One Pager On HB 1236: Prudent Layperson- Keep the Deal

What do the bills do? HB 1236 as filed changed the prudent layperson standard to prohibit any use of a final emergency care diagnosis to identify potential fraud patterns. That doesn’t align with federal law or policies of other states.

How did the House floor amendment address concerns? Under the amendment, the legislation now clarifies that diagnosis codes can be used to identify fraud and abuse in ER billing. That way patients are protected from being denied coverage for emergency care but also allows fraud and abuse to be investigated.

View the one pager.

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