1Requiring a hospital to provide notice to a patient of the
2patient's outpatient status, <-billing implications and the
3impact of the outpatient status on insurance coverage.

4The General Assembly of the Commonwealth of Pennsylvania
5hereby enacts as follows:

6Section 1. Short title.

7This act shall be known and may be cited as the Hospital
8Observation Status Consumer Notification Act.

9Section 2. Definitions.

10The following words and phrases when used in this act shall
11have the meanings given to them in this section unless the
12context clearly indicates otherwise:

13"Hospital emergency room." An entity within a hospital which
14is organizationally distinct from other outpatient facilities
15and whose primary function is to provide emergency accident and
16emergency medical or surgical care.

1Section 3. Patient notice of observation services.

2(a) Duty.--<-Within 90 days of the effective date of this 
3section, a hospital shall provide oral and written notice to a 
4patient of the patient's outpatient status, the billing 
5implications of the outpatient status and the impact of the 
6outpatient status on the patient's Medicare, Medicaid and 
7private insurance coverage for the current hospital services, 
8including medications and other pharmaceutical supplies and 
9coverage for a subsequent discharge to a skilled nursing 
10facility or home-based and community-based care <-A hospital shall 
11provide notice to a patient or patient's designee of the 
12patient's outpatient status, and information that provides a 
13general description of outpatient observation status, if all of
14the following apply:

15(1) The patient receives onsite services from the
16hospital for more than 23 consecutive hours.

17(2) The onsite services received by the patient include
18a hospital bed and meals that have been provided in an area
19of the hospital other than the hospital emergency room.

20(3) The patient has not been formally admitted as an
21inpatient at the hospital.

<-22(b) Contents.--The notice under subsection (a) shall include
23disclosure of the cost and ramification of the patient's status
24under subsection (a) and the patient's rights of appeal in
25regard to outpatient status.

26(c) Signature.--The written notice must be signed by the
27patient or the patient's legal representative to acknowledge
28receipt. The written notice must also be signed by the staff
29person who communicates the patient's status.

30Section 4. Training.

1A hospital shall provide training to each staff person that
2communicates outpatient status, billing implication of the
3outpatient status and the impact of the outpatient status on the
4patient's eligibility for Medicare so that a staff person can
5adequately respond to inquiries regarding the communication made
6by a patient and the patient's family.

<-7(b) Contents.--A patient notice required under subsection
8(a) shall include a statement that:

9(1) outpatient observation status may impact coverage
10determinations made by the Federal Medicare Program or the
11patient's insurance company for hospital and posthospital
12payments;

13(2) final decisions related to outpatient observation
14status can be made after a patient is no longer a patient at
15the hospital and after a patient has received hospital
16services or other services; and

17(3) a patient should contact Medicare, Medicaid or any
18other insurance provider if the patient has specific
19questions about the coverage.

20(c) Information.--A hospital shall provide information to a
21patient concerning observation status as follows:

22(1) by written notice; and

23(2) by oral notice, which must include a summary of the
24notice provided under paragraph (1) or, at the request of the
25patient, the notice provided under paragraph (1).

26Section 4. Change in status.

27If, during or after a patient receives a hospital service, a
28patient's inpatient stay is later recategorized, a hospital
29shall not be responsible for a coverage implication or notice
30requirement under this act.

1Section 5. Expiration.

2(a) Notice.--If the Federal Government amends 42 CFR
3409.30(a)(1) (relating to basic requirements) to eliminate or
4modify the Medicare three-day qualifying hospital stay
5requirement in a manner that makes the notification required
6under section 3 unnecessary, the Secretary of Health shall
7submit notice of the amendment for publication in the
8Pennsylvania Bulletin.

9(b) Time.--This act shall expire upon publication of the
10notice under subsection (a).

11Section 40. Effective date.

12This act shall take effect <-July 1, 2014, or immediately, 
13whichever is later <-in 180 days.