Texas 2009 - 81st Regular

Texas House Bill HB4183 Compare Versions

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Old	New	Differences
1	1	81R32396 E
2	2	By: Smithee H.B. No. 4183
3	3	Substitute the following for H.B. No. 4183:
4	4	By: Thompson C.S.H.B. No. 4183
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to billing practices for certain health care facilities
10	10	and providers.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 324.001, Health and Safety Code, is
13	13	amended by adding Subdivision (8) to read as follows:
14	14	(8) "Preferred provider" means a facility that
15	15	contracts to provide medical care or health care to participants or
16	16	beneficiaries of a health plan in accordance with agreed
17	17	reimbursement rates.
18	18	SECTION 2. Section 324.101, Health and Safety Code, is
19	19	amended by amending Subsections (e) and (f) and adding Subsections
20	20	(f-1), (f-2), (f-3), (f-4), (f-5), and (f-6) to read as follows:
21	21	(e) A facility shall provide to the consumer at the
22	22	consumer's request an itemized statement of the billed charges
23	23	[services] if the consumer requests the statement not later than
24	24	the first anniversary of the date the person is discharged from the
25	25	facility. The facility shall provide the statement to the consumer
26	26	not later than the 10th business day after the date on which the
27	27	statement is requested. The facility may provide the consumer with
28	28	an electronic copy of the itemized statement.
29	29	(f) If the billed charges exceed $10,000, the [A] facility
30	30	shall provide an itemized statement of the billed charges
31	31	[services] to a third-party payor who is actually or potentially
32	32	responsible for paying all or part of the billed charges for
33	33	providing services [provided] to a patient [and who has received a
34	34	claim for payment of those services. To be entitled to receive a
35	35	statement, the third-party payor must request the statement from
36	36	the facility and must have received a claim for payment. The
37	37	request must be made not later than one year after the date on which
38	38	the payor received the claim for payment]. The facility shall
39	39	provide the statement to the payor with the facility's claim for
40	40	payment.
41	41	(f-1) A third-party payor may request an itemized statement
42	42	for billed charges of $10,000 or less.
43	43	(f-2) A third-party payor may request additional
44	44	information, including medical records and operative reports,
45	45	relating to a claim that has been submitted for payment to the
46	46	third-party payor.
47	47	(f-3) The facility shall provide the itemized statement
48	48	requested under Subsection (f-1) or the information requested under
49	49	Subsection (f-2) as soon as practicable. The days between the date
50	50	a third-party payor requests the itemized statement or additional
51	51	information from the facility and the date the payor receives the
52	52	itemized statement or information may not be counted in a payment
53	53	period established by statute or under contract.
54	54	(f-4) The facility may provide the third-party payor with an
55	55	electronic copy of an itemized statement under this section [not
56	56	later than the 30th day after the date on which the payor requests
57	57	the statement].
58	58	(f-5) If a third-party payor receives a claim for payment of
59	59	part [but not all] of the billed charges [services], the
60	60	third-party payor is entitled to [may request] an itemized
61	61	statement of only the billed charges [services] for which payment
62	62	is claimed or to which any deduction or copayment applies.
63	63	(f-6) A third-party payor that requests an itemized
64	64	statement under Subsection (f-1) or additional information under
65	65	Subsection (f-2) must have evidence sufficient to prove the date
66	66	the payor made the request, which may include a certified mail
67	67	receipt or an electronic date stamp. Unless rebutted by sufficient
68	68	evidence provided by a facility, the date the payor receives the
69	69	itemized statement or additional information, as shown in the
70	70	payor's records, is presumed to be the date of receipt for purposes
71	71	of Subsection (f-3).
72	72	SECTION 3. Section 324.103, Health and Safety Code, is
73	73	amended to read as follows:
74	74	Sec. 324.103. [CONSUMER] WAIVER PROHIBITED. The
75	75	provisions of this chapter may not be waived, voided, or nullified
76	76	by a contract or an agreement between a facility and a consumer or
77	77	third-party payor.
