S629 Summary: Health Care Services Billing Transparency

• Establishes a "benchmark amount" for out-of-network health care services calculated as the lesser of: 100% of Medicare payment rates, the provider's actual charges, or the median contracted rate in the same geographic area.

• Prohibits health care providers and facilities from billing patients more than the benchmark amount for emergency services, out-of-network services at in-network facilities, or services referred without explicit written notice and consent.

• Requires health services facilities to provide written disclosures to patients at admission or scheduling explaining their liability limits, that nonparticipating providers may bill separately, and that benchmark amount payments foreclose additional billing.

• Defines health care providers' and facilities' obligations regarding balance billing and requires nonparticipating hospital-based providers to include statements on bills notifying patients of their limited cost-sharing responsibility.

• Makes willful violations of these billing and notice requirements actionable as unfair and deceptive trade practices under state law; effective October 1, 2017.