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Bill

S 8039

Prohibits hospitals, health systems, and health care providers from charging facility fees that are not covered by the patient's health insurance carrier

2025 Regular Session Introduced by Gustavo Rivera

Prohibits hospitals, health systems, and providers from charging facility fees not covered by a patient's insurer, protecting patients from surprise, unaffordable charges.

REFERRED TO HEALTH
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WeVote Research Nonpartisan
Bill Summary · S 8039

Summary of S 8039

Overview

  • Bill Number: S 8039
  • Title: Prohibits hospitals, health systems, and health care providers from charging facility fees that are not covered by the patient's health insurance carrier
  • Sponsor: Gustavo Rivera (primary)
  • Status: REFERRED TO HEALTH (as of introduction)
  • Introduced: May 15, 2025
  • Legislative Actions:
    • 2025-05-15: REFERRED TO HEALTH
    • 2025-05-15: REFERRED TO HEALTH (duplicate entry)
  • Related Bill (Companion): A 5342 (assembly)

What the bill would do (purpose)

The bill seeks to prohibit certain charges known as facility fees by hospitals, health systems, and health care providers if those fees are not covered by the patient’s health insurance carrier. In other words, it aims to limit or prohibit charging facility fees that fall outside what the patient’s insurer would pay or reimburse.

Key provisions (as indicated by the bill’s title and status)

  • Prohibition on facility fees: Hospitals, health systems, and health care providers would be barred from charging facility fees that are not covered by a patient’s health insurance.
  • Scope: Applies to hospitals, health systems, and health care providers (the exact definitions of these terms would be set forth in the bill’s text).
  • Coverage mechanics: The bill would regulate how facility fees are assessed in relation to a patient’s health insurance coverage (specific definitions, timing, and enforcement would be defined in the enacted text).
  • Enforcement and penalties: The available summary does not specify enforcement mechanisms or penalties; these would be addressed in the full bill language.

Note: The exact statutory definitions (e.g., what qualifies as a “facility fee”) and any exemptions, exceptions, or enforcement details are not provided in the summary available here.

Who would be affected

  • Patients: Potential protection from being charged facility fees that are not covered by their insurance.
  • Hospitals, health systems, and health care providers: Subject to the prohibition and any related compliance requirements.
  • Health insurers / payers: Their coverage decisions and claims processing would interact with the prohibition, depending on how “covered by insurance” is defined.
  • Health policy and regulatory bodies: May be involved in implementing, monitoring, and enforcing the provision.

Procedural and timeline aspects

  • Introduction date: May 15, 2025.
  • Current status: Referred to the Health committee for consideration. No further actions (as listed) beyond referral.
  • Process note: A companion bill exists in the Assembly (A 5342), indicating parallel consideration in the Assembly chamber.

Potential impact and considerations

  • Consumer protection: Could reduce surprise or balance-billing-like charges related to facility fees.
  • Hospital and provider operations: May require changes to billing practices and cost-shifting strategies; could affect revenue streams tied to facility fees.
  • Implementation details: Success depends on how clearly facility fees are defined, what is considered “covered by the patient’s health insurance carrier,” and what enforcement mechanisms are established.
  • Next steps: Await committee review, potential amendments, and legislative action on both the Senate (S 8039) and its companion Assembly bill (A 5342).

If you’d like, I can tailor this summary to a specific audience (e.g., patients, health system administrators) or incorporate any available text from the bill for more precise provisions.

Compiled from official sources — confirm details with the bill’s official record.

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