Texas 2009 - 81st Regular

Texas House Bill HB4502 Compare Versions

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

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1	1	By: Coleman H.B. No. 4502
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to charity care.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Sections 311.031(2) and (16), Health and Safety
9	9	Code, are amended to read as follows:
10	10	(2) "Charity care" means the unreimbursed cost, not
11	11	including bad debt expense, to a hospital of:
12	12	(A) providing, funding, or otherwise financially
13	13	supporting health care services on an inpatient or outpatient basis
14	14	to a person classified by the hospital as "financially indigent" or
15	15	"medically indigent"; and/or
16	16	(B) providing, funding, or otherwise financially
17	17	supporting health care services provided to financially indigent
18	18	persons through other nonprofit or public outpatient clinics,
19	19	hospitals, or health care organizations.
20	20	(16) "Unreimbursed costs" means the costs a hospital
21	21	incurs for providing services after subtracting payments received
22	22	from any source for such services including but not limited to the
23	23	following: third-party insurance payments; Medicare payments;
24	24	Medicaid payments; Medicare education reimbursements; state
25	25	reimbursements for education; payments from drug companies to
26	26	pursue research; grant funds for research; and disproportionate
27	27	share payments. For purposes of this definition, the term "costs"
28	28	shall be calculated by applying the hospital's Medicare cost ratio
29	29	[to charge ratios derived in accordance with generally accepted
30	30	accounting principles for hospitals] to billed charges. The
31	31	executive commissioner of the Health and Human Services Commission
32	32	by rule may supplement the Medicare cost ratio with additional
33	33	expenses and revenues that are reasonable and medically necessary
34	34	and subject to third-party insurer reimbursement. The calculation
35	35	of the cost to charge ratios shall be based on the most recently
36	36	completed and audited prior fiscal year of the hospital or hospital
37	37	system. Prior to January 1, 1996, for purposes of this definition,
38	38	charitable contributions and grants to a hospital, including
39	39	transfers from endowment or other funds controlled by the hospital
40	40	or its nonprofit supporting entities, shall not be subtracted from
41	41	the costs of providing services for purposes of determining
42	42	unreimbursed costs. After January 1, 1996, for purposes of this
43	43	definition, charitable contributions and grants to a hospital,
44	44	including transfers from endowment or other funds controlled by the
45	45	hospital or its nonprofit supporting entities, shall not be
46	46	subtracted from the costs of providing services for purposes of
47	47	determining the unreimbursed costs of charity care and
48	48	government-sponsored indigent health care.
49	49	SECTION 2. Amend Texas Government Code, Chapter 531 to add a
50	50	new Subchapter Q to read as follows:
51	51	Subchapter Q. Study on Hospital Billing and Collection Practices
52	52	Sec. 531.701. Study concerning hospital billing and
53	53	collection practices.
54	54	(a) The Texas Health and Human Services Commission shall study
55	55	the effects of hospital and billing practices on the uninsured and
56	56	underinsured.
57	57	(b) By the use of a hospital questionnaire and such other
58	58	investigative tools including sample hospital audits, interviews,
59	59	public hearings and reports, the study shall address:
60	60	(i) the effects of hospital billing, including pricing and
61	61	discounting. practices by public health region as designated under
62	62	Texas Health & Safety Code, Section 121.007 upon the uninsured, the
63	63	underinsured, insurers, governmental payors, and other third-party
64	64	payors;
65	65	(ii) The effects of hospital billing, including pricing and
66	66	discounting, and collection practices upon the uninsured and
67	67	underinsured including any barriers to health care access and
68	68	economic consequences; and
69	69	(iii) The actions other jurisdictions have taken through
70	70	legislation or litigation to address hospital billing and
71	71	collection practices upon the uninsured and the underinsured.
72	72	(c) Any data presented in the study shall be indexed by hospital
73	73	organizational structure: for profit, nonprofit, and public.
74	74	(d) The study shall commence no later than November 15, 2009 and
75	75	produce a report on the study to be filed with the legislature no
76	76	later than December 15, 2010. At that date, the commission shall
77	77	publish the report on its website in a conspicuous location.
