81R9258 KCR-D
By: Isett H.B. No. 1577
A BILL TO BE ENTITLED
AN ACT
relating to the pricing of certain health care goods and services
and to the compensation of certain health insurance agents;
providing an administrative penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle B, Title 4, Health and Safety Code, is
amended by adding Chapter 254 to read as follows:
CHAPTER 254. PATIENT ACCESS TO PRICING INFORMATION
Sec. 254.001. DEFINITIONS. In this chapter:
(1) "Facility" means a facility that is subject to the
authority of a licensing entity and at which a health care
practitioner, as defined by Section 112.001, Occupations Code,
engages in a health care profession. The term includes an abortion
facility licensed under Chapter 245 and an end stage renal disease
facility licensed under Chapter 251. The term does not include a
facility subject to Chapter 324.
(2) "Licensing entity" means a department,
commission, board, office, authority, or other agency of the state
that regulates the activities of and licenses a facility.
Sec. 254.002. PRICE LIST REQUIRED; AVAILABILITY. (a) Each
facility shall compile a list of the price charged by the facility
for each product or service provided by the facility. If the
facility bundles together prices for multiple products or services
provided by the facility during one treatment by or visit to the
facility, the facility shall include any price bundles used by the
facility in the list compiled under this subsection.
(b) A facility shall provide a copy of the price list
described by Subsection (a) to any patient at the facility who
requests a copy of the list.
Sec. 254.003. POSTING REQUIRED. (a) Each facility shall
post in any general waiting area maintained by the facility,
including any waiting areas of off-site or on-site registration, a
clear and conspicuous notice that advises patients of the
availability of the price list described by Section 254.002.
(b) If a facility maintains an Internet website, the
facility shall post the price list described by Section 254.002 in a
clear and conspicuous place on the facility's website.
Sec. 254.004. ITEMIZED BILLING REQUIRED. (a) A facility
shall provide to a patient at the patient's request an itemized
statement of the products and services for which the patient was
billed, if the patient requests the statement not later than the
first anniversary of the date the person receives the treatment to
which the statement relates. The facility shall provide the
itemized statement to the patient not later than the 10th business
day after the date on which the itemized statement is requested.
(b) A facility shall provide an itemized statement of billed
products and services to a third-party payor who is actually or
potentially responsible for paying all or part of the billed
services provided to a patient and who has received a claim for
payment of those services. To be entitled to receive a statement,
the third-party payor must request the statement from the facility
and must have received a claim for payment. The request must be
made not later than one year after the date on which the payor
received the claim for payment. The facility shall provide the
statement to the payor not later than the 10th day after the date on
which the payor requests the statement. If a third-party payor
receives a claim for payment of part but not all of the billed
services, the third-party payor may request an itemized statement
of only the billed services for which payment is claimed or to which
any deduction or copayment applies.
(c) If a licensing entity rule or another law of this state
requires a facility to provide an itemized statement described by
Subsection (a) or (b) before the 10th day after the date a request
for the statement is made, the facility shall comply with the time
frame required by the licensing entity rule or other law.
Sec. 254.005. OVERPAYMENT REFUNDS. A facility that
receives payment for products or services provided to a patient by
the facility that exceeds the price of those products or services
published in the price list described by Section 254.002 shall, not
later than the 30th day after the date the overpayment is discovered
by the facility, refund to the payor the amount of the overpayment.
This section does not apply to an overpayment subject to Section
843.350 or 1301.132, Insurance Code.
Sec. 254.006. DISCIPLINARY ACTION AND ADMINISTRATIVE
PENALTY. A violation of this chapter is grounds for disciplinary
action or the imposition of an administrative penalty by the entity
that licenses the facility or health care practitioner that
violates this chapter.
SECTION 2. Section 324.101, Health and Safety Code, is
amended by amending Subsections (c) and (f) and adding Subsection
(c-1) to read as follows:
(c) Each facility shall post in the general waiting area and
in the waiting areas of any off-site or on-site registration,
admission, or business office a clear and conspicuous notice
concerning:
(1) [of] the availability of the policies required by
Subsection (a); and
(2) the price charged by the facility for a product or
service, including any price bundles used by the facility if the
facility bundles together prices for multiple products or services
provided by the facility during one treatment by or visit to the
facility.
(c-1) If a facility maintains an Internet website, the
facility shall post the prices described by Subsection (c)(2) in a
clear and conspicuous place on the facility's website.
