Amendment S-5039 to SF 2381

Filed March 4, 2024 in the Senate by Sen. Jeff Edler (R)

What it changes

1. Page 1, line 4, by striking “514M.1” and inserting “514M”
2. Page 1, by striking lines 23 through
4. Page 2, by striking lines 1 through
6. Page 2, line 18, by striking “
7. ” and inserting “
8. ”
9. Page 2, after line 22 by inserting: “
10. “Covered benefits” or “benefits” means health care services that a covered person is entitled to under the terms of a health benefit plan.”
11. Page 2, by striking lines 23 and 24 and inserting: “
12. “Covered person” means a policyholder, subscriber, enrollee, or other individual participating in a health benefit plan.”
13. Page 2, by striking lines 25 through
15. Page 2, line 33, by striking “
16. ” and inserting “
17. ”
18. Page 3, by striking lines 1 and 2 and inserting: “
19. “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.”
20. Page 3, line 3, by striking “
21. ” and inserting “
22. ”
23. Page 3, by striking lines 12 and 13 and inserting: “
24. “Health care services” means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.”
25. Page 3, by striking lines 14 and 15 and inserting: “
26. a. “Health carrier” means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, a plan established pursuant to chapter 509A for public employees, or any other entity providing a plan of health insurance, health care benefits, or health care services. b. For purposes of this chapter, “health carrier” does not include an entity providing any of the following: (1) Coverage for accident-only, or disability income insurance. (2) Coverage issued as a supplement to liability insurance. (3) Liability insurance, including general liability insurance and automobile liability insurance. (4) Workers’ compensation or similar insurance. (5) Automobile medical-payment insurance. (6) Credit-only insurance. (7) Coverage for on-site medical clinic care. (8) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance coverage or benefits. c. For purposes of this chapter, “health carrier” does not include an entity providing benefits under a separate policy including any of the following: (1) Limited scope dental or vision benefits. (2) Benefits for long-term care, nursing home care, home health care, or community-based care. (3) Any other similar limited benefits as provided by the commissioner by rule. d. For purposes of this chapter, “health carrier” does not include an entity providing benefits offered as independent noncoordinated benefits including any of the following: (1) Coverage only for a specified disease or illness. (2) A hospital indemnity or other fixed indemnity insurance. e. For purposes of this chapter, “health carrier” does not include an entity providing a Medicare supplemental health insurance policy as defined under section 1882(g)(1) of the federal Social Security Act, coverage supplemental to the coverage provided under 10 U.S.C. ch. 55, and similar supplemental coverage provided to coverage under group health insurance coverage.”
27. Page 3, line 16, by striking “
28. ” and inserting “
29. ”
30. Page 3, line 18, by striking “
31. ” and inserting “
32. ”
33. Page 3, line 34, after “individuals.” by inserting “A health care provider may satisfy the requirements of this paragraph by complying with the centers for Medicare and Medicaid services of the United States department of health and human services hospital price transparency final rule published in the federal register on November 22,
34. ”
35. Page 4, by striking lines 6 through 21 and inserting: “c. (1) Prior to the provision of a scheduled health care service, a health care provider shall inform all covered persons and uninsured individuals of the right of the covered person or uninsured individual to pay for a health care service via the discounted cash price. The notice may be provided electronically, verbally, in writing, or posted at the physical location of the health care provider. (2) Prior to the provision of a scheduled health care service, a health care provider shall inform a covered person that the covered person may qualify for a deductible credit if the covered person pays the discounted cash price for the health care service and if the discounted cash price is below the average allowed amount paid by the health carrier to network providers for a comparable health care service. The notice may be provided electronically, verbally, in writing, or posted at the physical location of the health care provider.”
36. Page 4, after line 27 by inserting: “e. A health carrier shall not enter into a contract with a health care provider that prohibits the health care provider from offering a discounted cash price below the contracted rates the health care provider has with a health carrier, or that prohibits the health care provider from disclosing the health care provider’s discounted cash price under paragraph “b” .”
37. Page 4, line 28, by striking “e.” and inserting “f.”
38. Page 4, line 30, by striking “health care provider” and inserting “pharmacist”
39. Page 4, by striking line 32 and inserting “point the pharmacist fills a prescription drug”
40. Page 4, line 34, by striking “f.” and inserting “g.”
41. Page 7, by striking lines 5 through
43. Page 8, by striking lines 4 through
45. Page 9, by striking lines 1 and 2 and inserting: “
46. This chapter shall not be construed to prohibit a health care”
47. Page 9, line 9, by striking “
48. ” and inserting “
49. ”
50. Page 9, line 26, by striking “2025” and inserting “2026”
51. Title page, by striking line 2 and inserting “services.”

Official amendment (PDF) · In the Bill Book