Bill Description: Senate Bill 1319 would impose new regulations and billing limits on freestanding emergency rooms and micro-hospitals.
Rating: -4
Does it create, expand, or enlarge any agency, board, program, function, or activity of government? Conversely, does it eliminate or curtail the size or scope of government?
Senate Bill 1319 would create Chapter 67, Title 41, Idaho Code, titled the “Emergency Care Affordability Act.”
The primary function of the act is to require an “out-of-network freestanding emergency room that provides emergency services to a covered person” to “accept as payment in full the health benefit plan’s allowed amount for in-network providers of the same specialty or type for the same covered emergency service performed at an in-network facility.”
The act would give the Department of Insurance more authority over “freestanding emergency rooms” including verifying payment amounts, enforcing compliance through inquiries, and maintaining a public list of opting-in self-funded plans.
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Does it give government any new, additional, or expanded power to prohibit, restrict, or regulate activities in the free market? Conversely, does it eliminate or reduce government intervention in the market?
The act would assert government control over private billing and contractual arrangements by mandating what out-of-network providers must accept as payment, voiding certain private agreements, and prohibiting what it deems excess billing.
Specifically, it would prohibit out-of-network freestanding emergency rooms from billing above the “allowed amount” set by health benefit plans, void contractual provisions like balance billing waivers or assignments of benefits, and impose mandatory disclosures for non-participation in federal programs like Medicare and Medicaid.
The act would violate numerous constitutional principles, including due process, by interfering with freedom of contract—a core liberty—and effectively taking property rights in billing receivables without just compensation. Voiding private agreements and dictating payment terms restrict economic freedoms without a clear public necessity.
The act’s primary enforcement mechanism would be to make “any freestanding emergency room or health benefit plan” that violates the act “liable to pay the reasonable attorney’s fees and costs that the covered person or health plan incurs to challenge the provider’s or health benefit plan’s actions.”
It further says that “any billing by an out-of-network freestanding emergency room or any affiliated, related, or billing entity acting on its behalf to the covered person in violation of the provisions of this chapter shall be void and unenforceable.” And “an out-of-network freestanding emergency room shall be liable to a covered person for reasonable attorney’s fees and costs to defend against a provider’s attempts to collect amounts in excess of the amount for which the covered person is personally responsible pursuant to this chapter.”
“Each attempt to bill or collect amounts in violation of the provisions of this chapter shall constitute a separate violation.”
The law essentially weaponizes civil process to prevent the enforcement of contracts and the collection of debts pursuant to those contracts.
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Does it violate the principle of equal protection under the law? Examples include laws that discriminate or differentiate based on age, gender, or religion or which apply laws, regulations, rules, or penalties differently based on such characteristics. Conversely, does it restore or protect the principle of equal protection under the law?
The act’s regulations and mandates would apply only to freestanding emergency rooms, not to “critical access hospitals” or “a general acute care hospital operated as part of a multi-campus Idaho hospital system licensed pursuant to chapter 13, title 39, Idaho Code.”
The act does not create a uniform standard for emergency care medical billing, but instead specifically targets micro-hospitals and other specialty hospitals that operate under an out-of-network reimbursement strategy.
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Does it violate the principles of federalism by increasing federal authority, yielding to federal blandishments, or incorporating changeable federal laws into Idaho statutes or rules? Examples include citing federal code without noting as it is written on a certain date, using state resources to enforce federal law, and refusing to support and uphold the tenth amendment. Conversely, does it restore or uphold the principles of federalism?
The act incorporates federal law by reference in several places including the definition of “emergency services” (“a medical screening examination, as required pursuant to 42 U.S.C. 1395dd”); “freestanding emergency room” (a facility that “operates generally under an out-of-network reimbursement strategy and participates directly or indirectly in the federal independent dispute resolution process, whether in its own name or through any affiliated entity, pursuant to 42 U.S.C. 300gg-111”); and “stabilize” (“with respect to an emergency medical condition, has the same meaning as provided in 42 U.S.C. 1395dd(e)(3)”).
The definition of a “freestanding emergency room” would exclude facilities that are “designated as a critical access hospital under federal law.”
There are other references to “42 U.S.C. 1395dd” and the act would also apply to “a self-funded health plan, including a self-funded group health plan governed by the provisions of 29 U.S.C. 1001 et seq.”
These references allow the definitions in Idaho code to be altered by the federal government without any notice to either the legislature or the governed parties, potentially altering the scope and applicability of the act.
The act would also require the providers and facilities it governs to provide “clear and conspicuous disclosures” if they are not “enrolled as a participating provider in the medicare, medicaid, or TRICARE programs,” effectively creating a presumption of participation in these redistributive federal programs.
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