(a) Each healthcare facility licensed under this chapter shall be prohibited from requiring an uninsured patient to pay for services in an amount that exceeds one hundred seventy-five percent (175%) of the cost for the services provided, calculated using the cost to charge ratio in the most recent joint annual report.

Terms Used In Tennessee Code 68-11-262

  • Contract: A legal written agreement that becomes binding when signed.
  • Department: means the department of health. See Tennessee Code 68-11-201
  • Facility: means any institution, place or building providing health care services that is required to be licensed under this chapter. See Tennessee Code 68-11-201
  • Hospital: means any institution, place, building or agency represented and held out to the general public as ready, willing and able to furnish care, accommodations, facilities and equipment for the use, in connection with the services of a physician or dentist, of one (1) or more nonrelated persons who may be suffering from deformity, injury or disease or from any other condition for which nursing, medical or surgical services would be appropriate for care, diagnosis or treatment. See Tennessee Code 68-11-201
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Outpatient diagnostic center: except as otherwise limited in this subdivision (33), means any facility providing outpatient diagnostic services, unless the outpatient diagnostic services are provided as the services of another licensed healthcare institution that reports such outpatient diagnostic services on its joint annual report, or the facility is otherwise excluded from this subdivision (33). See Tennessee Code 68-11-201
  • Patient: includes , but is not limited to, any person who is suffering from an acute or chronic illness or injury or who is crippled, convalescent or infirm, or who is in need of obstetrical, surgical, medical, nursing or supervisory care. See Tennessee Code 68-11-201
  • Person: means any individual, partnership, association, corporation, other business entity, state or local governmental agencies and entities, and federal agencies and entities to the extent permitted by federal law. See Tennessee Code 68-11-201
(b) As used in this section, the following terms shall have the meaning indicated:

(1) “Cost to charge ratio” means the ratio of a specific healthcare facility’s total expenses to its grand total gross patient charges as reported in its joint annual report submitted annually to the department of health;
(2) “Healthcare facility” means a hospital, ambulatory surgery center, or outpatient diagnostic center; and
(3) “Uninsured patient” means a person with no public or private source of payment for medical services, including, but not limited to, medicare, TennCare, a contract of insurance, an employer-sponsored health plan, or other enforceable obligation under which a person is responsible for payment for healthcare services provided to the patient.
(c) Information obtained by the department of health as to the amounts billed for services by a healthcare facility, pursuant to this section, shall be maintained on a confidential basis.
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