Texas 2009 - 81st Regular

Texas House Bill HB1577 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R9258 KCR-D
2	2	By: Isett H.B. No. 1577
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the pricing of certain health care goods and services
8	8	and to the compensation of certain health insurance agents;
9	9	providing an administrative penalty.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subtitle B, Title 4, Health and Safety Code, is
12	12	amended by adding Chapter 254 to read as follows:
13	13	CHAPTER 254. PATIENT ACCESS TO PRICING INFORMATION
14	14	Sec. 254.001. DEFINITIONS. In this chapter:
15	15	(1) "Facility" means a facility that is subject to the
16	16	authority of a licensing entity and at which a health care
17	17	practitioner, as defined by Section 112.001, Occupations Code,
18	18	engages in a health care profession. The term includes an abortion
19	19	facility licensed under Chapter 245 and an end stage renal disease
20	20	facility licensed under Chapter 251. The term does not include a
21	21	facility subject to Chapter 324.
22	22	(2) "Licensing entity" means a department,
23	23	commission, board, office, authority, or other agency of the state
24	24	that regulates the activities of and licenses a facility.
25	25	Sec. 254.002. PRICE LIST REQUIRED; AVAILABILITY. (a) Each
26	26	facility shall compile a list of the price charged by the facility
27	27	for each product or service provided by the facility. If the
28	28	facility bundles together prices for multiple products or services
29	29	provided by the facility during one treatment by or visit to the
30	30	facility, the facility shall include any price bundles used by the
31	31	facility in the list compiled under this subsection.
32	32	(b) A facility shall provide a copy of the price list
33	33	described by Subsection (a) to any patient at the facility who
34	34	requests a copy of the list.
35	35	Sec. 254.003. POSTING REQUIRED. (a) Each facility shall
36	36	post in any general waiting area maintained by the facility,
37	37	including any waiting areas of off-site or on-site registration, a
38	38	clear and conspicuous notice that advises patients of the
39	39	availability of the price list described by Section 254.002.
40	40	(b) If a facility maintains an Internet website, the
41	41	facility shall post the price list described by Section 254.002 in a
42	42	clear and conspicuous place on the facility's website.
43	43	Sec. 254.004. ITEMIZED BILLING REQUIRED. (a) A facility
44	44	shall provide to a patient at the patient's request an itemized
45	45	statement of the products and services for which the patient was
46	46	billed, if the patient requests the statement not later than the
47	47	first anniversary of the date the person receives the treatment to
48	48	which the statement relates. The facility shall provide the
49	49	itemized statement to the patient not later than the 10th business
50	50	day after the date on which the itemized statement is requested.
51	51	(b) A facility shall provide an itemized statement of billed
52	52	products and services to a third-party payor who is actually or
53	53	potentially responsible for paying all or part of the billed
54	54	services provided to a patient and who has received a claim for
55	55	payment of those services. To be entitled to receive a statement,
56	56	the third-party payor must request the statement from the facility
57	57	and must have received a claim for payment. The request must be
58	58	made not later than one year after the date on which the payor
59	59	received the claim for payment. The facility shall provide the
60	60	statement to the payor not later than the 10th day after the date on
61	61	which the payor requests the statement. If a third-party payor
62	62	receives a claim for payment of part but not all of the billed
63	63	services, the third-party payor may request an itemized statement
64	64	of only the billed services for which payment is claimed or to which
65	65	any deduction or copayment applies.
66	66	(c) If a licensing entity rule or another law of this state
67	67	requires a facility to provide an itemized statement described by
68	68	Subsection (a) or (b) before the 10th day after the date a request
69	69	for the statement is made, the facility shall comply with the time
70	70	frame required by the licensing entity rule or other law.
71	71	Sec. 254.005. OVERPAYMENT REFUNDS. A facility that
72	72	receives payment for products or services provided to a patient by
73	73	the facility that exceeds the price of those products or services
74	74	published in the price list described by Section 254.002 shall, not
75	75	later than the 30th day after the date the overpayment is discovered
76	76	by the facility, refund to the payor the amount of the overpayment.
77	77	This section does not apply to an overpayment subject to Section
78	78	843.350 or 1301.132, Insurance Code.
79	79	Sec. 254.006. DISCIPLINARY ACTION AND ADMINISTRATIVE
80	80	PENALTY. A violation of this chapter is grounds for disciplinary
81	81	action or the imposition of an administrative penalty by the entity
82	82	that licenses the facility or health care practitioner that
83	83	violates this chapter.
