82R901 TRH-F
By: J. Davis of Harris H.B. No. 705
A BILL TO BE ENTITLED
AN ACT
relating to certain prohibited practices concerning the payment of
copayments and deductibles under health benefit plans; providing a
civil penalty and for injunctive relief.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Chapter 552, Insurance Code, is
amended to read as follows:
CHAPTER 552. ILLEGAL PRICING AND PAYMENT PRACTICES
SECTION 2. Sections 552.001, 552.002, and 552.003,
Insurance Code, are designated as Subchapter A, Chapter 552,
Insurance Code, and a heading is added to Subchapter A to read as
follows:
SUBCHAPTER A. ILLEGAL PRICING PRACTICES
SECTION 3. Section 552.001, Insurance Code, is amended to
read as follows:
Sec. 552.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. (a)
This subchapter [chapter] does not apply to the provision of a
health care service to a:
(1) Medicaid or Medicare patient or a patient who is
covered by a federal, state, or local government-sponsored indigent
health care program;
(2) financially or medically indigent person who
qualifies for indigent health care services based on:
(A) a sliding fee scale; or
(B) a written charity care policy established by
a health care provider; or
(3) person who is not covered by a health insurance
policy or other health benefit plan that provides benefits for the
services and qualifies for services for the uninsured based on a
written policy established by a health care provider.
(b) This subchapter [chapter] does not permit the
establishment of health care provider policies or contracts that
violate any other state or federal law.
(c) This subchapter [chapter] does not prohibit a health
care provider from entering into a contract to provide services
covered by a health insurance policy or other health benefit plan
with:
(1) the issuer of the health insurance policy or other
health benefit plan; or
(2) a preferred provider organization that contracts
with the issuer of the health insurance policy or other health
benefit plan.
SECTION 4. Chapter 552, Insurance Code, is amended by
adding Subchapter B to read as follows:
SUBCHAPTER B. ILLEGAL PAYMENT PRACTICES
Sec. 552.051. DEFINITIONS. In this subchapter:
(1) "Enrollee" means an individual entitled to
coverage under a health benefit plan.
(2) "Health benefit plan" means a plan that provides
benefits for hospital, medical, surgical, or other treatment
expenses incurred as a result of a health condition, an accident, or
sickness, including an individual, group, blanket, or franchise
health insurance policy or insurance agreement, a group hospital
service contract, an individual or group evidence of coverage, or
any other similar coverage document. The term includes a
self-funded plan that is otherwise described by this subdivision.
(3) "Health care provider" means an individual or
entity that is licensed or otherwise authorized to provide health
care services or supplies in this state. The term includes:
(A) an individual licensed under or otherwise
subject to Title 3, Occupations Code; and
(B) a public or private entity licensed under
Subtitle B, Title 4, or Subtitle C, Title 7, Health and Safety Code.
Sec. 552.052. DUTY TO COLLECT COPAYMENT OR DEDUCTIBLE;
CERTAIN WAIVERS PROHIBITED. (a) Except as provided by Subsection
(b), a health care provider:
(1) shall make a good faith effort to collect any
applicable copayment or deductible from each enrollee in a health
benefit plan; and
(2) based on an enrollee's coverage under a health
benefit plan, may not waive, in cash or in kind, all or part of any
applicable copayment or deductible under the health benefit plan to
induce or encourage the enrollee to purchase, order, use, or lease
any facility, service, or supply.
(b) A health care provider may waive any applicable
copayment or deductible for an enrollee if the enrollee
demonstrates special financial need or hardship.
Sec. 552.053. CIVIL PENALTY; INJUNCTION. (a) If it
appears that an individual or entity has violated or is violating
this subchapter, a district or county attorney in the jurisdiction
where the violation is alleged to have occurred or may occur may
institute a civil suit for:
(1) an order enjoining the violation;
(2) a permanent or temporary injunction, a temporary
restraining order, or other appropriate remedy if the district or
county attorney shows that the individual or entity has engaged in
or is engaging in a violation;
(3) the assessment and recovery of a civil penalty; or
(4) both injunctive relief and a civil penalty.
(b) A civil penalty may not exceed $25,000 a day for each
violation. Each day the violation occurs constitutes a separate
violation for the purposes of the assessment of a civil penalty.
(c) In determining the amount of the civil penalty, the
court hearing the matter shall consider:
(1) the individual's or entity's history of previous
violations;
(2) the seriousness of the violation;
(3) the hazard to the health and safety of the public;
(4) the demonstrated good faith of the individual or
entity charged; and
(5) any other matter that justice may require.
(d) A civil penalty recovered in a suit instituted by a
local government under this subchapter shall be paid to the local
government.
(e) The district or county attorney, as appropriate, may
recover, on behalf of the local government, reasonable expenses
incurred in obtaining injunctive relief or a civil penalty under
this section, including investigation and court costs, reasonable
attorney's fees, witness fees, and other expenses.
SECTION 5. The change in law made by this Act applies only
to a health benefit plan copayment or deductible relating to a
facility, service, or supply provided by a health care provider on
or after the effective date of this Act. A health benefit plan
copayment or deductible relating to a facility, service, or supply
provided before the effective date of this Act is covered by the law
in effect on the date the facility, service, or supply is provided,
and that law is continued in effect for that purpose.
SECTION 6. This Act takes effect September 1, 2011.