§ 2502J. Definitions.
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/de/title-6/2502jA research copy — for the controlling text, always check the official state or federal source. Not legal advice.
For purposes of this chapter:
(1)“Consumer” means an individual and excludes nonhuman entities.
(2)“Consumer reporting agency” means any person, which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties.
(3)“External review” means a review of an adverse benefit determination (including a final internal adverse benefit determination) conducted pursuant to any applicable state external review process, a federal external review process as described at 42 U.S.C. § 300gg-19, a review pursuant to 29 U.S.C. § 1133, a Medicare appeals process, a Medicaid appeals process, or another applicable appeals process.
(4)“Extraordinary collection action” means any of the following:
a. Selling an individual’s debt to another party, except if, prior to the sale, the medical creditor has entered into a legally binding written agreement with the medical debt buyer of the debt under which all of the following apply:
1. The medical debt buyer or collector is prohibited from engaging in any extraordinary collection actions to obtain payment for the care.
2. The medical debt buyer is prohibited from charging interest on the debt.
3. The debt is returnable to or recallable by the medical creditor upon a determination by the medical creditor or medical debt buyer that the individual is eligible for financial assistance.
4. The medical debt buyer is required to adhere to procedures which must be specified in the agreement that ensure that the individual does not pay, and has no obligation to pay, the medical debt buyer and the medical creditor together more than they are personally responsible for paying in compliance with this chapter.
5. The medical debt buyer is prohibited from communicating with, or reporting, any medical debt information to any consumer reporting agency regarding a consumer’s medical debt.
b. Reporting adverse information about the patient to a consumer reporting agency.
c. Actions that require a legal or judicial process, including any of the following:
1. Placing a lien on an individual’s property.
2. Attaching or seizing an individual’s bank account or any other personal property.
3. Commencing a civil action against an individual.
4. Garnishing an individual’s wages.
(5)“Financial assistance policy” means a written policy made pursuant to 26 U.S.C. § 501(r)(4) or its implementing regulations, including 26 CFR § 1.501(r)-1.
(6)“Health-care services” means services for the diagnosis, prevention, treatment, cure, or relief of a physical, dental, behavioral, substance use disorder, or mental health condition, illness, injury, or disease. These services include any procedures, products, devices, or medications.
(7)“Internal review or internal appeal” means review by a health insurance plan or other insurer of an adverse benefit determination.
(8)“Large health-care facility” means any of the following entities:
a. A hospital licensed under Chapter 10 of Title 16, whether a nonprofit subject to 26 U.S.C. § 501(c)(3), a not-for-profit entity, or a for-profit entity.
b. An outpatient clinic or facility operating under the license of a hospital or of which a majority of its ownership is by a hospital as defined in Chapter 10 of Title 16.
c. A licensed “freestanding emergency department” as defined in § 122 of Title 16.
(9)“Medical assistance” means any public assistance program that assists patients with health-care costs and includes “Medicaid assistance” as defined in § 505 of Title 31.
(10)“Medical creditor” means any large health-care facility that provides health-care services and to whom the consumer owes money for health-care services, or the large health-care facility that provided health-care services and to whom the consumer owes money for health-care services, or the large health-care facility that provided health-care services and to whom the consumer previously owed money if the medical debt has been purchased by 1 or more debt buyers.
(11)“Medical debt” means the following:
a. Debt owed by a consumer that is both of the following:
1. Owed to a person whose primary business is providing health-care services.
2. For the provision of medical services, products, or devices.
b. Medical debt includes medical bills that are not past due or have already been paid.
c. Medical debt does not include debt charged to a credit card unless the credit card is issued under an open-end or closed-end credit plan offered specifically for the payment of health-care services.
(12)“Medical debt buyer” means an individual or entity that is engaged in the business of purchasing medical debts for collection purposes, whether it collects the debt itself or hires a third party for collection or an attorney for litigation in order to collect such debt.
(13)“Medical debt collector” means any person that regularly collects or attempts to collect, directly or indirectly, medical debts originally owed or due or asserted to be owed or due another. A medical debt buyer is a medical debt collector. Medical debt collector does not include the Division of Child Support Services or an individual filing a child support action under Title 13. Medical debt collector does not include anyone collecting debt charged to a credit card.
(14)“Patient” means the individual who received health-care services, and for the purposes of this chapter, includes a parent if the patient is a minor or a legal guardian if the patient is an adult under guardianship.
(15)“Time of service” means before a patient leaves or is discharged from a large health-care facility, or within 10 days of discharge if the patient receives emergency care from a large health-care facility or from a provider employed by a large health-care facility.