84	84	SECTION 2. Section 324.101, Health and Safety Code, is
85	85	amended by amending Subsections (c) and (f) and adding Subsection
86	86	(c-1) to read as follows:
87	87	(c) Each facility shall post in the general waiting area and
88	88	in the waiting areas of any off-site or on-site registration,
89	89	admission, or business office a clear and conspicuous notice
90	90	concerning:
91	91	(1) [of] the availability of the policies required by
92	92	Subsection (a); and
93	93	(2) the price charged by the facility for a product or
94	94	service, including any price bundles used by the facility if the
95	95	facility bundles together prices for multiple products or services
96	96	provided by the facility during one treatment by or visit to the
97	97	facility.
98	98	(c-1) If a facility maintains an Internet website, the
99	99	facility shall post the prices described by Subsection (c)(2) in a
100	100	clear and conspicuous place on the facility's website.
101	101	(f) A facility shall provide an itemized statement of billed
102	102	services to a third-party payor who is actually or potentially
103	103	responsible for paying all or part of the billed services provided
104	104	to a patient and who has received a claim for payment of those
105	105	services. To be entitled to receive a statement, the third-party
106	106	payor must request the statement from the facility and must have
107	107	received a claim for payment. The request must be made not later
108	108	than one year after the date on which the payor received the claim
109	109	for payment. The facility shall provide the statement to the payor
110	110	not later than the 10th [30th] day after the date on which the payor
111	111	requests the statement. If a third-party payor receives a claim
112	112	for payment of part but not all of the billed services, the
113	113	third-party payor may request an itemized statement of only the
114	114	billed services for which payment is claimed or to which any
115	115	deduction or copayment applies.
116	116	SECTION 3. Chapter 550, Insurance Code, is amended by
117	117	adding Section 550.003 to read as follows:
118	118	Sec. 550.003. DISCLOSURE OF CERTAIN AGENT COMPENSATION
119	119	REQUIRED. (a) An insurer or an affiliate of the insurer may not pay
120	120	to an insurance agent, and an insurance agent may not receive from
121	121	an insurer or an affiliate of the insurer, compensation for an
122	122	insurance transaction that violates the disclosure requirements
123	123	adopted under Section 4005.056.
124	124	(b) For purposes of this section, "affiliate" means a person
125	125	or entity classified as an affiliate under Section 823.003.
126	126	SECTION 4. Chapter 552, Insurance Code, is amended to read
127	127	as follows:
128	128	CHAPTER 552. PRACTICES RELATED TO [ILLEGAL] PRICING AND
129	129	DISCOUNTING OF HEALTH CARE GOODS AND SERVICES [PRACTICES]
130	130	SUBCHAPTER A. PRICING PRACTICES
131	131	Sec. 552.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. (a)
132	132	This subchapter [chapter] does not apply to the provision of a
133	133	health care service to a:
134	134	(1) patient for which a health care provider has
135	135	accepted assignment for the health care service from Medicaid or
136	136	Medicare or any other [patient or a patient who is covered by a]
137	137	federal, state, or local government-sponsored indigent health care
138	138	program;
139	139	(2) financially or medically indigent person who
140	140	qualifies for indigent health care services based on:
141	141	(A) a sliding fee scale; or
142	142	(B) a written charity care policy established by
143	143	a health care provider; or
144	144	(3) person who is not covered by a health insurance
145	145	policy or other health benefit plan that provides benefits for the
146	146	services and qualifies for services for the uninsured based on a
147	147	written policy established by a health care provider.
148	148	(b) This subchapter [chapter] does not permit the
149	149	establishment of health care provider policies or contracts that
150	150	violate any other state or federal law.
151	151	[(c) This chapter does not prohibit a health care provider
152	152	from entering into a contract to provide services covered by a
153	153	health insurance policy or other health benefit plan with:
154	154	[(1) the issuer of the health insurance policy or
155	155	other health benefit plan; or
156	156	[(2) a preferred provider organization that contracts
157	157	with the issuer of the health insurance policy or other health
158	158	benefit plan.]
159	159	Sec. 552.002. FRAUDULENT INSURANCE ACT. An offense under
160	160	Section 552.003 is a fraudulent insurance act under Chapter 701.
161	161	Sec. 552.003. CHARGING DIFFERENT PRICES; OFFENSE. (a) A
162	162	person commits an offense if[:
163	163	[(1)] the person knowingly, [or] intentionally,
164	164	recklessly, or negligently charges two different prices for
165	165	providing the same product or service[; and
166	166	[(2) the higher price charged is based on the fact that
167	167	an insurer will pay all or part of the price of the product or
168	168	service].
