83R5326 JSC-F
By: Sheffield of Coryell H.B. No. 3020
A BILL TO BE ENTITLED
AN ACT
relating to disclosure of the price charged by a health care
provider for a health care service or supply; providing penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. This Act may be cited as the Texas Health Care
Pricing Disclosure Act.
SECTION 2. The heading to Subchapter H, Chapter 101,
Occupations Code, is amended to read as follows:
SUBCHAPTER H. BILLING AND PRICING INFORMATION
SECTION 3. Subchapter H, Chapter 101, Occupations Code, is
amended by adding Section 101.3515 to read as follows:
Sec. 101.3515. PRICING INFORMATION. (a) In this section:
(1) "Bundled health care services and supplies" means
for pricing purposes the grouping of multiple health care services
and supplies provided by a health care provider to a patient during
one visit to or treatment by the provider.
(2) "Health care price" means the total amount of
compensation a health care provider accepts as payment in full for a
health care service or supply or bundled health care services and
supplies provided to a patient.
(3) "Health care provider" means:
(A) a health care professional who performs a
health care service or provides a health care supply in this state
under a license, certificate, registration, or other authority
issued by this state to diagnose, prevent, alleviate, or cure a
human illness or injury, including a physician and dentist;
(B) a health care facility that provides a health
care service or supply in this state under a license, certificate,
registration, or other authority issued by this state to diagnose,
prevent, alleviate, or cure a human illness or injury, including an
institutional health care provider; or
(C) a person that provides to patients in this
state ancillary health care-related services and supplies under a
license, certificate, or registration issued by this state, or that
is otherwise authorized to provide to patients in this state
ancillary health care-related services and supplies ordered or
authorized by a licensed health care professional, to diagnose,
prevent, alleviate, or cure a human illness or injury, including
laboratory services, radiological services, and durable medical
equipment.
(b) Each health care provider shall compile a pricing
information list that lists the prices of certain frequently
performed services. A health care facility that provides inpatient
care shall list the prices for the 25 most frequently performed
procedures of each department in the facility based on the 25 most
frequently coded Diagnosis-Related Groups codes for that
department. A health care facility that provides outpatient care
shall list the prices for the 25 most frequently performed
procedures of each department in the facility based on the 25 most
frequently coded Ambulatory Payment Classification codes for that
department. A physician or other practitioner shall list the
prices for the 10 most frequently performed procedures of the
physician or other practitioner based on the 10 most frequently
coded Current Procedural Terminology codes.
(c) The health care provider may choose to disclose its
prices under Subsection (b) in either of the following formats:
(1) the prices of each health care service and each
health care supply; or
(2) the prices of each set of bundled health care
services and supplies.
(d) For each service in the pricing information list under
Subsection (b), a health care provider shall disclose:
(1) the highest charge the patient can expect to pay;
and
(2) the lowest discounted charge accepted for that
service from a payor.
(e) A health care provider shall make the provider's pricing
information list under Subsection (b) available to the public in
the form and manner determined by the provider.
(f) This section does not apply to a health care price of a
health care service or supply or bundled health care services and
supplies provided to:
(1) a patient for whom a health care provider has
accepted assignment for the health care service or supply from
Medicaid or Medicare or any other federal, state, or local
government-sponsored medical assistance program; or
(2) a financially or medically indigent person who
qualifies for indigent health care services based on:
(A) a sliding fee scale; or
(B) a health care provider's written charity care
policy.
(g) Each health care provider shall:
(1) compile a pricing information list under
Subsection (b);
(2) post on the provider's Internet website or
otherwise make public the pricing information list and the
effective date of the list before providing a health care service or
supply or bundled health care services and supplies to a patient;
and
(3) not less than 30 days before changing the health
care price of a health care service or supply or bundled health care
services and supplies provided by the provider to the patient,
provide notice of the price change by posting the notice on the
provider's Internet website or by another method of publication or
dissemination that the provider uses for the list.
(h) A health care provider may not:
(1) charge an amount that is different from the amount
listed as the health care price in the pricing information list
under Subsection (b) for a health care service or supply or bundled
health care services and supplies provided to a patient; or
(2) include a discount, bonus, fee, or other charge
that changes the health care price listed in the pricing
information list under Subsection (b).
(i) Notwithstanding Subsection (h), a health care provider
may accept or negotiate a payment that is less than the health care
price listed in the pricing information list under Subsection (b)
from an individual patient. A health care provider may not accept
or negotiate a payment that is less than the health care price
listed in the pricing information list under Subsection (b) from a
third party payor.
(j) A health care provider that violates this section is
subject to an administrative penalty, a civil penalty, or other
disciplinary action, as applicable, in the same manner as if the
provider violated the law under which the provider is licensed,
certified, registered, or authorized.
SECTION 4. Notwithstanding Section 101.3515, Occupations
Code, as added by this Act, a health care provider is not required
to comply with the change in law made by that section until
September 1, 2014.
SECTION 5. This Act takes effect September 1, 2013.