2019 -- H 5556

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LC001808

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO INSURANCE -- HEALTH CARE ACCESSIBILITY AND QUALITY

ASSURANCE ACT

     

     Introduced By: Representatives Donovan, Canario, Tanzi, Carson, and Casimiro

     Date Introduced: February 27, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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     SECTION 1. Chapter 27-18.8 of the General Laws entitled "Health Care Accessibility

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and Quality Assurance Act" is hereby amended by adding thereto the following section:

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     27-18.8-11. Development of common summary of payments forms.

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     (a) The commissioner shall develop a common summary of payments form to be used by

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all carriers in the state of Rhode Island and provided to health care consumers with respect to

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provider claims submitted to a payer. The common summary of payments form shall be written in

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an easily readable and understandable format showing the consumer’s responsibility, if any, for

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payment of any portion of a health care provider claim. The office shall allow the development

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and use of forms that may be exchanged securely through electronic means. Carriers shall not be

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obligated to issue a common summary of payments form for provider claims that consist solely of

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requests for copayment.

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     (b)(1) Carriers shall issue common summary of payments forms at the member level for

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each insured member. Carriers may establish a standard method of delivery of common summary

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of payments forms. All carriers shall permit the following individuals to choose, in writing, an

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alternative method of receiving the common summary of payments form:

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     (i) A subscriber who is legally authorized to consent to care for the insured member;

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     (ii) An insured member who is legally authorized to consent to that member’s own care;

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or

 

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     (iii) Another party who has the exclusive legal authorization to consent to care for the

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insured member.

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     (2) The alternative methods of receiving the common summary of payments form shall

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include, but not be limited to:

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     (i) Sending a paper form to the address of the subscriber;

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     (ii) Sending a paper form to the address of the insured member;

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     (iii) Sending a paper form to any alternate address upon request of the insured member;

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or

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     (iv) Allowing the subscriber, the insured member or both to access the form through

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electronic means; provided, however, that such access is provided in compliance with any

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applicable state and federal laws and regulations pertaining to data privacy and security.

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     (c) All carriers shall also permit an individual not authorized under subsection (b) of this

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section but who is legally authorized to consent to care for an insured member to request, and

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shall accommodate a reasonable request by such individual to receive, the forms on behalf of the

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member through any of the alternative methods enumerated in subsection (b) of this section;

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provided that, the individual clearly states in writing that the disclosure of all or part of the

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information could endanger the individual or the insured member. Upon receipt of such request,

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carriers shall not inquire as to the reasons for, or otherwise seek to confirm, the endangerment.

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     (d) The preferred method of receipt selected pursuant to subsection (b) of this section

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shall be valid until the insured member submits a request in writing for a different method;

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provided, however, that a carrier shall not be requested to maintain more than one alternate

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address for a member. Carriers shall comply with an insured member’s request pursuant to this

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subsection not later than three (3) business days after receipt of the request.

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     (e) Carriers shall not specify or describe sensitive health care services in a common

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summary of payments form. The commissioner shall define sensitive health care services for the

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purposes of this section. In determining that definition, the commissioner shall consider the

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recommendations of the National Committee on Vital and Health Statistics and similar

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regulations in other states and shall consult with experts in fields including, but not limited to,

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infectious disease, reproductive and sexual health, domestic violence and sexual assault, and

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mental health and substance abuse disorders.

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     (f) In the event that the insured member has no liability for payment for any procedure or

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service, carriers shall permit all insured members who are legally authorized to consent to care, or

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parties legally authorized to consent to care for the insured member, to request suppression of

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common summary of payments forms for a specific service or procedure, in which case the

 

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common summary of payments forms shall be not issued; provided, however, that the insured

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member clearly makes the request orally or in writing. The carrier may request verification of the

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request in writing following an oral request. A carrier shall not require an explanation as to the

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basis for an insured member’s request to suppress the common summary of payments forms,

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unless otherwise requested by law or court order.

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     (g) The insured member’s ability to request the preferred method of receipt pursuant to

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subsection (b) of this section and to request suppression of the common summary of payments

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forms pursuant to subsection (f) of this section shall be communicated in plain language and in

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clear and conspicuous manner in evidence of coverage documents, member privacy

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communications, and on every common summary of payments form and shall be conspicuously

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displayed on the carrier’s members website and online portals for individual members.

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     (h) The commissioner shall issue guidance as necessary to implement and enforce this

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section, which shall include requirements for reasonable reporting by carriers to the

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commissioner regarding compliance and the number and type of complaints received regarding

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noncompliance with this section.

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     (i) The commissioner, in collaboration with the office of the health insurance

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commissioner, shall develop and implement a plan to educate providers and consumers regarding

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the rights of insured members and the responsibilities of carriers to promote compliance with this

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section. The plan shall include, but not be limited to, staff training and other education for

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hospitals, community health centers, school-based health centers, physicians, nurses and other

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licensed health care professionals, as well as administrative staff including, but not limited to:

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     (1) All staff involved in patient registration and confidentiality education; and

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     (2) Billing staff involved in processing insurance claims. The plan shall be developed in

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consultation with groups representing health care insurers, providers and consumers, including

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consumer organizations concerned with the provision of sensitive health care services.

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     (j) Nothing in this section shall supersede any general or special law related to the

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informed consent of minors.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- HEALTH CARE ACCESSIBILITY AND QUALITY

ASSURANCE ACT

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     This act would provide for the development of a common summary of payments forms,

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to be used by all health insurance carriers and to be provided to health care consumers, providing

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the consumer with their responsibility for payment, if any, of any portion of a health care provider

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claim.

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     This act would take effect upon passage.

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LC001808

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