Texas 2015 - 84th Regular

Texas Senate Bill SB481 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	84R24075 LED-F
2		-	By: Hancock, et al. S.B. No. 481
3		-	(Smithee)
4		-	Substitute the following for S.B. No. 481: No.
	1	+	S.B. No. 481
5	2
6	3
7		-	A BILL TO BE ENTITLED
8	4		AN ACT
9	5		relating to consumer information concerning facility-based
10	6		physicians and notice and availability of mediation for balance
11	7		billing by a facility-based physician.
12	8		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	9		SECTION 1. Section 324.001(8), Health and Safety Code, is
14	10		amended to read as follows:
15	11		(8) "Facility-based physician" means a radiologist,
16	12		an anesthesiologist, a pathologist, an emergency department
17	13		physician, [or] a neonatologist, or an assistant surgeon.
18	14		SECTION 2. Section 1456.001(3), Insurance Code, is amended
19	15		to read as follows:
20	16		(3) "Facility-based physician" means a radiologist,
21	17		an anesthesiologist, a pathologist, an emergency department
22	18		physician, [or] a neonatologist, or an assistant surgeon:
23	19		(A) to whom the facility has granted clinical
24	20		privileges; and
25	21		(B) who provides services to patients of the
26	22		facility under those clinical privileges.
27	23		SECTION 3. Section 1456.004(c), Insurance Code, is amended
28	24		to read as follows:
29	25		(c) A facility-based physician who bills a patient covered
30	26		by a preferred provider benefit plan or a health benefit plan under
31	27		Chapter 1551 that does not have a contract with the facility-based
32	28		physician shall send a billing statement to the patient that
33	29		contains a conspicuous, plain-language explanation [with
34	30		information sufficient to notify the patient] of the mandatory
35	31		mediation process available under Chapter 1467 if the amount for
36	32		which the enrollee is responsible to the physician, after
37	33		copayments, deductibles, and coinsurance, including the amount
38	34		unpaid by the administrator or insurer, is greater than $500
39	35		[$1,000].
40	36		SECTION 4. Section 1467.001(4), Insurance Code, is amended
41	37		to read as follows:
42	38		(4) "Facility-based physician" means a radiologist,
43	39		an anesthesiologist, a pathologist, an emergency department
44	40		physician, [or] a neonatologist, or an assistant surgeon:
45	41		(A) to whom the facility has granted clinical
46	42		privileges; and
47	43		(B) who provides services to patients of the
48	44		facility under those clinical privileges.
49	45		SECTION 5. Section 1467.051(a), Insurance Code, is amended
50	46		to read as follows:
51	47		(a) An enrollee may request mediation of a settlement of an
52	48		out-of-network health benefit claim if:
53	49		(1) the amount for which the enrollee is responsible
54	50		to a facility-based physician, after copayments, deductibles, and
55	51		coinsurance, including the amount unpaid by the administrator or
56	52		insurer, is greater than $500 [$1,000]; and
57	53		(2) the health benefit claim is for a medical service
58	54		or supply provided by a facility-based physician in a hospital that
59	55		is a preferred provider or that has a contract with the
60	56		administrator.
61	57		SECTION 6. Sections 1456.004(c) and 1467.051(a), Insurance
62	58		Code, as amended by this Act, apply only to charges for a medical
63	59		service or supply provided on or after the effective date of this
64	60		Act. Charges for a medical service or supply provided before the
65	61		effective date of this Act are governed by the law as it existed
66	62		immediately before the effective date of this Act, and that law is
67	63		continued in effect for that purpose.
68	64		SECTION 7. This Act takes effect September 1, 2015.
	65	+	______________________________ ______________________________
	66	+	President of the Senate Speaker of the House
	67	+	I hereby certify that S.B. No. 481 passed the Senate on
	68	+	April 9, 2015, by the following vote: Yeas 28, Nays 3; and that
	69	+	the Senate concurred in House amendment on May 22, 2015, by the
	70	+	following vote: Yeas 29, Nays 2.
	71	+	______________________________
	72	+	Secretary of the Senate
	73	+	I hereby certify that S.B. No. 481 passed the House, with
	74	+	amendment, on May 18, 2015, by the following vote: Yeas 137,
	75	+	Nays 1, one present not voting.
	76	+	______________________________
	77	+	Chief Clerk of the House
	78	+	Approved:
	79	+	______________________________
	80	+	Date
	81	+	______________________________
	82	+	Governor