169	169	(b) An offense under this section is a Class B misdemeanor.
170	170	SUBCHAPTER B. DISCOUNTS
171	171	Sec. 552.051. DEFINITION. In this subchapter, "health care
172	172	provider" means an individual licensed or certified in this state
173	173	to practice medicine, pharmacy, chiropractic, nursing, physical
174	174	therapy, podiatry, dentistry, optometry, occupational therapy, or
175	175	another healing art.
176	176	Sec. 552.052. APPLICABILITY OF SUBCHAPTER. This subchapter
177	177	applies only to:
178	178	(1) a facility subject to Chapter 254 or 324, Health
179	179	and Safety Code; and
180	180	(2) a health care provider.
181	181	Sec. 552.053. ALLOWED DISCOUNTS. A facility or health care
182	182	provider may provide a discount to an individual, including an
183	183	individual described by Section 552.001(a)(1), (2), or (3), only if
184	184	the discount is applied to that portion of the facility's or
185	185	provider's bill that is the patient's responsibility after the
186	186	facility or provider receives any payment to which the facility or
187	187	provider is entitled from a third-party payor.
188	188	Sec. 552.054. PROHIBITED DISCOUNTS. Except as provided by
189	189	Section 552.053, a facility or health care provider may not
190	190	discount the price the facility or provider charges for a product or
191	191	service based on whether a third-party payor, including an insurer,
192	192	will pay all or part of the price of the product or service.
193	193	Sec. 552.055. DISCIPLINARY ACTION AND ADMINISTRATIVE
194	194	PENALTIES. A violation of this subchapter is grounds for
195	195	disciplinary action or the imposition of an administrative penalty
196	196	by the entity that licenses the facility or health care provider
197	197	that violates this subchapter.
198	198	SECTION 5. Subchapter B, Chapter 4005, Insurance Code, is
199	199	amended by adding Sections 4005.056 and 4005.057 to read as
200	200	follows:
201	201	Sec. 4005.056. DISCLOSURE OF CERTAIN COMPENSATION
202	202	REQUIRED. (a) In this section:
203	203	(1) "Affiliate" means a person or entity classified as
204	204	an affiliate under Section 823.003.
205	205	(2) "Compensation" means remuneration for services
206	206	rendered. The term includes payment of a salary, a fee, or a
207	207	commission.
208	208	(3) "Contingent compensation" means any commission or
209	209	other compensation an insurer, or an affiliate or vendor of the
210	210	insurer, pays to an agent that is contingent on:
211	211	(A) the writing or procurement of an insurance
212	212	product in the insurer;
213	213	(B) the procurement of an application for an
214	214	insurance product in the insurer;
215	215	(C) the payment of a renewal premium; or
216	216	(D) the assumption of an insurance risk by the
217	217	insurer.
218	218	(4) "Vendor of insurance" has the meaning assigned to
219	219	that term by rule by the commissioner.
220	220	(b) An agent may not accept or receive any compensation,
221	221	including a commission, from an insurer, or an affiliate or vendor
222	222	of the insurer, unless the agent has, before the purchase of an
223	223	insurance product by a client, disclosed to the client in writing
224	224	the amount of compensation to be received by the agent from the
225	225	insurer, or an affiliate or vendor of the insurer, and the method of
226	226	computing that compensation, including any contingent
227	227	compensation.
228	228	(c) If the amount of contingent compensation is not known at
229	229	the time of the disclosure required under Subsection (b), the agent
230	230	must disclose:
231	231	(1) a reasonable estimate of the amount of the
232	232	contingent compensation; and
233	233	(2) the method under which the contingent compensation
234	234	will be computed.
235	235	(d) An agent must disclose in writing to a client before the
236	236	purchase of an insurance product by the client that:
237	237	(1) the agent will receive compensation from the
238	238	insurer for the sale of the insurance product by the agent to the
239	239	client;
240	240	(2) the compensation received by the agent may vary
241	241	depending on the insurance product and the insurer; and
242	242	(3) the agent may receive additional compensation from
243	243	the insurer based on other factors, such as premium volume or
244	244	persistency of business placed with a particular insurer and loss
245	245	or claims experience.
246	246	(e) In addition to the information described by Subsection
247	247	(d), an agent must disclose to a client before the purchase of an
248	248	insurance product by the client a good faith estimate of the amount
249	249	of any compensation described by Subsection (d) that the agent may
250	250	receive as a result of the sale of the insurance product.
