Texas 2013 - 83rd Regular

Texas House Bill HB2700 Compare Versions

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1	1	83R20802 BEF-D
2	2	By: Bonnen of Galveston, et al. H.B. No. 2700
3	3	Substitute the following for H.B. No. 2700:
4	4	By: Bonnen of Galveston C.S.H.B. No. 2700
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the requirement that certain medical facilities and
10	10	physicians give patients a good faith estimate of the expected
11	11	payment for facility-based health care services before the services
12	12	are provided; providing an administrative penalty.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
15	15	amended by adding Chapter 326 to read as follows:
16	16	CHAPTER 326. GOOD FAITH ESTIMATE OF ACTUAL CHARGES FOR
17	17	FACILITY-BASED SERVICES
18	18	SUBCHAPTER A. GENERAL PROVISIONS
19	19	Sec. 326.001. DEFINITIONS. In this chapter:
20	20	(1) "Facility" means:
21	21	(A) an ambulatory surgical center licensed under
22	22	Chapter 243;
23	23	(B) a birthing center licensed under Chapter 244;
24	24	(C) a hospital licensed under Chapter 241; or
25	25	(D) an imaging center that is not part of another
26	26	facility.
27	27	(2) "Facility-based physician" means a radiologist,
28	28	an anesthesiologist, a pathologist, or a neonatologist.
29	29	(3) "Health care provider" means a facility, a
30	30	facility-based physician, or another physician required to provide
31	31	a good faith estimate under this chapter.
32	32	(4) "Medical implant" means an item, other than a
33	33	suture, implanted in a patient's body.
34	34	SUBCHAPTER B. GOOD FAITH ESTIMATE BY FACILITY AND FACILITY-BASED
35	35	PHYSICIAN
36	36	Sec. 326.051. ESTIMATE BY FACILITY. (a) A facility shall
37	37	provide to a person a good faith estimate as provided by this
38	38	chapter if the person:
39	39	(1) is expected to be admitted to the facility on a
40	40	nonemergency basis or receive a nonemergency procedure or service
41	41	at the facility; or
42	42	(2) may be admitted to the facility on a nonemergency
43	43	basis or receive a nonemergency procedure or service at the
44	44	facility and the person requests a good faith estimate from the
45	45	facility.
46	46	(b) A facility must provide a good faith estimate before
47	47	scheduling an admission, procedure, or service described by
48	48	Subsection (a).
49	49	(c) A facility shall provide to a person described by
50	50	Subsection (a) a good faith estimate of the actual charges, as
51	51	provided by Subchapter D, for facility fees and all procedures and
52	52	services, including diagnostic imaging, expected to be performed by
53	53	the facility and by facility-based physicians with whom the
54	54	facility has an agreement under Section 326.052(b) based on the
55	55	person's medical orders. The estimate must be based on
56	56	Diagnosis-Related Groups codes. The facility shall include with the
57	57	estimate a statement that the actual services performed at the
58	58	facility may differ from those provided in the estimate based on the
59	59	person's medical needs.
60	60	(d) A facility is not required to include in a good faith
61	61	estimate provided by the facility procedures or services performed
62	62	by a physician who is not a facility-based physician.
63	63	Sec. 326.052. ESTIMATE BY FACILITY-BASED PHYSICIAN. (a) A
64	64	facility-based physician shall provide a good faith estimate to a
65	65	person described by Section 326.051(a).
66	66	(b) A facility-based physician by contract may agree to
67	67	allow a facility to provide a good faith estimate of procedures and
68	68	services performed by the physician at the facility. The
69	69	facility-based physician is responsible for the estimate provided
70	70	by the facility according to the terms of the contract.
71	71	(c) A facility-based physician who does not enter into a
72	72	contract as provided by Subsection (b) must provide a good faith
73	73	estimate to a person before performing a procedure or service at a
74	74	facility in the same manner as a facility under Section 326.051.
75	75	Sec. 326.053. ESTIMATE OF ANESTHESIOLOGY SERVICES. (a) A
76	76	good faith estimate for anesthesiology services must be in the form
77	77	of a charge per unit of time and the expected number of units of time
78	78	required to complete the procedure or service originally ordered.
