07 LC 29
2631ER
Senate
Bill 229
By:
Senators Jones of the 10th, Brown of the 26th, Stoner of the 6th, Seay of the
34th and Davenport of the 44th
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating
to regulation and construction of hospitals and other health care facilities, so
as to require each hospital, as a condition of licensure, to maintain written
policies about discount payment and charity care for financially qualified
patients; to provide for eligibility criteria; to provide that each hospital
perform various functions in connection with the hospital charity care and
discount pay policies, including providing patients with notice that contains
information about the hospital´s discount payment and charity care
policies, and about eligibility and the availability of private or public health
insurance coverage for each patient; to provide for billing and collection
procedures to be followed by a hospital, its assignee, collection agency, or
billing service; to require each hospital to submit to the Department of Human
Resources a copy of the hospital´s discount payment and charity care
policies, eligibility procedures, review process, and the application for
charity care or discounted payment; to provide that a hospital director would
ensure that a hospital that overcharges a patient will reimburse such patient;
to provide for related matters; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Chapter
7 of Title 31 of the Official Code of Georgia Annotated, relating to regulation
of hospitals and related institutions, is amended by adding a new article as
follows:
"ARTICLE
1A
31-7-18.1.
As
used in this article, the term:
(1)
'A patient with high medical costs' means a person whose family income does not
exceed 350 percent of the federal poverty level if that individual does not
receive a discounted rate from the hospital as a result of his or her
third-party coverage and has high medical costs. For these purposes, 'high
medical costs' means any of the following:
(A)
Annual out-of-pocket costs incurred by the individual at the hospital that
exceed 10 percent of the patient´s family income in the prior 12
months;
(B)
Annual out-of-pocket expenses that exceed 10 percent of the patient´s
family income, if the patient provides documentation of the patient´s
medical expenses paid by the patient or the patient´s family in the prior
12 months; or
(C)
A lower level determined by the hospital in accordance with the hospital´s
charity care policy.
(2)
'Department' means the Department of Human Resources.
(3)
'Federal poverty level' means the poverty guidelines updated periodically in the
Federal Register by the United States Department of Health and Human Services
under authority of 42 U.S.C.A. Section 9902(2).
(4)
'Financially qualified patient' means a patient who is both of the
following:
(A)
A patient who is a self-pay patient; and
(B)
A patient with high medical costs.
(5)
'Hospital' means an institution which is primarily engaged in providing to
inpatients, by or under the supervision of physicians, diagnostic services and
therapeutic services for medical diagnosis, treatment, and care of injured,
disabled, or sick persons or rehabilitation services for the rehabilitation of
injured, disabled, or sick persons. Such term includes public, private,
psychiatric, rehabilitative, geriatric, osteopathic, and other specialty
hospitals, but shall not include a facility operated by the Division of Mental
Health, Developmental Disabilities, and Addictive Diseases of the Department of
Human Resources or the Department of Corrections.
(6)
'Patient´s family' means the following:
(A)
For persons 18 years of age and older, spouse, domestic partner, and dependent
children under 21 years of age, whether living at home or not; or
(B)
For persons under 18 years of age, parent, caregiver relatives, and other
children under 21 years of age of the parent or caregiver relative.
(7)
'Self-pay patient' means a patient who does not have third-party coverage from a
health insurer, health care service plan, medicare, or Medicaid, and whose
injury is not a compensable injury for purposes of workers´ compensation,
automobile insurance, or other insurance as determined and documented by the
hospital. Self-pay patients may include charity care patients.
31-7-18.2.
Every
hospital shall comply with the provisions of this article as a condition of
licensure. The department shall be responsible for the enforcement of these
provisions.
31-7-18.3.
(a)(1)
Each hospital shall maintain an easily understood written policy regarding
discount payments for financially qualified patients as well as an easily
understood written charity care policy. Uninsured patients or patients with
high medical costs who are at or below 350 percent of the federal poverty level
shall be eligible to apply for participation under each hospital´s charity
care policy or discount payment policy. Notwithstanding any other provision of
this article, a hospital may choose to grant eligibility for its discount
payment policy or charity care policies to patients with incomes over 350
percent of the federal poverty level. Both the charity care policy and the
discount payment policy shall state the process used by the hospital to
determine whether a patient is eligible for charity care or discounted payment.
In the event of a dispute, a patient may seek review from the business manager,
chief financial officer, or other appropriate manager of the hospital as
designated in the charity care policy and the discount payment
policy.
(2)
Rural hospitals, as defined paragraph (4) of subsection (c) of Code Section
31-7-94.1, may establish eligibility levels for financial assistance and charity
care at less than 350 percent of the federal poverty level as appropriate to
maintain their financial and operational integrity.
