninsured patient, including any patient the hospital determines is eligible
for hospital presumptive eligibility coverage, and any patient whose insurance coverage
status is not known to the hospital, a hospital must screen the patient for eligibility for charity
care from the hospital. The hospital must attempt to complete the screening process for
charity care 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,
paragraph (c), the hospital must determine whether the patient is ineligible or potentially
eligible for charity care. 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 (b) If the patient is not ineligible for charity care, the hospital must assist the patient
with applying for charity care and refer the patient to the appropriate department in the
hospital for follow-up. 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) A hospital may not initiate any of the actions described in subdivision 4 while the
patient's application for charity care is pending.
new text end

new text begin Subd. 4. new text end

new text begin Prohibited actions. new text end

new text begin A hospital must not initiate one or more of the following
actions until the hospital determines that the patient is ineligible for charity care or denies
an application for charity care:
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 Subd. 5. 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 Subd. 6. new text end

new text begin Patient may decline services. new text end

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

new text begin Subd. 7. new text end

new text begin Enforcement. new text end

new text begin In addition to the enforcement of this section by the
commissioner, the attorney general may enforce this section under section 8.31.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective November 1, 2023, and applies to services
and treatments provided on or after that date.
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 or guarantor for collection of medical debt owed
to a hospital or for garnishment of the patient's or guarantor'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:
new text end

new text begin (1) unless the patient declined to participate, the hospital complied with the requirements
in section 144.587;
new text end

new text begin (2) there is a reasonable basis to believe that the patient owes the debt;
new text end

new text begin (3) all known third-party payors have been properly billed by the hospital, such that any
remaining debt is the financial responsibility of the patient, and the hospital will not bill the
patient for any amount that an insurance company is obligated to pay;
new text end

new text begin (4) the patient has been given a reasonable opportunity to apply for charity care, if the
facts and circumstances suggest that the patient may be eligible for charity care;
new text end

new text begin (5) where the patient has indicated an inability to pay the full amount of the debt in one
payment and provided reasonable verification of the inability to pay the full amount of the
debt in one payment if requested by the hospital, the hospital has offered the patient a
reasonable payment plan;
new text end

new text begin (6) there is no reasonable basis to believe that the patient's or guarantor's wages or funds
at a financial institution are likely to be exempt from garnishment; and
new text end

new text begin (7) in the case of a default judgment proceeding, there is not a reasonable basis to believe:
new text end

new text begin (i) that the patient may already consider that the patient has adequately answered the
complaint by calling or writing to the hospital, its debt collection agency, or its attorney;
new text end

new text begin (ii) that the patient is potentially unable to answer the complaint due to age, disability,
or medical condition; or
new text end

new text begin (iii) the patient may not have received service of the complaint.
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:
new text end

new text begin (1) unless the patient declined to participate, the hospital complied with the requirements
in section 144.587;
new text end

new text begin (2) there is a reasonable basis to believe that the patient owes the debt;
new text end

new text begin (3) all known third-party payors have been properly billed by the hospital, such that any
remaining debt is the financial responsibility of the patient, and the hospital will not bill the
patient for any amount that an insurance company is obligated to pay;
new text end

new text begin (4) the patient has been given a reasonable opportunity to apply for charity care, if the
facts and circumstances suggest that the patient may be eligible for charity care; and
new text end

new text begin (5) where the patient has indicated an inability to pay the full amount of the debt in one
payment and provided reasonable verification of the inability to pay the full amount of the
debt in one payment if requested by the hospital, the hospital has offered the patient a
reasonable payment plan.
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 or guarantor's wages or bank accounts. Failure to comply
with subdivision 2 shall subject a hospital to a fine assessed by the commissioner of health.
In addition to the enforcement of this section by the commissioner, the attorney general
may enforce this section under section 8.31.
new text end

new text begin Subd. 4. new text end

new text begin Collection agency; immunity. new text end

new text begin A collection agency, as defined in section
332.31, subdivision 3, is not required to verify the submission of an affidavit of expert
review or assess the validity of an affidavit of expert review. The collection agency is not
liable for a hospital's failure to comply with this section.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective November 1, 2023, and applies to actions
and referrals to third-party debt collection agencies stemming from services and treatments
provided on or after that date.
new text end

Sec. 3.

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

new text begin Subdivision 1. new text end

new text begin Limits on charges. new text end

new text begin A hospital must 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 lowest total amount the provider would be reimbursed for that service or
treatment from a private insurer. The lowest total amount the provider would be reimbursed
for that service or treatment from a private insurer includes both the amount the provider
would be reimbursed directly from the private 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 Subd. 2. new text end

new text begin Enforcement. new text end

new text begin In addition to the enforcement of this section by the
commissioner, the attorney general may enforce this section under section 8.31.
new text end

new text begin EFFECTIVE DATE. new text end

new text begin This section is effective November 1, 2023, and applies to services
and treatments provided on or after that date.
new text end