251	251	(f) An agent who violates this section is subject to
252	252	disciplinary action as provided by Subchapter C.
253	253	Sec. 4005.057. DISCLOSURE OF OFFER OF COVERAGE REQUIRED.
254	254	(a) An agent shall disclose all proposals or offers of coverage
255	255	requested and received by the agent on behalf of a client or
256	256	potential client to the client or potential client as soon as
257	257	possible after receiving each proposal or offer.
258	258	(b) An agent shall make the disclosures required under
259	259	Sections 4005.056(d) and (e) at the same time the agent makes the
260	260	disclosure required by this section.
261	261	(c) An agent who violates this section is subject to
262	262	disciplinary action as provided by Subchapter C.
263	263	SECTION 6. Section 101.352, Occupations Code, is amended by
264	264	amending Subsections (b), (e), and (h) and adding Subsection (b-1)
265	265	to read as follows:
266	266	(b) Each physician who maintains a waiting area shall post
267	267	[a clear and conspicuous notice of the availability of the policies
268	268	required by Subsection (a)] in the waiting area and in any
269	269	registration, admission, or business office in which patients are
270	270	reasonably expected to seek service a clear and conspicuous notice
271	271	concerning:
272	272	(1) the availability of the policies required by
273	273	Subsection (a); and
274	274	(2) the price charged by the physician for a product or
275	275	service, including any price bundles used by the physician if the
276	276	physician bundles together prices for multiple products or services
277	277	provided by the physician during one treatment by or visit to the
278	278	physician.
279	279	(b-1) A physician shall make a list of prices described by
280	280	Subsection (b)(2) available to any patient or third-party payor who
281	281	requests a copy of the list. If a physician maintains an Internet
282	282	website, the physician shall post the prices described by
283	283	Subsection (b)(2) in a clear and conspicuous place on the
284	284	physician's website.
285	285	(e) A physician shall provide a patient or a third-party
286	286	payor who is actually or potentially responsible for paying all or
287	287	part of the billed products or services with an itemized statement
288	288	of the charges for professional services or supplies not later than
289	289	the 10th business day after the date on which the statement is
290	290	requested if the patient or third-party payor requests the
291	291	statement not later than the first anniversary of the date on which
292	292	the health care services or supplies were provided.
293	293	(h) If a patient overpays a physician, the physician must
294	294	refund the amount of the overpayment not later than the 10th [30th]
295	295	day after the date the physician determines that an overpayment has
296	296	been made. This subsection does not apply to an overpayment
297	297	subject to Section 1301.132 or 843.350, Insurance Code.
298	298	SECTION 7. Chapter 112, Occupations Code, is amended to
299	299	read as follows:
300	300	CHAPTER 112. GENERAL [LICENSING] REQUIREMENTS APPLICABLE TO
301	301	MULTIPLE HEALTH CARE PRACTITIONERS
302	302	SUBCHAPTER A. GENERAL PROVISIONS
303	303	Sec. 112.001. DEFINITIONS. In this chapter:
304	304	(1) "Health care practitioner" means an individual
305	305	issued a license, certificate, registration, title, permit, or
306	306	other authorization to engage in a health care profession.
307	307	(2) "Licensing entity" means a department,
308	308	commission, board, office, authority, or other agency of the state
309	309	that regulates activities and persons under this title.
310	310	SUBCHAPTER B. SERVICES PROVIDED TO CHARITIES
311	311	Sec. 112.051 [112.002]. APPLICABILITY. This subchapter
312	312	[chapter] applies only to licensing entities and health care
313	313	practitioners under Chapters 401, 453, and 454 and Subtitles B, C,
314	314	D, E, F, and K.
315	315	[SUBCHAPTER B. SERVICES PROVIDED TO CHARITIES]
316	316	Sec. 112.052 [112.051]. REDUCED LICENSE REQUIREMENTS FOR
317	317	RETIRED HEALTH CARE PRACTITIONERS PERFORMING CHARITY WORK. (a)
318	318	Each licensing entity shall adopt rules providing for reduced fees
319	319	and continuing education requirements for a retired health care
320	320	practitioner whose only practice is voluntary charity care.
321	321	(b) The licensing entity by rule shall define voluntary
322	322	charity care.
323	323	SUBCHAPTER C. AVAILABILITY OF PRICING INFORMATION
324	324	Sec. 112.101. PRICE LIST REQUIRED; AVAILABILITY. (a) Each
325	325	health care practitioner shall compile a list of the price charged
326	326	by the practitioner for each product or service provided by the
327	327	health care practitioner. If the health care practitioner bundles
328	328	together prices for multiple products or services provided by the
329	329	practitioner during one treatment by or visit to the practitioner,
330	330	the practitioner shall include any price bundles used by the
331	331	practitioner in the list compiled under this subsection.