(b)
Each hospital´s discount payment policy shall clearly state eligibility
criteria based upon income consistent with the application of the federal
poverty level. The discount payment policy shall also include an extended
payment plan to allow payment of the discounted price over time. The policy
shall provide that the hospital and the patient may negotiate the terms of the
payment plan.
(c)
The charity care policy shall clearly state eligibility criteria for charity
care. In determining eligibility under its charity care policy, a hospital may
consider income and monetary assets of the patient. For purposes of this
determination, monetary assets shall not include retirement or deferred
compensation plans qualified under the Internal Revenue Code or nonqualified
deferred compensation plans. Furthermore, the first $10,000.00 of a
patient´s monetary assets shall not be counted in determining eligibility,
nor shall 50 percent of a patient´s monetary assets over the first
$10,000.00 be counted in determining eligibility.
(d)
Each hospital shall limit expected payment for services it provides to any
patient at or below 350 percent of the federal poverty level eligible under its
discount payment policy to the amount of payment the hospital would receive for
providing services from Medicaid, medicare, or PeachCare or any other government
sponsored program of health benefits in which the hospital participates,
whichever is greater. If the hospital provides a service for which there is no
established payment by medicare or any other government sponsored program of
health benefits in which the hospital participates, the hospital shall establish
an appropriate discounted payment.
(e)
Any patient, or patient´s legal representative, who requests a discounted
payment, charity care, or other assistance in meeting such patient´s
financial obligation to the hospital shall make every reasonable effort to
provide the hospital with documentation of income and health benefits coverage.
If the person requests charity care or a discounted payment and fails to provide
information that is reasonable and necessary for the hospital to make a
determination, the hospital may consider that failure in making its
determination.
(f)
Eligibility for discounted payments or charity care, respectively, may be
determined at any time the hospital is in receipt of the following
information:
(1)
For the purpose of determining eligibility for discounted payment, documentation
of income shall be limited to recent pay stubs or income tax returns;
or
(2)
For the purpose of determining eligibility for charity care, documentation of
assets may include information on all monetary assets, but shall not include
statements on retirement or deferred compensation plans qualified under the
Internal Revenue Code or nonqualified deferred compensation plans. A hospital
may require waivers or releases from the patient or the patient´s family,
authorizing the hospital to obtain account information from financial or
commercial institutions, or other entities that hold or maintain the monetary
assets to verify their value. Information obtained pursuant to this paragraph
regarding the assets of the patient or the patient´s family shall not be
used for collections activities.
31-7-18.4.
(a)
Each hospital shall provide patients with a written notice that shall contain
information about availability of the hospital´s discount payment and
charity care policies, including information about eligibility, as well as
contact information for a hospital employee or office from which the person may
obtain further information about these policies. This written notice shall be
provided in addition to the estimate provided pursuant to Code Section 31-7-11.
The notice shall also be provided to patients who receive emergency or
outpatient care and who may be billed for that care, but who were not admitted.
The notice shall be provided in English. Written correspondence to the patient
required by this article shall also be in each language which is the primary
language of 2 percent or more of this state´s population.
(b)
Notice of the hospital´s policy for financially qualified and self-pay
patients shall be clearly and conspicuously posted in locations that are visible
to the public, including, but not limited to, all of the following:
(1)
Emergency department, if any;
(2)
Billing office;
(3)
Admissions office; and
(4)
Other outpatient settings.
31-7-18.5.
(a)
Each hospital shall make all reasonable efforts to obtain from the patient or
his or her representative information about whether private or public health
insurance or sponsorship may fully or partially cover the charges for care
rendered by the hospital to a patient, including, but not limited to, any of the
following:
(1)
Private health insurance;
(2)
Medicare; and
(3)
Medicaid, PeachCare, or other state-funded programs designed to provide health
coverage.