(f) A facility shall provide an itemized statement of billed
services to a third-party payor who is actually or potentially
responsible for paying all or part of the billed services provided
to a patient and who has received a claim for payment of those
services. To be entitled to receive a statement, the third-party
payor must request the statement from the facility and must have
received a claim for payment. The request must be made not later
than one year after the date on which the payor received the claim
for payment. The facility shall provide the statement to the payor
not later than the 10th [30th] day after the date on which the payor
requests the statement. If a third-party payor receives a claim
for payment of part but not all of the billed services, the
third-party payor may request an itemized statement of only the
billed services for which payment is claimed or to which any
deduction or copayment applies.
SECTION 3. Chapter 550, Insurance Code, is amended by
adding Section 550.003 to read as follows:
Sec. 550.003. DISCLOSURE OF CERTAIN AGENT COMPENSATION
REQUIRED. (a) An insurer or an affiliate of the insurer may not pay
to an insurance agent, and an insurance agent may not receive from
an insurer or an affiliate of the insurer, compensation for an
insurance transaction that violates the disclosure requirements
adopted under Section 4005.056.
(b) For purposes of this section, "affiliate" means a person
or entity classified as an affiliate under Section 823.003.
SECTION 4. Chapter 552, Insurance Code, is amended to read
as follows:
CHAPTER 552. PRACTICES RELATED TO [ILLEGAL] PRICING AND
DISCOUNTING OF HEALTH CARE GOODS AND SERVICES [PRACTICES]
SUBCHAPTER A. PRICING PRACTICES
Sec. 552.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. (a)
This subchapter [chapter] does not apply to the provision of a
health care service to a:
(1) patient for which a health care provider has
accepted assignment for the health care service from Medicaid or
Medicare or any other [patient or a patient who is covered by a]
federal, state, or local government-sponsored indigent health care
program;
(2) financially or medically indigent person who
qualifies for indigent health care services based on:
(A) a sliding fee scale; or
(B) a written charity care policy established by
a health care provider; or
(3) person who is not covered by a health insurance
policy or other health benefit plan that provides benefits for the
services and qualifies for services for the uninsured based on a
written policy established by a health care provider.
(b) This subchapter [chapter] does not permit the
establishment of health care provider policies or contracts that
violate any other state or federal law.
[(c) This chapter does not prohibit a health care provider
from entering into a contract to provide services covered by a
health insurance policy or other health benefit plan with:
[(1) the issuer of the health insurance policy or
other health benefit plan; or
[(2) a preferred provider organization that contracts
with the issuer of the health insurance policy or other health
benefit plan.]
Sec. 552.002. FRAUDULENT INSURANCE ACT. An offense under
Section 552.003 is a fraudulent insurance act under Chapter 701.
Sec. 552.003. CHARGING DIFFERENT PRICES; OFFENSE. (a) A
person commits an offense if[:
[(1)] the person knowingly, [or] intentionally,
recklessly, or negligently charges two different prices for
providing the same product or service[; and
[(2) the higher price charged is based on the fact that
an insurer will pay all or part of the price of the product or
service].
(b) An offense under this section is a Class B misdemeanor.
SUBCHAPTER B. DISCOUNTS
Sec. 552.051. DEFINITION. In this subchapter, "health care
provider" means an individual licensed or certified in this state
to practice medicine, pharmacy, chiropractic, nursing, physical
therapy, podiatry, dentistry, optometry, occupational therapy, or
another healing art.
Sec. 552.052. APPLICABILITY OF SUBCHAPTER. This subchapter
applies only to:
(1) a facility subject to Chapter 254 or 324, Health
and Safety Code; and
(2) a health care provider.
Sec. 552.053. ALLOWED DISCOUNTS. A facility or health care
provider may provide a discount to an individual, including an
individual described by Section 552.001(a)(1), (2), or (3), only if
the discount is applied to that portion of the facility's or
provider's bill that is the patient's responsibility after the
facility or provider receives any payment to which the facility or
provider is entitled from a third-party payor.
Sec. 552.054. PROHIBITED DISCOUNTS. Except as provided by
Section 552.053, a facility or health care provider may not
discount the price the facility or provider charges for a product or
service based on whether a third-party payor, including an insurer,
will pay all or part of the price of the product or service.
Sec. 552.055. DISCIPLINARY ACTION AND ADMINISTRATIVE
PENALTIES. A violation of this subchapter is grounds for
disciplinary action or the imposition of an administrative penalty
by the entity that licenses the facility or health care provider
that violates this subchapter.
SECTION 5. Subchapter B, Chapter 4005, Insurance Code, is
amended by adding Sections 4005.056 and 4005.057 to read as
follows:
Sec. 4005.056. DISCLOSURE OF CERTAIN COMPENSATION
REQUIRED. (a) In this section:
(1) "Affiliate" means a person or entity classified as
an affiliate under Section 823.003.