332	332	(b) A health care practitioner shall provide a copy of the
333	333	price list described by Subsection (a) to any patient of the health
334	334	care practitioner who requests a copy of the list.
335	335	Sec. 112.102. POSTING REQUIRED. (a) Each health care
336	336	practitioner shall post in any general waiting area maintained by
337	337	the practitioner, including any waiting areas of off-site or
338	338	on-site registration, a clear and conspicuous notice that advises
339	339	patients of the availability of the price list described by Section
340	340	112.101.
341	341	(b) If a health care practitioner maintains an Internet
342	342	website, the practitioner shall post the price list described by
343	343	Section 112.101 on the practitioner's website.
344	344	Sec. 112.103. ITEMIZED BILLING REQUIRED. (a) A health
345	345	care practitioner shall provide to a patient at the patient's
346	346	request an itemized statement of the products and services for
347	347	which the patient was billed, if the patient requests the statement
348	348	not later than the first anniversary of the date the person receives
349	349	the treatment to which the statement relates. The health care
350	350	practitioner shall provide the itemized statement to the patient
351	351	not later than the 10th business day after the date on which the
352	352	itemized statement is requested.
353	353	(b) A health care practitioner shall provide an itemized
354	354	statement of billed products and services to a third-party payor
355	355	who is actually or potentially responsible for paying all or part of
356	356	the billed services provided to a patient and who has received a
357	357	claim for payment of those services. To be entitled to receive a
358	358	statement, the third-party payor must request the statement from
359	359	the health care practitioner and must have received a claim for
360	360	payment. The request must be made not later than one year after the
361	361	date on which the payor received the claim for payment. The health
362	362	care practitioner shall provide the statement to the payor not
363	363	later than the 10th day after the date on which the payor requests
364	364	the statement. If a third-party payor receives a claim for payment
365	365	of part but not all of the billed services, the third-party payor
366	366	may request an itemized statement of only the billed services for
367	367	which payment is claimed or to which any deduction or copayment
368	368	applies.
369	369	(c) If an entity that licenses a health care practitioner or
370	370	another law of this state requires the practitioner to provide an
371	371	itemized statement described by Subsection (a) or (b) before the
372	372	10th day after the date a request for the statement is made, the
373	373	health care practitioner shall comply with the time frame required
374	374	by the licensing entity or other law.
375	375	Sec. 112.104. OVERPAYMENT REFUNDS. A health care
376	376	practitioner that receives payment for products or services
377	377	provided to a patient by the practitioner that exceeds the price of
378	378	those products or services published in the price list described by
379	379	Section 112.101 shall, not later than the 30th day after the date
380	380	the overpayment is discovered by the practitioner, refund to the
381	381	payor the amount of the overpayment. This section does not apply to
382	382	an overpayment subject to Section 843.350 or 1301.132, Insurance
383	383	Code.
384	384	Sec. 112.105. DISCIPLINARY ACTIONS AND ADMINISTRATIVE
385	385	PENALTY. A violation of this subchapter is grounds for
386	386	disciplinary action or the imposition of an administrative penalty
387	387	by the entity that licenses the health care practitioner that
388	388	violates this subchapter.
389	389	SECTION 8. A facility, physician, or health care
390	390	practitioner shall compile the price list and post the notice
391	391	required by Chapter 254, Health and Safety Code, as added by this
392	392	Act, and Section 324.101, Health and Safety Code, Section
393	393	101.352(b), Occupations Code, and Chapter 112, Occupations Code, as
394	394	amended by this Act, as applicable, not later than January 1, 2010.
395	395	SECTION 9. The change in law made by Sections 550.003 and
396	396	4005.056, Insurance Code, as added by this Act, applies to
397	397	compensation paid to an insurance agent regarding a policy or
398	398	contract relating to an insurance product that is entered into on or
399	399	after the effective date of this Act. Compensation paid before that
400	400	date is governed by the law in effect on the date the compensation
401	401	was paid, and the former law is continued in effect for that
402	402	purpose.
403	403	SECTION 10. This Act takes effect immediately if it
404	404	receives a vote of two-thirds of all the members elected to each
405	405	house, as provided by Section 39, Article III, Texas Constitution.
406	406	If this Act does not receive the vote necessary for immediate
407	407	effect, this Act takes effect September 1, 2009.