81R7500 YDB-D
By: Duncan S.B. No. 1747
A BILL TO BE ENTITLED
AN ACT
relating to billing practices for certain health care facilities
and providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 324.001, Health and Safety Code, is
amended by adding Subdivision (8) to read as follows:
(8) "Preferred provider" means a facility that
contracts to provide medical care or health care to participants or
beneficiaries of a health plan in accordance with agreed
reimbursement rates.
SECTION 2. Section 324.101, Health and Safety Code, is
amended by amending Subsections (e) and (f) and adding Subsections
(f-1), (f-2), (f-3), (f-4), (f-5), and (f-6) to read as follows:
(e) A facility shall provide to the consumer at the
consumer's request an itemized statement of the billed charges
[services] if the consumer requests the statement not later than
the first anniversary of the date the person is discharged from the
facility. The facility shall provide the statement to the consumer
not later than the 10th business day after the date on which the
statement is requested. The facility may provide the consumer with
an electronic copy of the itemized statement.
(f) If the billed charges exceed $20,000, the [A] facility
shall provide an itemized statement of the billed charges
[services] to a third-party payor who is actually or potentially
responsible for paying all or part of the billed charges for
providing 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 with the facility's claim for
payment.
(f-1) A third-party payor may request an itemized statement
for billed charges of $20,000 or less.
(f-2) After receiving an itemized statement under
Subsection (f) or (f-1), a third-party payor may request additional
information, including medical records and operative reports.
(f-3) The facility shall provide the statement requested
under Subsection (f-1) or information requested under Subsection
(f-2) as soon as practicable. The third-party payor and the
facility may agree to allow the itemized statement and the
additional information to be requested simultaneously to
facilitate investigation and payment of billed charges. The days
between the date a third-party payor requests an itemized statement
or additional information from the facility and the date the payor
receives the statement or information may not be counted in a
payment period established by statute or under contract.
(f-4) The facility may provide the third-party payor with an
electronic copy of an itemized statement under this section [not
later than the 30th day after the date on which the payor requests
the statement].
(f-5) If a third-party payor receives a claim for payment of
part [but not all] of the billed services, the third-party payor is
entitled to [may request] an itemized statement of only the billed
charges [services] for which payment is claimed or to which any
deduction or copayment applies.
(f-6) A third-party payor that requests an itemized
statement or additional information under Subsection (f-1) or (f-2)
must have evidence sufficient to prove the date the payor made the
request, which may include a certified mail receipt or an
electronic date stamp. Unless rebutted by sufficient evidence
provided by a facility, the date the payor receives the statement or
additional information, as shown in the payor's records, is
presumed to be the date of receipt for purposes of Subsection (f-3).
SECTION 3. Section 324.103, Health and Safety Code, is
amended to read as follows:
Sec. 324.103. [CONSUMER] WAIVER PROHIBITED. The
provisions of this chapter may not be waived, voided, or nullified
by a contract or an agreement between a facility and a consumer or
third-party payor.
SECTION 4. Subchapter C, Chapter 324, Health and Safety
Code, is amended by adding Sections 324.104, 324.105, and 324.106
to read as follows:
Sec. 324.104. CLAIM FOR PAYMENT FROM PREFERRED PROVIDER.
(a) A preferred provider that directly or through its agent or
assignee asserts that a claim for payment of a medical or health
care service or supply provided to a consumer, including a claim for
payment of the amount due for a disallowed discount on the service
or supply provided, has not been timely or accurately paid shall
provide written notification of the nonpayment or inaccuracy to the
third-party payor not later than the 180th day after the earlier of
the date the preferred provider received payment from the payor or
the date that payment was due. A preferred provider or agent that
fails to provide the notification before the 180th day is barred
from asserting the claim of nonpayment or inaccuracy.
(b) If a patient is admitted to a preferred provider for
more than 15 days, the preferred provider on request of a
third-party payor shall provide an interim statement of the
facility's billed charges to the third-party payor not later than
the 10th day after the date the third-party payor submits the
request.
Sec. 324.105. OVERPAYMENT AND REIMBURSEMENT. (a) Not
later than the 45th day after the date a preferred provider receives
a written notice of overpayment and request for reimbursement from
a third-party payor or the preferred provider makes a determination
that it has received an overpayment, the preferred provider shall
reimburse the third-party payor for any payment amount that exceeds
the amount owed to the preferred provider for an eligible charge.
(b) A preferred provider that fails to make a reimbursement
required by this section shall pay, in addition to the
reimbursement, a late payment penalty in an amount equal to 10
percent of the amount of the required reimbursement.
Sec. 324.106. COLLECTION OF BILLED CHARGES BY OTHERS. A
person collecting a billed charge of a facility subject to this
chapter shall comply with the requirements of this chapter before
submitting a demand for payment. This section applies without
regard to whether the person collecting the billed charge is acting
on behalf of the facility or otherwise.
SECTION 5. The changes in law made by this Act to Chapter
324, Health and Safety Code, apply only to services or supplies
provided by a health care facility to a consumer on or after the
effective date of this Act. Services or supplies provided before
the effective date of this Act are governed by the law in effect
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 6. This Act takes effect September 1, 2009.