(2) "Compensation" means remuneration for services
rendered. The term includes payment of a salary, a fee, or a
commission.
(3) "Contingent compensation" means any commission or
other compensation an insurer, or an affiliate or vendor of the
insurer, pays to an agent that is contingent on:
(A) the writing or procurement of an insurance
product in the insurer;
(B) the procurement of an application for an
insurance product in the insurer;
(C) the payment of a renewal premium; or
(D) the assumption of an insurance risk by the
insurer.
(4) "Vendor of insurance" has the meaning assigned to
that term by rule by the commissioner.
(b) An agent may not accept or receive any compensation,
including a commission, from an insurer, or an affiliate or vendor
of the insurer, unless the agent has, before the purchase of an
insurance product by a client, disclosed to the client in writing
the amount of compensation to be received by the agent from the
insurer, or an affiliate or vendor of the insurer, and the method of
computing that compensation, including any contingent
compensation.
(c) If the amount of contingent compensation is not known at
the time of the disclosure required under Subsection (b), the agent
must disclose:
(1) a reasonable estimate of the amount of the
contingent compensation; and
(2) the method under which the contingent compensation
will be computed.
(d) An agent must disclose in writing to a client before the
purchase of an insurance product by the client that:
(1) the agent will receive compensation from the
insurer for the sale of the insurance product by the agent to the
client;
(2) the compensation received by the agent may vary
depending on the insurance product and the insurer; and
(3) the agent may receive additional compensation from
the insurer based on other factors, such as premium volume or
persistency of business placed with a particular insurer and loss
or claims experience.
(e) In addition to the information described by Subsection
(d), an agent must disclose to a client before the purchase of an
insurance product by the client a good faith estimate of the amount
of any compensation described by Subsection (d) that the agent may
receive as a result of the sale of the insurance product.
(f) An agent who violates this section is subject to
disciplinary action as provided by Subchapter C.
Sec. 4005.057. DISCLOSURE OF OFFER OF COVERAGE REQUIRED.
(a) An agent shall disclose all proposals or offers of coverage
requested and received by the agent on behalf of a client or
potential client to the client or potential client as soon as
possible after receiving each proposal or offer.
(b) An agent shall make the disclosures required under
Sections 4005.056(d) and (e) at the same time the agent makes the
disclosure required by this section.
(c) An agent who violates this section is subject to
disciplinary action as provided by Subchapter C.
SECTION 6. Section 101.352, Occupations Code, is amended by
amending Subsections (b), (e), and (h) and adding Subsection (b-1)
to read as follows:
(b) Each physician who maintains a waiting area shall post
[a clear and conspicuous notice of the availability of the policies
required by Subsection (a)] in the waiting area and in any
registration, admission, or business office in which patients are
reasonably expected to seek service a clear and conspicuous notice
concerning:
(1) the availability of the policies required by
Subsection (a); and
(2) the price charged by the physician for a product or
service, including any price bundles used by the physician if the
physician bundles together prices for multiple products or services
provided by the physician during one treatment by or visit to the
physician.
(b-1) A physician shall make a list of prices described by
Subsection (b)(2) available to any patient or third-party payor who
requests a copy of the list. If a physician maintains an Internet
website, the physician shall post the prices described by
Subsection (b)(2) in a clear and conspicuous place on the
physician's website.
(e) A physician shall provide a patient or a third-party
payor who is actually or potentially responsible for paying all or
part of the billed products or services with an itemized statement
of the charges for professional services or supplies not later than
the 10th business day after the date on which the statement is
requested if the patient or third-party payor requests the
statement not later than the first anniversary of the date on which
the health care services or supplies were provided.
(h) If a patient overpays a physician, the physician must
refund the amount of the overpayment not later than the 10th [30th]
day after the date the physician determines that an overpayment has
been made. This subsection does not apply to an overpayment
subject to Section 1301.132 or 843.350, Insurance Code.
SECTION 7. Chapter 112, Occupations Code, is amended to
read as follows:
CHAPTER 112. GENERAL [LICENSING] REQUIREMENTS APPLICABLE TO
MULTIPLE HEALTH CARE PRACTITIONERS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 112.001. DEFINITIONS. In this chapter:
(1) "Health care practitioner" means an individual
issued a license, certificate, registration, title, permit, or
other authorization to engage in a health care profession.
(2) "Licensing entity" means a department,
commission, board, office, authority, or other agency of the state
that regulates activities and persons under this title.