(b)
If a hospital bills a patient who has not provided proof of coverage by a third
party at the time the care is provided or upon discharge, as a part of that
billing, the hospital shall provide the patient with a clear and conspicuous
notice that includes all of the following:
(1)
A statement of charges for services rendered by the hospital;
(2)
A request that the patient inform the hospital if the patient has health
insurance coverage, medicare, Medicaid, PeachCare, or other
coverage;
(3)
A statement that if the consumer does not have health insurance coverage, the
consumer may be eligible for medicare, Medicaid, PeachCare, or charity
care;
(4)
A statement indicating how patients may obtain applications for the Medicaid and
PeachCare programs and that the hospital will provide these applications. If
the patient does not indicate coverage by a third-party payor specified in
subsection (a) of this Code section or requests a discounted price or charity
care, then the hospital shall provide an application for Medicaid, PeachCare, or
other governmental program to the patient. This application shall be provided
prior to discharge if the patient has been admitted or to patients receiving
emergency or outpatient care; and
(5)
Information regarding the financially qualified patient and charity care
application, including the following:
(A)
A statement that indicates that if the patient lacks or has inadequate insurance
and meets certain low- and moderate-income requirements, the patient may qualify
for discounted payment or charity care; and
(B)
The name and telephone number of a hospital employee or office from whom or
which the patient may obtain information about the hospital´s discount
payment and charity care policies and how to apply for that
assistance.
31-7-18.6.
(a)
Each hospital shall have a written policy about when and under whose authority
patient debt is advanced for collection, whether the collection activity is
conducted by the hospital, an affiliate or subsidiary of the hospital, or an
external collection agency.
(b)
Each hospital shall establish a written policy defining standards and practices
for the collection of debt and shall obtain a written agreement from any agency
that collects hospital receivables that it will adhere to the hospital´s
standards and scope of practices. The policy shall not conflict with other
applicable laws and shall not be construed to create a joint venture between the
hospital and the external entity or otherwise to allow hospital governance of an
external entity that collects hospital receivables. In determining the amount
of a debt a hospital may seek to recover from patients who are eligible under
the hospital´s charity care policy or discount payment policy, the hospital
may consider only income and monetary assets as limited by Code Section
31-7-18.3.
(c)
At time of billing, each hospital shall provide a written summary consistent
with Code Section 31-7-18.4, which includes the same information concerning
services and charges provided to all other patients who receive health care at
the hospital.
(d)
For a patient that lacks health care coverage or for a patient that provides
information that he or she may be a patient with high medical costs, a hospital,
any assignee of the hospital, or other owner of the patient debt, including a
collection agency, shall not report adverse information to a consumer credit
reporting agency or commence civil action against the patient for nonpayment at
any time prior to 150 days after initial billing.
(e)
If a patient is attempting to qualify for eligibility under the hospital´s
charity care or discount payment policy and is attempting in good faith to
settle an outstanding bill with the hospital by negotiating a reasonable payment
plan or by making regular partial payments of a reasonable amount, the hospital
shall not send the unpaid bill to any collection agency or other assignee,
unless that entity has agreed to comply with this article.
(f)(1)
The hospital or other assignee which is an affiliate or subsidiary of the
hospital shall not, in dealing with patients eligible under the hospital´s
charity care or discount payment policies, use wage garnishments or liens on
primary residences as a means of collecting unpaid hospital bills.
(2)
A collection agency or other assignee that is not a subsidiary or affiliate of
the hospital shall not, in dealing with any patient under the hospital´s
charity care or discount payment policies, use as a means of collecting unpaid
hospital bills any of the following:
(A)
A wage garnishment, except by order of the court upon noticed motion, supported
by a declaration filed by the movant identifying the basis for which it believes
that the patient has the ability to make payments on the judgment under the wage
garnishment, which the court shall consider in light of the size of the judgment
and additional information provided by the patient prior to, or at, the hearing
concerning the patient´s ability to pay, including information about
probable future medical expenses based on the current condition of the patient
and other obligations of the patient; or
(B)
Notice or conduct a sale of the patient´s primary residence during the life
of the patient or his or her spouse, or during the period a child of the patient
is a minor, or a child of the patient who has attained the age of majority is
unable to care for himself or herself and resides in the dwelling as his or her
primary residence. In the event a person protected by this subparagraph owns
more than one dwelling, the primary residence shall be the dwelling that is the
patient´s current homestead or was the patient´s homestead at the time
of the death of a person other than the patient who is asserting the protections
of this paragraph.
(3)
This requirement shall not preclude a hospital, collection agency, or other
assignee from pursuing reimbursement and any enforcement remedy or remedies from
third-party liability settlements, tortfeasors, or other legally responsible
parties.
(g)
Any extended payment plans offered by a hospital to assist patients eligible
under the hospital´s charity care policy, discount payment policy, or any
other policy adopted by the hospital for assisting low-income patients with no
insurance or high medical costs in settling outstanding past due hospital bills
shall be interest free.
(h)
Nothing in this Code section shall be construed to diminish or eliminate any
protections consumers have under existing federal and state debt collection laws
or any other consumer protections available under state or federal law. This
subsection shall not limit or alter the obligation of the patient to make
payments from the first date due on the obligation owing to the hospital
pursuant to any contract or applicable statute, in the event that the patient
fails to make payments for 90 days or to renegotiate the payment
plan.
