Bill > H0506

This bill establishes the No Surprises Act to protect patients from surprise billing practices by out-of-network medical providers. The key provisions are: 1. Out-of-network providers who provide emergency services at in-network facilities must accept the health plan's in-network allowed amount as full payment, and cannot bill the patient for any amounts beyond the patient's cost-sharing responsibility. 2. For post-emergency or non-emergency services provided by out-of-network providers at in-network facilities, the providers must also accept the health plan's in-network allowed amount as full payment, with the same restrictions on billing the patient. 3. The patient's cost-sharing responsibility is calculated based on the health plan's in-network benefit design. 4. Out-of-network providers can only bill and seek reimbursement above the allowed amounts if they have a separate agreement with the patient that meets specific requirements, such as being signed at least 5 days in advance. 5. The provisions apply to self-funded group health plans if they elect to participate by notifying the state insurance director. 6. Violations can result in the provider being liable for the patient's reasonable attorney's fees and costs.

Health and Social Services, Justice

Health and Welfare Committee (House)

https://legislature.idaho.gov/sessioninfo/2020/legislation/H0506/