2. Notifying patients when a transfer of ownership creates a hospital-based facility
Beginning January 1, 2016 when ownership of an outpatient facility transfers to a new owner and creates a hospital-based facility that may bill patients a facility fee, the purchaser (likely a hospital or health system) needs to notify patients who previously used that physician practice or outpatient office location. The written notice must be sent to each patient that received a service at the facility or office within the past three years; and the written notice must be sent within 30 days of the change of ownership.
The notice must include information about how the facility is now a hospital-based facility and is part of a hospital or health system and that facility fees may apply. The notice must also explain that the facility fee is in addition to, and separate from, any professional fee billed; that the patient may incur financial liability; an estimated amount of the facility fee; and a statement advising patients to contact their insurance plan for coverage information.
For example, if a physician-owned surgery center is purchased by a hospital, then the hospital needs to send a notice to all of the patients that previously used the physician-owned outpatient surgery center for the past three years and provide the information that is outlined above. The volume of physician practices and other outpatient services the hospital or health system is pursuing will determine the level of work involved with the implementation of this requirement.
This written notice also needs to be provided to the Office of Health Care Access ("OHCA"), and the agency will post it on the OHCA website. A hospital, health system or hospital-based facility cannot collect a facility fee for services at a hospital-based facility (subject to this subsection) until at least 30 days after the written notice is mailed to the patient or a copy is filed with OHCA, whichever is later. A violation of this subsection is considered an unfair trade practice.
3. Charging no facility fee for certain outpatient services and limiting fees for the uninsured
The most significant change created by this law is that beginning January 1, 2017, no hospital, health system or hospital-based facility can collect a facility fee for many outpatient office visits. Also, the law states that facility fees charges for uninsured individuals cannot be more than the Medicare rate.
The new law does not allow any facility fee to be charged for outpatient services that use a CPT evaluation and management code when that service is provided at a hospital-based facility. This prohibits the facility fee to be charged for many of the services provided at physician practices that are owned and operated by a hospital or health system. For example, CPT codes 99201 to 99205 and 99211 to 99215; and other E&M codes as per the CPT. This requirement does not apply to services provided at remote emergency departments not located on the hospital campus.
As patients are being required to pay out-of-pocket for more of their healthcare services because of health plan designs, this provision reduces the amount of money a patient incurs. On the other hand, hospitals and health systems use the revenue generated by these facilities fees to defray their expenses related to the high cost of providing the infrastructure necessary to coordinate patient care in response to federal health care reform initiatives. Many of the strategic decisions hospitals and health systems have made were based on receiving facility fees to operate the outpatient facilities so the long-term impact on access to these services will need to be examined.
4. Reporting facility fee data to OHCA
Because the common theme during the 2015 legislative session surrounded the issue of transparency, the Connecticut lawmakers went one step further to request from hospital-based facilities, detailed data related to the revenue generated and how many patients are impacted by the facility fees. Each hospital and health system will need to report several pieces of data related to the facility fee charged, billed and collected. These data items are listed in the color panel below.