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Health Insurance Surprise Billing Protections

Concerning updates to state surprise billing laws to facilitate the implementation of surprise billing protections, and, in connection therewith, aligning state law with the federal "No Surprises Act" and making an appropriation.
2022 Regular Session
Bill Summary

The bill changes current state law to align with the federal "No Surprises Act" (act) by:

  • Allowing a covered person who requests an independent external review of a health-care coverage decision to request a review to determine if the services that were provided or may be provided by an out-of-network provider or facility are subject to an in-network benefit level of coverage;
  • Requiring that payments made for health-care services provided at an in-network facility or by an out-of-network provider be applied to the covered person's in-network deductible and any out-of-pocket maximum amounts as if the services were provided by an in-network provider;
  • Requiring that emergency health-care services, regardless of the facility at which they are provided, be covered at the in-network benefit level;
  • Requiring each health insurance carrier (carrier) to cover post-stabilization services to stabilize a patient after a medical emergency at the in-network benefit level unless specific criteria are met;
  • Requiring carriers to develop disclosures to provide to covered persons that comply with the act;
  • Requiring the commissioner of insurance (commissioner) and certain regulators of health-care occupations to adopt rules concerning disclosure requirements, including a list of ancillary services for which a provider or facility cannot charge a balance bill;
  • Requiring the commissioner to convene a work group to facilitate and streamline the implementation of the payment of claims for services provided by an out-of-network provider at an in-network facility and for services surrounding a medical emergency;
  • Prohibiting a carrier from recalculating a covered person's cost-sharing amount based on an additional payment made as a result of arbitration;
  • Requiring the parties to an arbitration over health-care coverage to split the costs of the arbitrator if the parties reach an agreement before the final decision of the arbitrator;
  • Allowing administrators of self-funded health benefit plans to elect to be subject to state law concerning coverage for health-care services from out-of-network providers and facilities;
  • Authorizing the commissioner to promulgate rules to implement the requirements of the act;
  • Changing the amount of time that a managed care plan must allow a person to continue to receive care from a provider from 60 to 90 days after the date an in-network provider is terminated from a plan without cause;
  • Implementing specific requirements for health-care coverage and services for covered persons who are continuing care patients of a provider or facility whose contract with the patient's health insurer is terminated; and
  • Allowing an out-of-network provider and an out-of-network facility to charge a covered person a balance bill for health-care services other than ancillary services if the out-of-network provider complies with specific notice requirements and obtains the covered person's signed consent.

The bill changes from January 1 to March 1 the date by which a carrier is required to submit information to the commissioner concerning the use of out-of-network providers and out-of-network facilities and the impact on health insurance premiums for consumers.

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)


Became Law


Bill Text