SB626: SB626 'Georgia Medical Debt Fairness Act'; enact

26 LC 52 1076 Senate Bill 626 By: Senator Hufstetler of the 52nd A BILL TO BE ENTITLED AN ACT To amend Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to1 regulation and construction of hospitals and other health care facilities, so as to provide for2 certain consumer financial assistance and protections with rega rd to medical debt arising3 from certain healthcare services received by patients at hospitals; to provide a short title; to4 provide definitions; to provide for the Department of Community Health to publish on its5 website a uniform sample financial assistance policy, screening tool, and application form;6 to provide for hospital implementation; to provide for requirem ents prior to billing; to7 provide for compliance; to provide for copayments and deductibles; to provide for notice on8 hospital bills; to provide for an appeal of financial assistanc e eligibility or charity care9 determination; to provide for incorrect determination protectio ns; to prohibit certain10 financing products; to provide for payment plans; to prohibit debt collection under certain11 circumstances; to provide for enforcement; to provide for rules and regulations; to provide12 for related matters; to repeal conflicting laws; and for other purposes.13 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:14 S. B. 626 - 1 - 26 LC 52 1076 SECTION 1.15 Chapter 7 of Title 31 of the Official Code of Georgia Annotated, relating to regulation and16 construction of hospitals and other health care facilities, is amended by adding a new article17 to read as follows:18 "ARTICLE 1719 31-7-450.20 This chapter shall be known and may be cited as the 'Georgia Medical Debt Fairness Act.'21 31-7-451.22 As used in this article, the term:23 (1) 'Debt collector' means any person that regularly collects or attempts to collect,24 directly or indirectly, debts for another person or entity or uses some name other than its25 own when collecting debts.26 (2) 'Emergency medical services' means physical or mental health care services rendered27 for a medical or traumatic condition, sickness, or injury, incl uding a mental health28 condition or substance use disorder, in which a person is exhibiting acute symptoms of29 sufficient severity, including, but not limited to, severe pain , regardless of the initial,30 interim, final, or other diagnoses that are given, that would l ead a prudent layperson31 possessing an average knowledge of medicine and health to belie ve that his or her32 condition, sickness, or injury is of such a nature that failure to obtain immediate medical33 care could result in:34 (A) Placing the patient's health in serious jeopardy;35 (B) Serious impairment to bodily functions; or36 (C) Serious dysfunction of any bodily organ or part.37 S. B. 626 - 2 - 26 LC 52 1076 (3) 'Healthcare services' means services for the diagnosis, pr evention, treatment, cure,38 or relief of a physical, mental, or behavioral health condition, illness, injury, or disease,39 including mental health and substance abuse disorders. Such te rm includes but is not40 limited to emergency medical services or nonemergency medical s ervices and the41 provision of pharmaceutical products or services and durable medical equipment or other42 devices.43 (4) 'Hospital' means a publicly or privately owned hospital li censed pursuant to this44 chapter. Such term includes any hospital, nonprofit hospital, or hospital owned or45 operated by a hospital authority or a nonprofit corporation formed, created, or operated46 by or on behalf of a hospital authority.47 (5) 'Medical debt' means an amount owed by a patient to a hosp ital for healthcare48 services received at the hospital or to the hospital's agent or assignee.49 31-7-452.50 (a) No later than January 1, 2027, the department shall create and post in a prominent51 location on its website a uniform sample financial assistance p olicy, screening tool, and52 application form for hospital implementation pursuant to this article.53 (b) The uniform financial assistance policy under subsection (a) of this Code section shall54 include but not be limited to:55 (1) Eligibility criteria for financial assistance and whether such assistance includes56 discounted or charity care;57 (2) The basis for calculating amounts charged to patients;58 (3) The method for applying for financial assistance;59 (4) The actions that may be taken in the event of nonpayment; and60 (5) The information obtained from sources other than an indivi dual seeking financial61 assistance that a hospital may use and whether and under what circumstances a hospital62 S. B. 626 - 3 - 26 LC 52 1076 may use prior eligibility determinations to presumptively deter mine that a patient is63 eligible for financial assistance.64 (c) Each hospital shall implement financial assistance policies, screening tools, application65 forms, and procedures that comply with this article. Any such policy shall apply to all66 healthcare services received by a patient at the hospital, unless such services were provided67 by an independent healthcare