Texas 2009 - 81st Regular

Texas Senate Bill SB1747 Compare Versions

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

Old	New	Differences
1	1	81R7500 YDB-D
2	2	By: Duncan S.B. No. 1747
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to billing practices for certain health care facilities
8	8	and providers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 324.001, Health and Safety Code, is
11	11	amended by adding Subdivision (8) to read as follows:
12	12	(8) "Preferred provider" means a facility that
13	13	contracts to provide medical care or health care to participants or
14	14	beneficiaries of a health plan in accordance with agreed
15	15	reimbursement rates.
16	16	SECTION 2. Section 324.101, Health and Safety Code, is
17	17	amended by amending Subsections (e) and (f) and adding Subsections
18	18	(f-1), (f-2), (f-3), (f-4), (f-5), and (f-6) to read as follows:
19	19	(e) A facility shall provide to the consumer at the
20	20	consumer's request an itemized statement of the billed charges
21	21	[services] if the consumer requests the statement not later than
22	22	the first anniversary of the date the person is discharged from the
23	23	facility. The facility shall provide the statement to the consumer
24	24	not later than the 10th business day after the date on which the
25	25	statement is requested. The facility may provide the consumer with
26	26	an electronic copy of the itemized statement.
27	27	(f) If the billed charges exceed $20,000, the [A] facility
28	28	shall provide an itemized statement of the billed charges
29	29	[services] to a third-party payor who is actually or potentially
30	30	responsible for paying all or part of the billed charges for
31	31	providing services [provided] to a patient [and who has received a
32	32	claim for payment of those services. To be entitled to receive a
33	33	statement, the third-party payor must request the statement from
34	34	the facility and must have received a claim for payment. The
35	35	request must be made not later than one year after the date on which
36	36	the payor received the claim for payment]. The facility shall
37	37	provide the statement to the payor with the facility's claim for
38	38	payment.
39	39	(f-1) A third-party payor may request an itemized statement
40	40	for billed charges of $20,000 or less.
41	41	(f-2) After receiving an itemized statement under
42	42	Subsection (f) or (f-1), a third-party payor may request additional
43	43	information, including medical records and operative reports.
44	44	(f-3) The facility shall provide the statement requested
45	45	under Subsection (f-1) or information requested under Subsection
46	46	(f-2) as soon as practicable. The third-party payor and the
47	47	facility may agree to allow the itemized statement and the
48	48	additional information to be requested simultaneously to
49	49	facilitate investigation and payment of billed charges. The days
50	50	between the date a third-party payor requests an itemized statement
51	51	or additional information from the facility and the date the payor
52	52	receives the statement or information may not be counted in a
53	53	payment 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 services, the third-party payor is
60	60	entitled to [may request] an itemized statement of only the billed
61	61	charges [services] for which payment is claimed or to which any
62	62	deduction or copayment applies.
63	63	(f-6) A third-party payor that requests an itemized
64	64	statement or additional information under Subsection (f-1) or (f-2)
65	65	must have evidence sufficient to prove the date the payor made the
66	66	request, which may include a certified mail receipt or an
67	67	electronic date stamp. Unless rebutted by sufficient evidence
68	68	provided by a facility, the date the payor receives the statement or
69	69	additional information, as shown in the payor's records, is
70	70	presumed to be the date of receipt for purposes of Subsection (f-3).
71	71	SECTION 3. Section 324.103, Health and Safety Code, is
72	72	amended to read as follows:
73	73	Sec. 324.103. [CONSUMER] WAIVER PROHIBITED. The
74	74	provisions of this chapter may not be waived, voided, or nullified
75	75	by a contract or an agreement between a facility and a consumer or
76	76	third-party payor.
77	77	SECTION 4. Subchapter C, Chapter 324, Health and Safety
78	78	Code, is amended by adding Sections 324.104, 324.105, and 324.106
79	79	to read as follows:
80	80	Sec. 324.104. CLAIM FOR PAYMENT FROM PREFERRED PROVIDER.
81	81	(a) A preferred provider that directly or through its agent or
82	82	assignee asserts that a claim for payment of a medical or health
83	83	care service or supply provided to a consumer, including a claim for
84	84	payment of the amount due for a disallowed discount on the service
85	85	or supply provided, has not been timely or accurately paid shall
86	86	provide written notification of the nonpayment or inaccuracy to the
87	87	third-party payor not later than the 180th day after the earlier of
88	88	the date the preferred provider received payment from the payor or
89	89	the date that payment was due. A preferred provider or agent that
90	90	fails to provide the notification before the 180th day is barred
91	91	from asserting the claim of nonpayment or inaccuracy.
92	92	(b) If a patient is admitted to a preferred provider for
93	93	more than 15 days, the preferred provider on request of a
94	94	third-party payor shall provide an interim statement of the
95	95	facility's billed charges to the third-party payor not later than
96	96	the 10th day after the date the third-party payor submits the
97	97	request.
98	98	Sec. 324.105. OVERPAYMENT AND REIMBURSEMENT. (a) Not
99	99	later than the 45th day after the date a preferred provider receives
100	100	a written notice of overpayment and request for reimbursement from
101	101	a third-party payor or the preferred provider makes a determination
102	102	that it has received an overpayment, the preferred provider shall
103	103	reimburse the third-party payor for any payment amount that exceeds
104	104	the amount owed to the preferred provider for an eligible charge.
105	105	(b) A preferred provider that fails to make a reimbursement
106	106	required by this section shall pay, in addition to the
107	107	reimbursement, a late payment penalty in an amount equal to 10
108	108	percent of the amount of the required reimbursement.
109	109	Sec. 324.106. COLLECTION OF BILLED CHARGES BY OTHERS. A
110	110	person collecting a billed charge of a facility subject to this
111	111	chapter shall comply with the requirements of this chapter before
112	112	submitting a demand for payment. This section applies without
113	113	regard to whether the person collecting the billed charge is acting
114	114	on behalf of the facility or otherwise.
115	115	SECTION 5. The changes in law made by this Act to Chapter
116	116	324, Health and Safety Code, apply only to services or supplies
117	117	provided by a health care facility to a consumer on or after the
118	118	effective date of this Act. Services or supplies provided before
119	119	the effective date of this Act are governed by the law in effect
120	120	immediately before the effective date of this Act, and that law is
121	121	continued in effect for that purpose.
122	122	SECTION 6. This Act takes effect September 1, 2009.