HB 5770

HOUSE BILL NO. 5770
A bill to regulate the use of facility fees by certain
health care providers; and to provide remedies.
the people of the state of michigan enact:
Sec. 1. As used in this
act:
(a) "Emergency room" means
a specialized area in which immediate medical evaluation, treatment, and
stabilization is provided to an individual with an acute illness or an injury
that may be life threatening, limb threatening, or time critical.
(b) "Facility fee" means
a fee that meets all of the following:
(i)
The fee is charged or billed by a health care
provider.
(ii)
The fee is intended to compensate the health
care provider for the operational expenses of the health care provider.
(iii)
The fee is separate and distinct from a professional fee.
(c) "Freestanding emergency
facility" means an emergency room that is not physically connected to a
hospital and that performs laboratory tests, ultrasounds, computerized
tomography scans, and other tests and procedures that are performed in an
emergency room of a hospital.
(d) "Health care
provider" means a health facility or a health
professional.
(e) "Health facility"
means a health facility or agency as that term is defined in section 20106 of
the public health code, 1978 PA 368, or any other organized entity that
provides health care to patients, including, but not limited to, a health
system, a hospital-based facility, a freestanding emergency facility, or an
urgent care clinic.
(f) "Health professional"
means an individual who is licensed, registered, or authorized to engage in a
health profession under article 15 of the public health code, 1978 PA 368, MCL
333.16101 to 333.18838, but not including a dentist, dental hygienist, or
dental assistant under part 166 of the public health code, 1978 PA 368, MCL
333.16601 to 16659, or a veterinarian or veterinary technician under part 188
of the public health code, 1978 PA 368, MCL 333.18801 to 18838.
(g) "Health system" means
any of the following:
(i) A
parent corporation of 1 or more hospitals.
(ii)
An entity affiliated with a parent corporation of 1 or more hospitals through
ownership, governance, membership, or other means.
(iii)
A hospital and an entity affiliated with the hospital.
(h) "Hospital"
means a hospital licensed under article 17 of
the public health code, 1978 PA 368, MCL 333.20101 to
333.22260.
(i) "Hospital-based
facility" means a facility that meets both of the following requirements:
(i)
The facility is owned or operated, in whole or in part, by a hospital.
(ii) A
hospital service or professional medical service is provided in the facility.
(j) "Hospital's campus"
means any of the following:
(i)
The physical area that is immediately adjacent to a hospital's main building
and any other area or structure that is not strictly contiguous to the
hospital's main building but is located within 250 yards of the main building.
(ii)
An area that the Centers for Medicare and Medicaid Services has determined, on
an individual basis, to be part of the campus of a hospital.
(k) "Observation" means a
service furnished by a hospital on the hospital's campus that includes, regardless
of length of stay, the use of a bed and periodic monitoring by the hospital's
staff, to evaluate an outpatient's condition or to determine the need to admit
an individual to the hospital as an inpatient.
(l)
"Off-campus hospital-based facility" means a hospital-based facility that
is not located on the hospital's campus.
(m) "Professional
fee" means a fee that is charged or
billed by a health care provider for a professional
medical service provided in a hospital, the hospital's campus, or an off-campus
hospital-based facility.
(n) "Telemedicine" means
that term as defined in section 3476 of the insurance code of 1956, 1956 PA
218, MCL 500.3476.
Sec. 3. Beginning January 1, 2027, a health care provider shall not charge, bill, or collect a facility fee for any of the following:
(a) A professional medical service
provided through telemedicine.
(b) A professional medical service
that is provided to a patient in a facility that is not a hospital.
(c) A professional medical service
that is provided to a patient who is receiving an outpatient service in a
hospital unless either of the following applies:
(i)
The outpatient service is provided in an emergency room of the hospital.
(ii)
The outpatient service is observation.
Sec.
4. Both of the following apply to a health care provider that charges, bills,
or collects a facility fee under this act:
(a) The health care provider shall
identify the fee as a facility fee on the billing statement.
(b) The health care provider shall
inform the patient before the professional medical service is provided that the
patient will be charged a facility fee and the amount of the facility fee.
Sec. 5. (1) A person
aggrieved by a violation of section 3 or 4 may
bring a civil action for damages against the health
care provider.
(2) A court shall award reasonable costs and attorney fees to
a plaintiff who prevails in an action brought under this section.
Sec.
7. This act does not prohibit an insurer as that term as defined in section 106
of the insurance code of 1956, 1956 PA 218, MCL 500.106, from entering into an
agreement with a health system for the payment of fees or costs considered
appropriate by the insurer and the health system.