78	78	(e) The performance of the study may be delegated by the
79	79	commission to one or more working groups that may include public
80	80	members and representatives from the Texas Attorney General, Texas
81	81	Comptroller of Public Accounts and the Texas Department of State
82	82	Health Services. At least half of the public members appointed to
83	83	any working group must be individuals or representatives of
84	84	organizations that advocate on behalf of consumers on health care
85	85	issues.
86	86	(f) Public hearings shall be held throughout the state to receive
87	87	public testimony for inclusion in the report. At the commission's
88	88	request, a working group member may coordinate, convene, and
89	89	preside at a public hearing. Among other resources, the commission
90	90	may rely on donations of space, equipment, and personnel for the
91	91	public hearing.
92	92	(g) The commission or its delegate may retain public accountants
93	93	and such other experts considered reasonably necessary to perform
94	94	the study and may seek collaboration from the Texas Attorney
95	95	General, the Texas Comptroller of Public Accounts and the Texas
96	96	Department of State Health Services.
97	97	Sec. 531.702. Expiration of Subchaper. This Subchapter
98	98	expires on January 31, 2011.
99	99	SECTION 3. Subchapter D, Chapter 311, Health and Safety
100	100	Code is amended by adding Section 311.0471 to read as follows:
101	101	Sec. 311.0471. INVESTIGATION AND ENFORCEMENT. (a) Except
102	102	as otherwise provided, this section applies only to a hospital, as
103	103	that term is defined by Section 311.031.
104	104	(b) The attorney general shall investigate whether a
105	105	hospital has violated this Subchapter on receipt of a public
106	106	complaint.
107	107	(c) The attorney general may conduct any investigation
108	108	considered necessary regarding possible violations of this
109	109	Subchapter by a hospital, including:
110	110	(1) examination of the hospital's premises;
111	111	(2) on written request to the chief operating officer
112	112	of the hospital, examination of any record, book, document,
113	113	account, or paper necessary to investigate the alleged violation;
114	114	(3) requiring the hospital to file a statement or
115	115	report or answer interrogatories in writing relating to all
116	116	information relevant to the alleged violations; and
117	117	(4) subpoena examination under oath of any person who
118	118	possesses knowledge or information directly related to the alleged
119	119	violations.
120	120	(d) If the attorney general has reason to believe that a
121	121	hospital has violated this Subchapter, the attorney general may
122	122	bring action on behalf of the state against the hospital to obtain
123	123	temporary, preliminary, or permanent injunctive relief for any act,
124	124	policy, or practice by the hospital that violates this Subchapter.
125	125	Before bringing an action, the attorney general may permit the
126	126	hospital to submit a correction plan for the attorney general's
127	127	approval.
128	128	(e) The attorney general may seek a civil monetary penalty
129	129	not to exceed $1,000 per violation per day if a hospital, by pattern
130	130	or practice, knowingly violates this Subchapter.
131	131	(f) In an action filed under this Subchapter, the attorney
132	132	general may seek the recovery of court costs and legal fees.
133	133	(g) If a court grants a final order of relief against a
134	134	nonprofit hospital for a violation of this Subchapter, the
135	135	attorney general shall notify each taxing authority that has
136	136	granted the nonprofit hospital a tax exemption about the court's
137	137	decision.
138	138	(h) The attorney general shall establish a complaint
139	139	process through which the public may file complaints involving
140	140	violations of this Subchapter. The complaint process at a minimum
141	141	must include:
142	142	(1) a mail address, a toll-free telephone number, and
143	143	an e-mail address for receiving complaints;
144	144	(2) a public education campaign concerning the
145	145	obligations hospitals have to the public under this Subchapter;
146	146	(3) a public education campaign concerning the
147	147	attorney general's complaint process; and
148	148	(4) complaint forms and instructions to aid the public
149	149	in making complaints.
150	150	(i) The attorney general shall prepare and publicly
151	151	distribute, including posting in a conspicuous location on the
152	152	attorney general's website, an annual report that informs the
153	153	public of the attorney general's activities under this Subchapter
154	154	for the previous year.
155	155	SECTION 4. This Act takes effect September 1, 2009.