Budget Amendment ID: FY2015-S4-165

GOV 165

Confidentiality for Patient Dependents

Ms. Spilka and Mr. Lewis moved that the proposed new text be amended moved that the bill be amended to amend the bill by inserting, after section __, the following new section:-

"Chapter 176O of the General Laws is hereby amended by striking out section 27 and inserting in place thereof the following:-

Section 27. (a) The division shall develop a common summary of payments form to be used by all health care payers in the commonwealth that is provided to health care consumers with respect to provider claims submitted to a payer and 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; provided that the division shall allow the development of forms to be exchanged through electronic means. The division shall consult with stakeholders to develop these forms.

(b) Carriers shall issue common summary of payments forms at the member level for all insureds. Carriers shall permit an insured to choose his or her preferred method of receiving the common summary of payments form, which shall include, but not be limited to, the following: (1) sending the form to the address of the subscriber; (2) sending the form to the address of the insured dependent; (3) sending the form to an alternate address upon request of the insured; or (4) sending the form through electronic means when available. The preferred method of receipt shall be valid until the insured submits a new preferred method.

(c) Unless specifically requested by the insured, a carrier shall not provide a common summary of payments form if the insured has no liability for payment for any procedure or service, including, but not limited to, the United States Preventive Services Taskforce recommended A and B preventive services.

(d) Carriers shall not specifically identify the diagnostic descriptions for sensitive health care services in a common summary of payment form. The division shall define by regulation sensitive health care services for purposes of this section. The division shall refer to 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 use disorders, in promulgating the definition.

(e) Upon the request of an insured, the carrier shall not issue a common summary of payments form.  The request may be made either orally or by written communication. Carriers shall not require an explanation as to the basis for an insured’s request.

(f) The availability of an insured to make a request that a summary of payment form not be issued pursuant to subsection (e) shall be communicated in plain language and in a clear and conspicuous manner to all insureds, including insured dependents, in evidence of coverage documents, member privacy communications and on every summary of payments form.  The request shall be valid until the insured submits a revocation of the request.

(g) The division shall promulgate regulations necessary to implement this section."