79	79	(b) A facility or anesthesiologist that provides a good
80	80	faith estimate of anesthesiology charges shall include with the
81	81	estimate a statement that the actual number of units of time
82	82	required to complete the procedure or service may differ from the
83	83	number provided in the estimate based on the person's medical
84	84	needs.
85	85	Sec. 326.054. ESTIMATE OF PATHOLOGY SERVICES. (a) A good
86	86	faith estimate for pathology services must be in the form of a
87	87	charge per specimen and the expected number of specimens required
88	88	for the procedure or service originally ordered.
89	89	(b) A facility or pathologist that provides a good faith
90	90	estimate of pathology charges shall include with the estimate a
91	91	statement that the actual number of specimens required may differ
92	92	from the number provided in the estimate based on the person's
93	93	medical needs.
94	94	Sec. 326.055. ESTIMATE FOR MEDICAL IMPLANTS. A
95	95	facility-based physician who provides to a person a good faith
96	96	estimate for a medical implant or a facility that provides to a
97	97	person a good faith estimate that includes a medical implant to be
98	98	implanted by a facility-based physician shall provide to the person
99	99	a list of all available medical implants that meet the person's
100	100	medical needs, including a good faith estimate of the actual
101	101	charges for each medical implant as provided by Subchapter D.
102	102	SUBCHAPTER C. GOOD FAITH ESTIMATE BY PHYSICIAN WHO WILL PERFORM
103	103	PROCEDURE OR SERVICE AT FACILITY
104	104	Sec. 326.101. ESTIMATE BY PHYSICIAN. (a) A physician who is
105	105	not a facility-based physician and who will perform for a person a
106	106	nonemergency procedure or service at a facility shall provide to
107	107	the person a good faith estimate for the procedure or service as
108	108	provided by this chapter.
109	109	(b) A physician must provide a good faith estimate before
110	110	scheduling a procedure or service described by Subsection (a).
111	111	(c) A physician shall provide to a person described by
112	112	Subsection (a) a good faith estimate of the physician's actual
113	113	charges, as provided by Subchapter D, for the procedure or service.
114	114	The estimate must be based on Diagnosis-Related Groups codes,
115	115	Current Procedural Terminology codes, or other applicable medical
116	116	billing codes. The physician shall include with the estimate a
117	117	statement that the actual services performed by the physician may
118	118	differ from those provided in the estimate based on the person's
119	119	medical needs.
120	120	(d) A physician is not required to include in a good faith
121	121	estimate provided by the physician facility fees, procedures, or
122	122	services performed by a facility or by facility-based physicians.
123	123	Sec. 326.102. GOOD FAITH ESTIMATE FOR MEDICAL IMPLANTS. A
124	124	physician who is not a facility-based physician and who provides to
125	125	a person a good faith estimate for a medical implant shall provide
126	126	to the person a list of all available medical implants that meet the
127	127	person's medical needs, including a good faith estimate of the
128	128	actual charges for each medical implant as provided by Subchapter
129	129	D.
130	130	SUBCHAPTER D. GOOD FAITH ESTIMATE OF ACTUAL CHARGES
131	131	Sec. 326.151. DISCLOSURE OF EXPECTED PAYMENT METHOD. A
132	132	health care provider shall ask a person to disclose the person's
133	133	anticipated method of payment for purposes of complying with this
134	134	subchapter.
135	135	Sec. 326.152. GOOD FAITH ESTIMATE FOR INSURED PERSONS. If a
136	136	person has an individual, group, or other private or commercial
137	137	health insurance plan or policy, including coverage through a
138	138	preferred provider organization or health maintenance
139	139	organization, a health care provider shall provide the person a
140	140	good faith estimate of:
141	141	(1) the amount the insurance plan or policy will
142	142	actually pay the health care provider for the fees, procedures, and
143	143	services described by Subchapter B or C based on the relevant
144	144	billing codes, the terms of the person's insurance plan or policy,
145	145	and the negotiated rate between the health care provider and the
146	146	insurance plan or policy, if applicable; and
147	147	(2) the amount of any copayment, coinsurance, or other
148	148	amount the person is expected to pay the health care provider for
149	149	the fees, procedures, and services described by Subchapter B or C
150	150	based on the relevant billing codes, the terms of the person's
151	151	insurance plan or policy, and the negotiated rate between the
152	152	health care provider and the person's insurance plan or policy, if
153	153	applicable.
