84R11368 AJA-D
By: Frullo H.B. No. 3102
A BILL TO BE ENTITLED
AN ACT
relating to the disclosure by health care practitioners and
facilities of patient liability for payment for certain health care
services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Chapter 1456, Insurance Code, is
amended to read as follows:
CHAPTER 1456. DISCLOSURE OF PROVIDER STATUS AND PATIENT LIABILITY
SECTION 2. Section 1456.003(a), Insurance Code, is amended
to read as follows:
(a) Each health benefit plan that provides health care
through a provider network shall provide notice to its enrollees
that:
(1) a facility-based physician or other health care
practitioner may not be included in the health benefit plan's
provider network; and
(2) subject to Subchapter D, Chapter 324, Health and
Safety Code, a health care practitioner described by Subdivision
(1) may balance bill the enrollee for amounts not paid by the health
benefit plan.
SECTION 3. Section 1456.007, Insurance Code, is amended to
read as follows:
Sec. 1456.007. HEALTH BENEFIT PLAN ESTIMATE OF CHARGES. A
health benefit plan that must comply with this chapter under
Section 1456.002 shall, on the request of an enrollee, provide an
estimate of payments that will be made for any health care service
or supply and shall also specify any applicable deductibles,
copayments, or coinsurance[, or other amounts for which the
enrollee is responsible]. The estimate must be provided not later
than the 10th business day after the date on which the estimate was
requested. A health benefit plan must advise the enrollee that:
(1) the actual payment and charges for the services or
supplies will vary based upon the enrollee's actual medical
condition and other factors associated with performance of medical
services; and
(2) subject to Subchapter D, Chapter 324, Health and
Safety Code, the enrollee may be personally liable for the payment
of services or supplies based upon the enrollee's health benefit
plan coverage.
SECTION 4. Chapter 324, Health and Safety Code, is amended
by adding Subchapter D to read as follows:
SUBCHAPTER D. PRICE DISCLOSURE
Sec. 324.151. DEFINITIONS. Notwithstanding Section
324.001, in this subchapter:
(1) "Health care facility" means a hospital, emergency
clinic, outpatient clinic, birthing center, ambulatory surgical
center, or other facility providing health care services.
(2) "Health care practitioner" means an individual who
is licensed to provide and provides health care services.
Sec. 324.152. PRICE DISCLOSURE BY HEALTH CARE PRACTITIONERS
AND FACILITIES. (a) At least three business days before providing a
health care service other than emergency care, as defined by
Section 1301.155, Insurance Code, to a patient, a health care
practitioner or facility must disclose to the patient the price
that will be accepted as payment in full for the service. The
disclosure required by this section must be provided in writing in a
readily understandable manner.
(b) Notwithstanding another provision of this subchapter,
Chapter 1456, Insurance Code, or any other law, a health care
practitioner or facility that does not make a disclosure required
by this section before providing a health care service may not:
(1) attempt to collect from the patient, by lawsuit or
otherwise, any billed amount that would otherwise be owed by the
patient for the service;
(2) transfer or sell to a third party the right to
collect any billed amount that would otherwise be owed by the
patient for the service; or
(3) furnish adverse information to a consumer
reporting agency regarding any billed amount that would otherwise
be owed by the patient for the service.
Sec. 324.153. DUPLICATIVE ESTIMATE NOT REQUIRED. A
facility that receives a request for an estimate under Section
324.101(d) may provide, instead of an estimate, the price
disclosure required by this subchapter. A facility that provides
an estimate under Section 324.101(d) is not relieved of the
obligation to provide a price disclosure under this subchapter.
Sec. 324.154. PATIENT HELD HARMLESS. In addition to any
other remedy provided by this subchapter or other law, a health care
practitioner or facility shall hold a patient harmless from any
damages resulting from the practitioner's or facility's violation
of this subchapter.
SECTION 5. The change in law made by this Act applies only
to a service provided by a health care practitioner or facility on
or after January 1, 2016. A service provided by a health care
practitioner or facility before January 1, 2016, is 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, 2015.