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.
2019-03-14: Introduced, referred to Senate Health and Human Services
2019-04-05: Scheduled for hearing and/or consideration (04/09/2019)
2019-04-09: Committee recommended measure be held for further study
2019-04-10: Committee recommended measure be held for further study
2019-06-21: Scheduled for consideration (06/25/2019)
2019-06-24: Proposed Substitute
2019-06-25: Committee recommends passage of Sub A
2019-06-25: Placed on the Senate Consent Calendar (06/26/2019)
2019-06-26: Senate passed Sub A
Changes since original draft
2019 – S 0580
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
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.
BY THE LEGISLATIVE COUNCIL
A N A C T
RELATING TO INSURANCE – HEALTH CARE ACCESSIBILITY AND QUALITY
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 ========
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