provider that bills separately fro m such hospital. The68 implementation required by this subsection shall apply whether or not a hospital is required69 to develop a financial assistance policy under 26 U.S.C. Sectio n 501(r)(4) and70 implementing regulations.71 31-7-453.72 (a) All hospitals, prior to billing a patient receiving healthcare services at such hospital,73 shall:74 (1) Screen the patient for financial assistance eligibility us ing a screening tool as75 provided for in Code Section 31-7-452; provided, however, that such patient may decline76 to provide information to the hospital;77 (2) Provide the patient with a financial assistance application form as provided for Code78 Section 31-7-452 and offer to assist in completing such form; p rovided, however, that79 such patient may decline to complete such form;80 (3) Automatically enroll any such patient who qualifies for financial assistance; and81 (4) Automatically apply any discounts available to any such patient.82 (b)(1) No hospital shall deliver any bill to a patient receiving healthcare services at such83 hospital prior to complying with the requirements provided for in subsection (a) of this84 Code section. A hospital shall be deemed compliant with paragraph (1) of subsection (a)85 of this Code section if the hospital has screened the patient f or financial assistance86 eligibility, has updated financial assistance eligibility information on the patient at least87 S. B. 626 - 4 - 26 LC 52 1076 once within the calendar year, or has documented that the patient has declined to provide88 information to the hospital.89 (2) The prohibition provided for in this subsection shall not preclude a hospital from90 collecting any copayment or deductible at the time of providing a healthcare service.91 (c) Each bill sent to a patient receiving healthcare services at a hospital shall include notice92 of the availability of financial assistance, the contact inform ation for the office or93 department of the hospital that can provide information about o btaining financing94 assistance, and a link to the financial assistance policy for such hospital.95 (d) A patient may apply for financial assistance or charity care if such patient was screened96 for eligibility and found not to be eligible or was screened and found to be eligible but such97 patient disagrees with the amount of charity care.98 (e) If a hospital makes an incorrect financial assistance eligibility determination based on99 information provided by the patient or available to the hospita l at the time of such100 determination, such hospital shall:101 (1) Credit to such patient's account the amount of charity car e for which the patient102 qualified and reimburse any other associated reasonable costs incurred by the patient in103 securing charity care, including but not limited to reasonable legal expenses and fees; and104 (2) If such hospital transferred such patient's medical debt t o a debt collector or105 authorized a debt collector to collect such debt on behalf of t he hospital, such hospital106 shall notify such debt collector that such medical debt is no longer valid.107 31-7-454.108 (a) No hospital shall offer financing products, including but not limited to consumer credit109 cards or installment loans, to a patient for medical debt arisi ng from healthcare services110 provided at such hospital if such products include an interest rate greater than 1 percent of111 such medical debt.112 S. B. 626 - 5 - 26 LC 52 1076 (b) A hospital may offer a payment plan to a patient for medic al debt arising from113 healthcare services provided at such hospital only after the hospital is in compliance with114 all provisions in subsection (a) of Code Section 31-7-453 and exhausts all other coverage115 and payment options available for such patient; provided, however, that no such payment116 plan shall result in fees, late charges, maintenance charges, o r interest rate greater than117 1 percent of the medical debt for the duration of the medical debt.118 31-7-455.119 (a) No hospital shall pursue collections against a patient for medical debt arising from120 healthcare services provided to such patient at such hospital unless the hospital complies121 with all provisions in subsection (a) of Code Section 31-7-453 and exhausts all other122 coverage and payment options available for the patient.123 (b) No hospital shall pursue collections against a patient for medical debt arising from124 healthcare services provided to such patient at such hospital while the patient is appealing125 insurance coverage, applying for financial assistance, applying for charity care, appealing126 a determination regarding eligibility for or the amount of char ity care, negotiating a bill127 within such medical debt, or participating in a payment plan offered by the hospital.128 31-7-456.129 The department shall enforce this article and promulgate rules and regulations required to130 administer this Code section."131 SECTION 2.132 All laws and parts of laws in conflict with this Act are repealed.133 S. 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