SUBCHAPTER B. SERVICES PROVIDED TO CHARITIES
Sec. 112.051 [112.002]. APPLICABILITY. This subchapter
[chapter] applies only to licensing entities and health care
practitioners under Chapters 401, 453, and 454 and Subtitles B, C,
D, E, F, and K.
[SUBCHAPTER B. SERVICES PROVIDED TO CHARITIES]
Sec. 112.052 [112.051]. REDUCED LICENSE REQUIREMENTS FOR
RETIRED HEALTH CARE PRACTITIONERS PERFORMING CHARITY WORK. (a)
Each licensing entity shall adopt rules providing for reduced fees
and continuing education requirements for a retired health care
practitioner whose only practice is voluntary charity care.
(b) The licensing entity by rule shall define voluntary
charity care.
SUBCHAPTER C. AVAILABILITY OF PRICING INFORMATION
Sec. 112.101. PRICE LIST REQUIRED; AVAILABILITY. (a) Each
health care practitioner shall compile a list of the price charged
by the practitioner for each product or service provided by the
health care practitioner. If the health care practitioner bundles
together prices for multiple products or services provided by the
practitioner during one treatment by or visit to the practitioner,
the practitioner shall include any price bundles used by the
practitioner in the list compiled under this subsection.
(b) A health care practitioner shall provide a copy of the
price list described by Subsection (a) to any patient of the health
care practitioner who requests a copy of the list.
Sec. 112.102. POSTING REQUIRED. (a) Each health care
practitioner shall post in any general waiting area maintained by
the practitioner, including any waiting areas of off-site or
on-site registration, a clear and conspicuous notice that advises
patients of the availability of the price list described by Section
112.101.
(b) If a health care practitioner maintains an Internet
website, the practitioner shall post the price list described by
Section 112.101 on the practitioner's website.
Sec. 112.103. ITEMIZED BILLING REQUIRED. (a) A health
care practitioner shall provide to a patient at the patient's
request an itemized statement of the products and services for
which the patient was billed, if the patient requests the statement
not later than the first anniversary of the date the person receives
the treatment to which the statement relates. The health care
practitioner shall provide the itemized statement to the patient
not later than the 10th business day after the date on which the
itemized statement is requested.
(b) A health care practitioner shall provide an itemized
statement of billed products and services to a third-party payor
who is actually or potentially responsible for paying all or part of
the billed services provided to a patient and who has received a
claim for payment of those services. To be entitled to receive a
statement, the third-party payor must request the statement from
the health care practitioner and must have received a claim for
payment. The request must be made not later than one year after the
date on which the payor received the claim for payment. The health
care practitioner shall provide the statement to the payor not
later than the 10th day after the date on which the payor requests
the statement. If a third-party payor receives a claim for payment
of part but not all of the billed services, the third-party payor
may request an itemized statement of only the billed services for
which payment is claimed or to which any deduction or copayment
applies.
(c) If an entity that licenses a health care practitioner or
another law of this state requires the practitioner to provide an
itemized statement described by Subsection (a) or (b) before the
10th day after the date a request for the statement is made, the
health care practitioner shall comply with the time frame required
by the licensing entity or other law.
Sec. 112.104. OVERPAYMENT REFUNDS. A health care
practitioner that receives payment for products or services
provided to a patient by the practitioner that exceeds the price of
those products or services published in the price list described by
Section 112.101 shall, not later than the 30th day after the date
the overpayment is discovered by the practitioner, refund to the
payor the amount of the overpayment. This section does not apply to
an overpayment subject to Section 843.350 or 1301.132, Insurance
Code.
Sec. 112.105. DISCIPLINARY ACTIONS AND ADMINISTRATIVE
PENALTY. A violation of this subchapter is grounds for
disciplinary action or the imposition of an administrative penalty
by the entity that licenses the health care practitioner that
violates this subchapter.
SECTION 8. A facility, physician, or health care
practitioner shall compile the price list and post the notice
required by Chapter 254, Health and Safety Code, as added by this
Act, and Section 324.101, Health and Safety Code, Section
101.352(b), Occupations Code, and Chapter 112, Occupations Code, as
amended by this Act, as applicable, not later than January 1, 2010.
SECTION 9. The change in law made by Sections 550.003 and
4005.056, Insurance Code, as added by this Act, applies to
compensation paid to an insurance agent regarding a policy or
contract relating to an insurance product that is entered into on or
after the effective date of this Act. Compensation paid before that
date is governed by the law in effect on the date the compensation
was paid, and the former law is continued in effect for that
purpose.
SECTION 10. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2009.