Health Insurance Surprise Billing Protections

The act changes current state law to align with the federal "No Surprises Act" (federal 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;
• 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;
• Authorizing the commissioner to promulgate rules to implement the requirements of the act, including rules necessary to implement the requirements of the federal 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 after the date an in-network provider is terminated from a plan without cause to up to 90 days after a carrier provides notice that the contract is terminated;
• 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;
• Authorizing the regulator of health-care providers, in consultation with the commissioner, to adopt rules concerning consumer disclosures;
• 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; and
• Requiring a carrier offering an individual health benefit plan or short-term limited duration health insurance policy to make consumer disclosures.

The act 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.

$233,018 is appropriated from the division of insurance cash fund to the department of regulatory agencies for use in the 2022-23 state fiscal year for personal services, operating expenses, and to purchase legal services, and of that amount, $88,713 is reappropriated to the department of law to provide legal services for the department of regulatory agencies.

$7,506 is appropriated from the health facilities general licensure cash fund to the department of public health and environment for use in the 2022-23 state fiscal year by health facilities and emergency medical services division to implement the act.

(Note: This summary applies to this bill as enacted.)