78	78	SECTION 4. Subchapter C, Chapter 324, Health and Safety
79	79	Code, is amended by adding Sections 324.104, 324.105, 324.106, and
80	80	324.107 to read as follows:
81	81	Sec. 324.104. CLAIM FOR PAYMENT FROM PREFERRED PROVIDER.
82	82	(a) A preferred provider that directly or through its agent or
83	83	assignee asserts that a claim for payment of a medical or health
84	84	care service or supply provided to a consumer, including a claim for
85	85	payment of the amount due for a disallowed discount on the service
86	86	or supply provided, has not been timely or accurately paid shall
87	87	provide written notification of the nonpayment or inaccuracy to the
88	88	third-party payor not later than the first anniversary of the
89	89	earlier of the date the preferred provider received payment from
90	90	the payor or the date that payment was due. A preferred provider or
91	91	agent that fails to provide the notification before that date is
92	92	barred from asserting the claim of nonpayment or inaccuracy. The
93	93	notice required by this subsection does not affect a statute of
94	94	limitations applicable to a claim.
95	95	(b) If a patient is admitted to a preferred provider for
96	96	more than 30 days, the preferred provider on request of a
97	97	third-party payor shall provide an interim statement of the
98	98	facility's billed charges to the third-party payor not later than
99	99	the 10th day after the date the third-party payor submits the
100	100	request.
101	101	Sec. 324.105. OVERPAYMENT AND REIMBURSEMENT. (a) A
102	102	third-party payor may recover an overpayment to a preferred
103	103	provider if:
104	104	(1) not later than the 180th day after the date the
105	105	provider receives the payment, the payor provides written notice of
106	106	the overpayment to the provider that includes the basis and
107	107	specific reasons for the request for recovery of funds; and
108	108	(2) the provider does not make arrangements for
109	109	repayment of the requested funds on or before the 45th day after the
110	110	date the provider receives the notice.
111	111	(b) A third-party payor that fails to provide notice of
112	112	overpayment by the 180th day after the date the preferred provider
113	113	receives a payment on a claim is barred from recovering an
114	114	overpayment on that claim.
115	115	(c) If a preferred provider disagrees with a request for
116	116	recovery of an overpayment, the third-party payor shall allow the
117	117	provider an opportunity to appeal, and the payor may not attempt to
118	118	recover the overpayment until all appeal rights are exhausted.
119	119	(d) A preferred provider that fails to make a reimbursement
120	120	required by this section shall pay, in addition to the
121	121	reimbursement, a late penalty in an amount equal to 10 percent of
122	122	the amount of the required reimbursement.
123	123	Sec. 324.106. APPLICABILITY TO ENTITIES CONTRACTING WITH
124	124	PREFERRED PROVIDER OR THIRD-PARTY PAYOR. This subchapter applies
125	125	to a person with whom:
126	126	(1) a preferred provider contracts to submit or
127	127	collect a claim for payment; or
128	128	(2) a third-party payor contracts to process or pay a
129	129	claim for payment by a preferred provider.
130	130	Sec. 324.107. APPLICABILITY OF OTHER LAW. If a provision of
131	131	this chapter and a provision of Chapter 1301, Insurance Code, apply
132	132	to the same person, conduct, or circumstance, Chapter 1301,
133	133	Insurance Code, controls.
134	134	SECTION 5. The changes in law made by this Act to Chapter
135	135	324, Health and Safety Code, apply only to services or supplies
136	136	provided by a health care facility to a consumer on or after the
137	137	effective date of this Act. Services or supplies provided before
138	138	the effective date of this Act are governed by the law in effect
139	139	immediately before the effective date of this Act, and that law is
140	140	continued in effect for that purpose.
141	141	SECTION 6. This Act takes effect September 1, 2009.