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Legislative Year: 2022 Change
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Bill Detail: HB22-1284

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Title Health Insurance Surprise Billing Protections
Status Signed by the President of the Senate (06/06/2022)
Bill Subjects
  • Health Care & Health Insurance
  • Insurance
House Sponsors D. Esgar (D)
M. Catlin (R)
Senate Sponsors B. Pettersen (D)
R. Gardner (R)
House Committee Health and Insurance
Senate Committee Health and Human Services
Date Introduced 03/08/2022
Summary

The bill changes current state law to align with the federal No
Surprises Act (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 unless
specific criteria are met;
  • 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;
  • Allowing administrators of self-funded health benefit plans
to elect to be subject to state law concerning coverage for
health-care services from out-of-network providers and
facilities;
  • Authorizing the commissioner to promulgate rules to
implement the requirements of the 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 to 90 days after the date an in-network
provider is terminated from a plan without cause;
  • 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; and
  • 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.
The bill 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.

Committee Reports
with Amendments
Full Text
Full Text of Bill (pdf) (most recent)
Fiscal Notes Fiscal Notes (04/27/2022) (most recent)  
Additional Bill Documents Bill Documents
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  • Past fiscal notes
  • Committee activity and documents
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