31-7-18.7.
(a)
The period described in Code Section 31-7-18.6 shall be extended if the patient
has a pending appeal for coverage of the services, until a final determination
of that appeal is made, if the patient makes a reasonable effort to communicate
with the hospital about the progress of any pending appeals.
(b)
For purposes of this Code section, 'pending appeal' includes any of the
following:
(1)
A grievance against a contracting health care service plan or against an
insurer;
(2)
An independent medical review;
(3)
A fair hearing for a review of a Medicaid claim; or
(4)
An appeal regarding medicare coverage consistent with federal law and
regulations.
31-7-18.8.
(a)
Prior to commencing collection activities against a patient, the hospital, any
assignee of the hospital, or other owner of the patient debt, including a
collection agency, shall provide the patient with a clear and conspicuous
written notice containing both of the following:
(1)
A plain language summary of the patient´s rights pursuant to this article
and 15 U.S.C.A. Section 1692, et seq., the federal Fair Debt Collection
Practices Act. The summary shall include a statement that the Federal Trade
Commission enforces the federal act. The summary shall be sufficient if it
appears in substantially the following form:
'State
and federal law require debt collectors to treat you fairly and prohibit debt
collectors from making false statements or threats of violence, using obscene or
profane language, and making improper communications with third parties,
including your employer. Except under unusual circumstances, debt collectors
may not contact you before 8:00 A.M. or after 9:00 P.M. In general, a debt
collector may not give information about your debt to another person, other than
your attorney or spouse. A debt collector may contact another person to confirm
your location or to enforce a judgment. For more information about debt
collection activities, you may contact the Federal Trade Commission by telephone
at 1-877-FTC-HELP (382-4357) or online at www.ftc.gov.'; and
(2)
A statement that nonprofit credit counseling services may be available in the
area.
(b)
The notice required by subsection (a) of this Code section shall also accompany
any document indicating that the commencement of collection activities may
occur.
(c)
The requirements of this Code section shall apply to the entity engaged in
collection activities. If a hospital assigns or sells the debt to another
entity, the obligations shall apply to the entity, including a collection
agency, engaged in the debt collection activity.
31-7-18.9.
Each
hospital shall provide to the department a copy of its discount payment policy,
charity care policy, eligibility procedures for those policies, review process,
and the application for charity care or discounted payment programs. The
department may determine whether the information is to be provided
electronically or in some other manner. The information shall be provided at
least biennially on January 1 or when a significant change is made. If no
significant change has been made by the hospital since the information was
previously provided, notifying the department of the lack of change shall meet
the requirements of this Code section. The department shall make this
information available to the public.
31-7-18.10.
The
hospital shall reimburse the patient or patients any amount actually paid in
excess of the amount due under this article, including interest.
31-7-19.
The
rights, remedies, and penalties established by this article are cumulative and
shall not supersede the rights, remedies, or penalties established under federal
or Georgia law.
31-7-19.1.
Nothing
in this article shall be construed to prohibit a hospital from uniformly
imposing charges from its established charge schedule or published rates, nor
shall this article preclude the recognition of a hospital´s established
charge schedule or published rates for purposes of applying any payment limit,
interim payment amount, or other payment calculation based upon a
hospital´s rates or charges under the Medicaid program, the medicare
program, workers´ compensation, or other federal, state, or local public
program of health benefits.
31-7-19.2.
Notwithstanding
any other provision of law, the amounts paid by parties for services resulting
from reduced or waived charges under a hospital´s discounted payment or
charity care policy shall not constitute a hospital´s uniform, published,
prevailing, or customary charges, its usual fees to the general public, or its
charges to non-Medicaid purchasers under comparable circumstances and shall not
be used to calculate a hospital´s median non-medicare or Medicaid charges,
for purposes of any payment limit under medicare, Medicaid, or any other federal
or state-financed health care program.
31-7-19.3.
To
the extent that any requirement of Code Section 31-7-18.1, 31-7-18.2, or
31-7-18.3 results in a federal determination that a hospital´s established
charge schedule or published rates are not the hospital´s customary or
prevailing charges for services, the requirement in question shall be
inoperative for all hospitals, including, but not limited to, a hospital that is
licensed to and operated by a county or a hospital authority established
pursuant to Article 4 of Chapter 7 of this title. The department shall seek
federal guidance regarding modifications to the requirement in question. All
other requirements of this article shall remain in effect."
SECTION
2.
All
laws and parts of laws in conflict with this Act are repealed.