PROHIBIT CERTAIN HEALTH CARE FACILITY FEES

HHHC/HB 306
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AN ACT
RELATING TO HEALTH CARE; PROHIBITING HEALTH CARE FACILITY
FEES FROM BEING CHARGED FOR CERTAIN SERVICES; REQUIRING
DISCLOSURE OF FACILITY FEES TO PATIENTS AND REPORTING OF
FACILITY FEES TO THE ALL-PAYER CLAIMS DATABASE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. SHORT TITLE.--This act may be cited as the
"Fair Pricing for Routine Medical Care Act".
SECTION 2. DEFINITIONS.--As used in the Fair Pricing
for Routine Medical Care Act:
A. "affiliated with" means that a person is:
(1) employed by a hospital or health system;
or
(2) under a professional services agreement,
faculty agreement or management agreement with a hospital or
health system that permits the hospital or health system to
bill on behalf of the person;
B. "campus" means:
(1) a hospital's main buildings;
(2) the physical area immediately adjacent
to a hospital's main buildings;
(3) structures owned by a hospital that are
not strictly contiguous to the main buildings but are located
within two hundred fifty yards of the main buildings; or
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(4) any other area that has been determined
by the federal centers for medicare and medicaid services, on
an individual case-by-case basis, to be part of a hospital's
campus;
C. "facility fee" means a fee charged or billed by
a hospital or health system for outpatient hospital services
that is:
(1) intended to compensate the health system
or hospital for operational expenses; and
(2) separate and distinct from a
professional fee charged or billed by a hospital or health
system for professional medical services;
D. "freestanding emergency department" means a
facility licensed by the health care authority that is
separate from an acute care hospital and that provides
twenty-four-hour emergency care to patients at the same level
of care that a hospital-based emergency department delivers;
E. "health facility" means a health facility or
health agency required to be licensed by the health care
authority pursuant to the Health Care Code;
F. "health system" means a:
(1) parent corporation of one or more
hospitals and any person affiliated with the parent
corporation through ownership, governance, membership or
other means; or
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(2) hospital and any person affiliated with
the hospital through ownership, governance, membership or
other means;
G. "hospital" means a health facility that is
licensed by the health care authority as a hospital;
H. "preventive health care service" means a
service recommended by the United States preventive services
task force;
I. "rural" means a rural county or an
unincorporated area of a partially rural county, as
designated by the health resources and services
administration of the United States department of health and
human services; and
J. "telehealth" means the use of electronic
information, imaging and communication technologies,
including interactive audio, video, data communications and
store-and-forward technologies, to provide and support health
care delivery, diagnosis, consultation, treatment, transfer
of medical data and education when distance separates the
patient and the health care provider.
SECTION 3. LIMITATIONS ON CHARGES FOR CERTAIN HEALTH
CARE SERVICES PROVIDED IN CERTAIN SETTINGS.--
A. Except as provided in Subsection D of this
section, beginning January 1, 2027, a hospital or health
system shall not charge, bill or collect a facility fee
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directly from a patient for:
(1) preventive health care services provided
in an outpatient setting, including services accessed from
the patient's vehicle;
(2) vaccination services provided in an
outpatient setting, including services accessed from the
patient's vehicle; or
(3) telehealth services.
B. Nothing in this section prohibits a hospital or
health system from charging a facility fee for:
(1) health care services provided in an
inpatient setting;
(2) health care services provided at a
hospital emergency department; or
(3) health care services provided at a
freestanding emergency department.
C. Nothing in this section prohibits a hospital or
health system from charging, billing or collecting a facility
fee from a patient's insurer pursuant to an agreement between
the hospital or health system and the insurer or as required
by law.
D. The provisions of Subsection A of this section
shall not apply to a hospital or a hospital's clinic located
in a rural area.
E. Notwithstanding the provisions of Subsections
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B, C and D of this section, a hospital or health system shall
not charge, bill or collect a facility fee directly from a
patient who does not have health insurance coverage and is
provided the benefits of a health care service for which a
facility fee would otherwise be charged.
SECTION 4. BILLING TRANSPARENCY AND PATIENT
NOTIFICATION.--
A. Beginning January 1, 2027, a hospital or health
system that charges a facility fee shall:
(1) at the time an appointment is scheduled
and again at the time health care services are rendered,
provide notice to a patient that:
(a) discloses that a facility fee may
be charged;
(b) indicates the amount of the
facility fee;
(c) discloses that a facility fee may
not be covered in whole or in part by the patient's
insurance; and
(d) to the extent practicable, shall be
provided in the patient's preferred language;
(2) post a plainly visible sign written in
English and Spanish that states that a patient may or may not
be charged a facility fee in addition to the cost of a
professional fee. The sign shall:
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(a) include information on the types of
facility fees that the hospital or health system is
prohibited from charging under the Fair Pricing for Routine
Medical Care Act;
(b) disclose that patients who do not
have health insurance coverage are exempt from paying a
facility fee under the Fair Pricing for Routine Medical Care
Act;
(c) be located within the health
facility in an area where patients seeking care register or
check in; and
(d) include information on where a
patient may inquire further about facility fees; and
(3) provide patients with a standardized
bill that:
(a) is clear, consumer-friendly and, to
the extent practicable, in the patient's preferred language;
(b) includes itemized charges for each
health care service provided;
(c) specifically identifies any
facility fee charged;
(d) identifies specific charges that
have been billed to the patient's insurance; and
(e) provides contact information for a
person the patient may contact to contest charges in the
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bill.
B. If a patient, after receiving notice pursuant
to Paragraph (1) of Subsection A of this section and before
services are rendered, declines, cancels or reschedules an
appointment because the facility fee is too high or may not
be covered by the patient’s insurance plan, the hospital or
health system shall not impose a cancellation fee, no-show
fee or other penalty for that appointment.
SECTION 5. FACILITY FEE REPORTING.--A hospital or
health system that charges a facility fee shall report data
related to the facility fee to the all-payer claims database
established pursuant to the Health Information System Act.
The data shall include the following information for services
provided by a hospital in inpatient settings and outpatient
settings and in locations on the hospital's campus and off
the hospital's campus during each of the three previous
calendar years:
A. the number of times facility fees were charged
to patients;
B. the total dollar amount of facility fees
charged to patients;
C. the twenty-five most common billing codes for
which a facility fee was charged and the total amount charged
to patients for each of those codes;
D. the twenty-five billing codes with the highest
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average patient charges and the total amount charged to
patients for each billing code; and
E. any other data required by the department of
health to assess the prevalence and cost of facility fees in
the state.