Senate Resolution #580 (2019)

SENATE RESOLUTION RESPECTFULLY REQUESTING THE RHODE ISLAND DEPARTMENT OF HEALTH TO DEVELOP AND PROMULGATE RULES AND REGULATIONS TO ENSURE THE CONFIDENTIAL COMMUNICATION OF SENSITIVE MEDICAL INFORMATION

Develops a common summary of payments forms, to be used by all health insurance carriers and to be provided to health care consumers, providing the consumer with their responsibility for payment, of any portion of a health care provider claim.

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Changes since original draft

  • 2019 – S 0580
  • 2019 – S 0580 SUBSTITUTE A
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  • LC002063
  • LC002063/SUB A
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  • S T A T E O F R H O D E I S L A N D
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2019
  • ____________
  • A N A C T
  • RELATING TO INSURANCE – HEALTH CARE ACCESSIBILITY AND QUALITY
  • ASSURANCE ACT
  • S TATE OF RHODE IS L AND
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2019
  • ____________
  • S E N A T E R E S O L U T I O N
  • RESPECTFULLY REQUESTING THE RHODE ISLAND DEPARTMENT OF HEALTH TO
  • DEVELOP AND PROMULGATE RULES AND REGULATIONS TO ENSURE THE
  • CONFIDENTIAL COMMUNICATION OF SENSITIVE MEDICAL INFORMATION
  • Introduced By: Senators Goldin, and Miller
  • Date Introduced: March 14, 2019
  • Referred To: Senate Health & Human Services
  • It is enacted by the General Assembly as follows:
  • SECTION 1. Chapter 27-18.8 of the General Laws entitled "Health Care Accessibility and Quality Assurance Act" is hereby amended by adding thereto the following section:
  • 27-18.8-11. Development of common summary of payments forms.
  • (a) The commissioner shall develop a common summary of payments form to be used by all carriers in the state of Rhode Island and provided to health care consumers with respect to provider claims submitted to a payer. The common summary of payments form shall be written in an easily readable and understandable format showing the consumer's responsibility, if any, for payment of any portion of a health care provider claim. The office shall allow the development and use of forms that may be exchanged securely through electronic means. Carriers shall not be obligated to issue a common summary of payments form for provider claims that consist solely of requests for copayment.
  • (b)(1) Carriers shall issue common summary of payments forms at the member level for each insured member. Carriers may establish a standard method of delivery of common summary of payments forms. All carriers shall permit the following individuals to choose, in writing, an alternative method of receiving the common summary of payments form:
  • (i) A subscriber who is legally authorized to consent to care for the insured member;
  • (ii) An insured member who is legally authorized to consent to that member's own care; or
  • (iii) Another party who has the exclusive legal authorization to consent to care for the insured member.
  • (2) The alternative methods of receiving the common summary of payments form shall include, but not be limited to:
  • (i) Sending a paper form to the address of the subscriber;
  • (ii) Sending a paper form to the address of the insured member;
  • (iii) Sending a paper form to any alternate address upon request of the insured member; or
  • (iv) Allowing the subscriber, the insured member or both to access the form through electronic means; provided, however, that such access is provided in compliance with any applicable state and federal laws and regulations pertaining to data privacy and security.
  • (c) All carriers shall also permit an individual not authorized under subsection (b) of this section but who is legally authorized to consent to care for an insured member to request, and shall accommodate a reasonable request by such individual to receive, the forms on behalf of the member through any of the alternative methods enumerated in subsection (b) of this section; provided that, the individual clearly states in writing that the disclosure of all or part of the information could endanger the individual or the insured member. Upon receipt of such request, carriers shall not inquire as to the reasons for, or otherwise seek to confirm, the endangerment.
  • (d) The preferred method of receipt selected pursuant to subsection (b) of this section shall be valid until the insured member submits a request in writing for a different method; provided, however, that a carrier shall not be requested to maintain more than one alternate address for a member. Carriers shall comply with an insured member's request pursuant to this subsection not later than three (3) business days after receipt of the request.
  • (e) Carriers shall not specify or describe sensitive health care services in a common summary of payments form. The commissioner shall define sensitive health care services for the purposes of this section. In determining that definition, the commissioner shall consider the recommendations of the National Committee on Vital and Health Statistics and similar regulations in other states and shall consult with experts in fields including, but not limited to, infectious disease, reproductive and sexual health, domestic violence and sexual assault, and mental health and substance abuse disorders.
  • (f) In the event that the insured member has no liability for payment for any procedure or service, carriers shall permit all insured members who are legally authorized to consent to care, or parties legally authorized to consent to care for the insured member, to request suppression of common summary of payments forms for a specific service or procedure, in which case the common summary of payments forms shall be not issued; provided, however, that the insured member clearly makes the request orally or in writing. The carrier may request verification of the request in writing following an oral request. A carrier shall not require an explanation as to the basis for an insured member's request to suppress the common summary of payments forms, unless otherwise requested by law or court order.
