84R24075 LED-F
By: Hancock, et al. S.B. No. 481
(Smithee)
Substitute the following for S.B. No. 481: No.
A BILL TO BE ENTITLED
AN ACT
relating to consumer information concerning facility-based
physicians and notice and availability of mediation for balance
billing by a facility-based physician.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 324.001(8), Health and Safety Code, is
amended to read as follows:
(8) "Facility-based physician" means a radiologist,
an anesthesiologist, a pathologist, an emergency department
physician, [or] a neonatologist, or an assistant surgeon.
SECTION 2. Section 1456.001(3), Insurance Code, is amended
to read as follows:
(3) "Facility-based physician" means a radiologist,
an anesthesiologist, a pathologist, an emergency department
physician, [or] a neonatologist, or an assistant surgeon:
(A) to whom the facility has granted clinical
privileges; and
(B) who provides services to patients of the
facility under those clinical privileges.
SECTION 3. Section 1456.004(c), Insurance Code, is amended
to read as follows:
(c) A facility-based physician who bills a patient covered
by a preferred provider benefit plan or a health benefit plan under
Chapter 1551 that does not have a contract with the facility-based
physician shall send a billing statement to the patient that
contains a conspicuous, plain-language explanation [with
information sufficient to notify the patient] of the mandatory
mediation process available under Chapter 1467 if the amount for
which the enrollee is responsible to the physician, after
copayments, deductibles, and coinsurance, including the amount
unpaid by the administrator or insurer, is greater than $500
[$1,000].
SECTION 4. Section 1467.001(4), Insurance Code, is amended
to read as follows:
(4) "Facility-based physician" means a radiologist,
an anesthesiologist, a pathologist, an emergency department
physician, [or] a neonatologist, or an assistant surgeon:
(A) to whom the facility has granted clinical
privileges; and
(B) who provides services to patients of the
facility under those clinical privileges.
SECTION 5. Section 1467.051(a), Insurance Code, is amended
to read as follows:
(a) An enrollee may request mediation of a settlement of an
out-of-network health benefit claim if:
(1) the amount for which the enrollee is responsible
to a facility-based physician, after copayments, deductibles, and
coinsurance, including the amount unpaid by the administrator or
insurer, is greater than $500 [$1,000]; and
(2) the health benefit claim is for a medical service
or supply provided by a facility-based physician in a hospital that
is a preferred provider or that has a contract with the
administrator.
SECTION 6. Sections 1456.004(c) and 1467.051(a), Insurance
Code, as amended by this Act, apply only to charges for a medical
service or supply provided on or after the effective date of this
Act. Charges for a medical service or supply provided before the
effective date of this Act are governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 7. This Act takes effect September 1, 2015.