154	154	Sec. 326.153. GOOD FAITH ESTIMATE FOR RECIPIENTS OF
155	155	GOVERNMENT-SPONSORED PROGRAM. If a person receives benefits under
156	156	a government-sponsored health benefits program, including the
157	157	Medicaid program, the Medicare program, the Children's Health
158	158	Insurance Program (CHIP), and the TRICARE military health system, a
159	159	health care provider shall provide the person a good faith estimate
160	160	of:
161	161	(1) the amount the government-sponsored health
162	162	benefits program will actually pay the health care provider for the
163	163	fees, procedures, and services described by Subchapter B or C based
164	164	on the relevant billing codes; and
165	165	(2) any amount the person is expected to pay the health
166	166	care provider for fees, procedures, and services described by
167	167	Subchapter B or C based on the relevant billing codes under the
168	168	terms of the government-sponsored health benefits program.
169	169	Sec. 326.154. GOOD FAITH ESTIMATE FOR RECIPIENTS OF
170	170	WORKERS' COMPENSATION BENEFITS. If a person receives benefits under
171	171	a workers' compensation claim, a health care provider shall provide
172	172	the person a good faith estimate of:
173	173	(1) the amount the workers' compensation insurance
174	174	carrier, workers' compensation claims processor, employer, or
175	175	other payor will actually pay the health care provider for the fees,
176	176	procedures, and services described by Subchapter B or C based on the
177	177	relevant billing codes; and
178	178	(2) the amount the person is expected to pay the health
179	179	care provider for the fees, procedures, and services described by
180	180	Subchapter B or C based on the relevant billing codes, if any.
181	181	Sec. 326.155. STATEMENT FOR PERSONS PAYING CASH, PERSONS
182	182	RECEIVING CHARITY CARE, AND INDIGENT PERSONS. If a person will pay
183	183	cash or will receive charity care for an admission, procedure, or
184	184	service or if a person is indigent, a health care provider shall
185	185	provide the person with a statement of:
186	186	(1) the average amount the health care provider was
187	187	actually paid for the fees, procedures, and services described by
188	188	Subchapter B or C based on the relevant billing codes by the five
189	189	insurance carriers or government-sponsored programs described by
190	190	Sections 326.152, 326.153, and 326.154 that paid the health care
191	191	provider for the greatest number of the applicable fees,
192	192	procedures, and services in the preceding calendar year, or in the
193	193	current calendar year if the health care provider did not practice
194	194	in the preceding calendar year; and
195	195	(2) the average amount the health care provider was
196	196	actually paid by patients described by this section for the
197	197	applicable fees, procedures, and services in that year.
198	198	SUBCHAPTER E. ADMINISTRATIVE PENALTY
199	199	Sec. 326.201. ADMINISTRATIVE PENALTY AUTHORIZED. (a) The
200	200	commissioner of insurance may impose an administrative penalty on a
201	201	facility or physician that violates this chapter.
202	202	(b) The amount of the penalty may not exceed $1,000 for each
203	203	violation.
204	204	(c) Chapter 84, Insurance Code, governs the imposition,
205	205	enforcement, and collection of the administrative penalty.
206	206	SECTION 2. The changes in law made by this Act apply only to
207	207	an admission, procedure, or service ordered or provided on or after
208	208	the effective date of this Act. An admission, procedure, or service
209	209	ordered or provided before the effective date of this Act is
210	210	governed by the law in effect on the date the admission, procedure,
211	211	or service was ordered or provided, and the former law is continued
212	212	in effect for that purpose.
213	213	SECTION 3. This Act takes effect January 1, 2014.