SB122
To Create The Healthcare Cost-sharing Collections Act.
Last Action (May 1, 2023): Sine Die adjournment
Sponsors
AI-Generated Summary
Senate Bill 122, titled the 'Healthcare Cost-Sharing Collections Act,' establishes a new legal framework for how healthcare insurers collect cost-sharing amounts, such as deductibles and copayments, from enrollees. The bill mandates that healthcare insurers are solely responsible for collecting these cost-sharing amounts from enrollees and must pay healthcare providers the full amount due for services rendered, without withholding any cost-sharing portions. Insurers are prohibited from requiring providers to offer additional discounts outside of their contracts or canceling an enrollee’s plan for failure to collect cost-sharing. Additionally, the bill requires that the value of copay assistance programs be applied toward an enrollee’s annual cost-sharing requirements. It stipulates that insurers cannot use the costs of implementing these requirements as a justification for increasing premiums or decreasing provider payments. Violations of these provisions are classified as deceptive acts under the state's Trade Practices Act, subjecting insurers to enforcement by the Insurance Commissioner.
Potential Impact Analysis
Who Might Benefit?
Healthcare providers are the primary beneficiaries, as the bill ensures they receive full payment for services upfront without having to manage the administrative and financial burden of collecting deductibles, copayments, and coinsurance from patients. Enrollees may also benefit through the provision that requires insurers to accept copay assistance toward their cost-sharing requirements and the option to pay cost-sharing amounts in increments throughout the plan year.
Who Might Suffer?
Healthcare insurers and contracting entities would be the primary groups negatively impacted, as the bill imposes new, significant administrative and financial responsibilities on them by mandating that they take sole control of cost-sharing collections. Insurers may face increased operational costs to manage these collections and the potential risk of uncollected debt from enrollees, while being explicitly restricted from passing these implementation costs on to consumers via increased premiums or to providers via reduced payments.
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