Texas 2009 - 81st Regular

Texas House Bill HB3459 Compare Versions

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

Old	New	Differences
1	1	81R8858 PMO-D
2	2	By: Isett H.B. No. 3459
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to pricing for health care services and supplies and
8	8	reimbursement for those services or supplies under certain health
9	9	benefit plans; imposing penalties.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
12	12	by adding Chapter 1225 to read as follows:
13	13	CHAPTER 1225. PRICING FOR HEALTH CARE SERVICES AND SUPPLIES;
14	14	REIMBURSEMENT RATES
15	15	Sec. 1225.001. DEFINITION. In this chapter, "health care
16	16	provider" includes a physician, health care practitioner, and
17	17	health care facility.
18	18	Sec. 1225.002. APPLICABILITY OF CHAPTER. (a) This chapter
19	19	does not apply to the provision of a health care service or supply
20	20	to a:
21	21	(1) patient for which a health care provider has
22	22	accepted assignment for the health care service or supply from
23	23	Medicaid or Medicare or any other federal, state, or local
24	24	government-sponsored indigent health care program;
25	25	(2) financially or medically indigent person who
26	26	qualifies for indigent health care services based on:
27	27	(A) a sliding fee scale; or
28	28	(B) a written charity care policy established by
29	29	a health care provider; or
30	30	(3) person who is not covered by a health benefit plan
31	31	that provides benefits for the services and qualifies for services
32	32	for the uninsured based on a written policy established by a health
33	33	care provider.
34	34	(b) This chapter does not apply to payments made for a
35	35	health care service or supply on a capitation basis.
36	36	(c) This chapter does not permit the establishment of health
37	37	care provider policies or contracts that violate any other state or
38	38	federal law.
39	39	Sec. 1225.003. PRICING INFORMATION; AVAILABILITY. (a)
40	40	Each health care provider shall compile a list of the price charged
41	41	by the provider for each service or supply provided by the health
42	42	care provider. If the health care provider bundles together prices
43	43	for multiple services or supplies provided by the provider during
44	44	one treatment by or visit to the provider, the provider shall
45	45	include any price bundles used by the provider in the list compiled
46	46	under this subsection.
47	47	(b) A health care provider shall provide a copy of the price
48	48	list described by Subsection (a) to any patient of the health care
49	49	provider who requests a copy of the list.
50	50	Sec. 1225.004. POSTING REQUIRED. (a) Each health care
51	51	provider shall post in any general waiting area maintained by the
52	52	provider, including any waiting areas of off-site or on-site
53	53	registration, a clear and conspicuous notice that advises patients
54	54	of the availability of the price list described by Section
55	55	1225.003.
56	56	(b) If a health care provider maintains an Internet website,
57	57	the provider shall post the price list described by Section
58	58	1225.003 on the provider's website.
59	59	Sec. 1225.005. OVERPAYMENT; REFUNDS. (a) A health care
60	60	provider that receives payment for a health care service or supply
61	61	provided to a patient by the provider that exceeds the price of
62	62	those products or services published in the price list described by
63	63	Section 1225.003 shall, not later than the 30th day after the date
64	64	the overpayment is discovered by the provider, refund to the payor
65	65	the amount of the overpayment. This section does not apply to an
66	66	overpayment subject to Section 843.350 or 1301.132.
67	67	(b) The health care provider shall refund the overpayment
68	68	described by Subsection (a) by:
69	69	(1) crediting the patient's account to pay a copayment
70	70	amount, deductible, or other charge that the patient owes to the
71	71	provider; or
72	72	(2) funding an established qualified account of the
73	73	patient such as a savings account or medical reimbursement account
74	74	dedicated to the payment of a future medical expense.
75	75	Sec. 1225.006. DISCIPLINARY ACTIONS AND ADMINISTRATIVE
76	76	PENALTY. A violation of this chapter is grounds for disciplinary
77	77	action or the imposition of an administrative penalty by the entity
78	78	that licenses the health care provider that violates this chapter.
79	79	Sec. 1225.007. FRAUDULENT INSURANCE ACT. An offense under
80	80	this chapter is a fraudulent insurance act under Chapter 701.
81	81	Sec. 1225.008. CHARGING DIFFERENT PRICES; OFFENSE. (a) A
82	82	health care provider commits an offense if the provider knowingly
83	83	charges different prices for providing the same health care service
84	84	or supply.
85	85	(b) It is a defense to prosecution under this section that
86	86	the health care provider refunded the overpayment as required by
87	87	Section 843.350, 1225.005, or 1301.132, as applicable.
88	88	(c) An offense under this section is a Class B misdemeanor.
89	89	Sec. 1225.009. ESTABLISHMENT OF RATES. (a) The department
90	90	shall analyze reimbursement payments made by health benefit plan
91	91	issuers to a health care provider for specific health care services
92	92	or supplies in each health service region established by the
93	93	Department of State Health Services under Section 121.007, Health
94	94	and Safety Code.
95	95	(b) For each region analyzed under Subsection (a), and for
96	96	each health care service or supply, the commissioner shall
97	97	determine the 25th quartile of the reimbursement payment.
98	98	(c) The amount determined for each health care service or
99	99	supply for each region by the department under Subsection (b) is the
100	100	maximum amount that a health benefit plan issuer may reimburse a
101	101	health care provider for the health care service or supply.
102	102	Sec. 1225.010. EXCEPTION. For good cause shown, the
103	103	commissioner may by rule except from the maximum reimbursement rate
104	104	established under Section 1225.009 a payment made:
105	105	(1) to a tertiary care facility as defined by Section
106	106	46.001, Health and Safety Code; or
107	107	(2) for tertiary medical services as defined by
108	108	Section 46.001, Health and Safety Code, or a supply related to those
109	109	services.
110	110	SECTION 2. A health care provider shall compile the price
111	111	list and post the notice required by Chapter 1225, Insurance Code,
112	112	as added by this Act, not later than January 1, 2010.
113	113	SECTION 3. This Act applies only to an insurance policy,
114	114	contract, or evidence of coverage that is delivered, issued for
115	115	delivery, or renewed on or after January 1, 2010. A policy,
116	116	contract, or evidence of coverage delivered, issued for delivery,
117	117	or renewed before January 1, 2010, is governed by the law as it
118	118	existed immediately before the effective date of this Act, and that
119	119	law is continued in effect for that purpose.
120	120	SECTION 4. This Act takes effect immediately if it receives
121	121	a vote of two-thirds of all the members elected to each house, as
122	122	provided by Section 39, Article III, Texas Constitution. If this
123	123	Act does not receive the vote necessary for immediate effect, this
124	124	Act takes effect September 1, 2009.