81R10792 YDB-D
By: Leibowitz H.B. No. 3100
A BILL TO BE ENTITLED
AN ACT
relating to billing for certain adverse events that occur during
the provision of health care services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Subtitle I, Title 2, Health and
Safety Code, is amended to read as follows:
SUBTITLE I. MEDICAL RECORDS AND BILLING
SECTION 2. Subtitle I, Title 2, Health and Safety Code, is
amended by adding Chapter 183 to read as follows:
CHAPTER 183. PROHIBITED BILLING PRACTICES
Sec. 183.001. DEFINITIONS. In this chapter:
(1) "Health care facility" means a facility licensed,
certified, or otherwise authorized by the laws of this state to
administer health care, for profit or otherwise, in the ordinary
course of business.
(2) "Health care provider" means a person or facility
licensed, certified, or otherwise authorized by the laws of this
state to administer health care, for profit or otherwise, in the
ordinary course of business or professional practice.
(3) "Serious disability" means:
(A) a physical or mental impairment that
substantially limits one or more major life activities of an
individual such as seeing, hearing, speaking, walking, or
breathing, or a loss of a bodily function, if the impairment or loss
lasts more than seven days or is still present at the time of
discharge from an inpatient health care facility; or
(B) loss of a body part.
Sec. 183.002. PREVENTABLE ADVERSE EVENT. For purposes of
this chapter, a preventable adverse event is any of the following
events that occur during the provision of a health care service to a
patient:
(1) the unintended retention of a foreign object in
the patient after surgery or another procedure;
(2) death or serious disability caused by an
intravascular air embolism that occurs while the patient is
receiving care in a health care facility, excluding a death
associated with a neurological procedure known to present a high
risk of intravascular air embolism;
(3) death or serious disability of a patient caused by
a hemolytic reaction resulting from the administration of ABO- or
HLA-incompatible blood or blood products;
(4) stage three or four pressure ulcers acquired after
admission to a health care facility, excluding progression from
stage two to stage three if stage two was recognized on admission;
(5) death or serious disability caused by an electric
shock while the patient is receiving care in a health care facility,
excluding an event involving a planned treatment such as electric
countershock;
(6) death or serious disability caused by a burn
incurred from any source while the patient is receiving care in a
health care facility;
(7) death or serious disability caused by a fall or
trauma resulting in a fracture, dislocation, intracranial injury,
or crushing injury while the patient is receiving care in a health
care facility;
(8) death or serious disability directly related to
the following manifestations of poor glycemic control, the onset of
which occurs while the patient is receiving care in a health care
facility:
(A) diabetic ketoacidosis;
(B) nonketotic hyperosmolar coma;
(C) hypoglycemic coma;
(D) secondary diabetes with ketoacidosis; and
(E) secondary diabetes with hyperosmolarity;
(9) death or serious disability caused by a urinary
tract infection resulting from the insertion of a catheter by an
individual health care provider;
(10) death or serious disability caused by an
infection resulting from the insertion of a vascular catheter by an
individual health care provider;
(11) death or serious disability caused by a surgical
site infection occurring as a result of the following procedures:
(A) a coronary artery bypass graft;
(B) bariatric surgery such as laparoscopic
gastric bypass surgery, gastroenterostomy, and laparoscopic
gastric restrictive surgery; and
(C) orthopedic procedures involving the spine,
neck, shoulder, or elbow; and
(12) death or serious disability caused by a pulmonary
embolism or deep vein thrombosis that occurs while the patient is
receiving care in a health care facility following an orthopedic
procedure, including total knee replacement or hip replacement.
Sec. 183.003. PROHIBITED BILLING FOR PREVENTABLE ADVERSE
EVENT. A health care provider may not present or cause to be
presented to any person, including the state Medicaid program, an
insurer, or another third party payor, a bill or demand for payment
for a health care service that included a preventable adverse event
or a health care service provided to a patient in this state as a
result of or to correct a preventable adverse event that is caused
by the provider or a person employed or supervised by or holding
practice privileges from the provider.
Sec. 183.004. RULES. The appropriate regulatory agency of
this state that issues a license or certificate to a licensed health
care provider may adopt rules necessary to implement and enforce
this chapter.
Sec. 183.005. DISCIPLINARY ACTION. A licensed health care
provider who violates this chapter or a rule adopted under this
chapter by the appropriate regulatory agency of this state is
subject to disciplinary action by the regulatory agency under
applicable law, including revocation, suspension, or nonrenewal of
the provider's license.
SECTION 3. Section 183.003, Health and Safety Code, as
added by this Act, applies only to a preventable adverse event
occurring on or after November 1, 2009.
SECTION 4. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 5. This Act takes effect September 1, 2009.