  • (g) The insured member's ability to request the preferred method of receipt pursuant to subsection (b) of this section and to request suppression of the common summary of payments forms pursuant to subsection (f) of this section shall be communicated in plain language and in clear and conspicuous manner in evidence of coverage documents, member privacy communications, and on every common summary of payments form and shall be conspicuously displayed on the carrier's members website and online portals for individual members.
  • (h) The commissioner shall issue guidance as necessary to implement and enforce this section, which shall include requirements for reasonable reporting by carriers to the commissioner regarding compliance and the number and type of complaints received regarding noncompliance with this section.
  • (i) The commissioner, in collaboration with the office of the health insurance commissioner, shall develop and implement a plan to educate providers and consumers regarding the rights of insured members and the responsibilities of carriers to promote compliance with this section. The plan shall include, but not be limited to, staff training and other education for hospitals, community health centers, school-based health centers, physicians, nurses and other licensed health care professionals, as well as administrative staff including, but not limited to:
  • (1) All staff involved in patient registration and confidentiality education; and
  • (2) Billing staff involved in processing insurance claims. The plan shall be developed in consultation with groups representing health care insurers, providers and consumers, including consumer organizations concerned with the provision of sensitive health care services.
  • (j) Nothing in this section shall supersede any general or special law related to the informed consent of minors.
  • SECTION 2. This act shall take effect upon passage.
  • WHEREAS, Confidentiality of personal medical information is integral to a patient's health and to the provider-patient relationship; and
  • WHEREAS, Patient confidentiality has been raised as a serious concern in the context of third-party billing for sensitive medical screenings and treatments; and
  • WHEREAS, Despite patient privacy protections in place at the state and federal level, separate billing requirements and common health insurance practices may put the confidentiality of patient information at risk when sensitive medical services are billed to a private insurer or Medicaid; and
  • WHEREAS, The confidentiality of patient information may be exposed due to third- party payers sending an Explanation of Benefits (EOB), which details medical services received by a patient, or other types of communications, to the primary policyholder instead of the dependent who received the care; and
  • WHEREAS, A dependent's information may be at risk without their knowledge or consent; and
  • WHEREAS, Minors who are accessing services to which, by law, they can consent to independently, as well as young adults and adults that are on their spouses' health insurance plan are greatly affected by this issue; and
  • WHEREAS,The Affordable Care Act allows dependents to stay on their parents' medical insurance coverage until age twenty-six; and
  • WHEREAS, Patients may delay or completely avoid getting sensitive medicalscreenings or treatments, for fear of their medical information being exposed, which could put them and others at risk; and
  • WHEREAS, Patients may delay or completely avoid getting mental health care because the policyholder might find out; and
  • WHEREAS, Patients that are victims of domestic violence may not seek treatment for their injuries because they may be at risk of experiencing retaliatory violence if their abuser receives a communication regarding their private medical information, such as an Explanation of Benefits; and
  • WHEREAS, Thirteen states have provisions that serve to protect the confidentiality of individuals insured as dependents; and
  • WHEREAS, Developing procedures and protocols to protect patient confidentiality and educating providers and patients about how to protect patient confidentiality could improve patient privacy and decrease the risk of exposing sensitive medical information without a patient's knowledge or consent; now, therefore be it
  • RESOLVED, That this Senate of the State of Rhode Island and Providence Plantations hereby respectfully requests the Rhode Island Department of Health to develop and promulgate rules and regulations to ensure the confidential communication of sensitive medical information; and be it further
  • RESOLVED, That the Rhode Island Department of Health may consult with the other state agencies to implement said regulations, as necessary, including, but not limited to, the Office of the Health Insurance Commissioner and The Office of the Attorney General; and be it further
  • RESOLVED, That this Senate hereby requests the Rhode Island Department of Health to finalize these rules and regulations and notify the Rhode Island Senate Committee on Health and Human Services of these rules and regulations on or before January 2, 2020; and be it further
  • RESOLVED, That the Secretary of State be and hereby is authorized and directed to transmit duly certified copies of this resolution to the Honorable Gina Raimondo, Governor of the State of Rhode Island, Nicole Alexander-Scott, MD, MPH, Director of the Rhode Island Department of Health, Marie L. Ganim, PhD, Health Insurance Commissioner, and the Honorable Peter Neronha, Rhode Island Attorney General.
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  • LC002063
  • LC002063/SUB A
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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
  • ***
  • This act would provide for the development of a common summary of payments forms, to be used by all health insurance carriers and to be provided to health care consumers, providing the consumer with their responsibility for payment, if any, of any portion of a health care provider claim.
  • This act would take effect upon passage. ======== LC002063 ========
  • LC002063/SUB A - Page 2of 2

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