Texas 2017 - 85th Regular

Texas House Bill HB307 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	85R3983 LED-F
2	2	By: Burrows H.B. No. 307
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to disclosure of certain health care costs and shared
8	8	savings between certain health benefit plans and enrollees.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Title 2, Health and Safety Code, is amended by
11	11	adding Subtitle J to read as follows:
12	12	SUBTITLE J. HEALTH CARE PRICE DISCLOSURES
13	13	CHAPTER 185. HEALTH CARE PRICE DISCLOSURES
14	14	Sec. 185.001. DEFINITIONS. In this chapter:
15	15	(1) "Facility" means a hospital, outpatient clinic,
16	16	birthing center, ambulatory surgical center, or other licensed
17	17	facility providing health care services. The term does not include
18	18	an emergency clinic, a freestanding emergency medical care
19	19	facility, or other facility providing only emergency care.
20	20	(2) "Patient" includes a prospective patient and a
21	21	personal representative of the patient.
22	22	(3) "Practitioner" means an individual who is licensed
23	23	to provide and provides medical or other health care services.
24	24	Sec. 185.002. PRICE DISCLOSURE OR ESTIMATE. (a) Before
25	25	providing a nonemergency health care service offered to the patient
26	26	by the facility or practitioner, a facility or practitioner shall
27	27	provide a price disclosure described by Subsection (b) or an
28	28	estimate described by Subsection (c), as applicable, unless
29	29	declined by the patient.
30	30	(b) Except as provided by Subsection (c), a facility or
31	31	practitioner required to provide a price disclosure under
32	32	Subsection (a) shall disclose to the patient the amount, including
33	33	facility fees, that:
34	34	(1) the patient's health benefit plan will reimburse
35	35	the facility or practitioner for the service, if the facility or
36	36	practitioner is a participating provider under the patient's health
37	37	benefit plan; or
38	38	(2) the facility or practitioner will charge for the
39	39	service, if the facility or practitioner is not a participating
40	40	provider under the patient's health benefit plan.
41	41	(c) If a facility or practitioner is unable to quote a
42	42	specific amount under Subsection (b) because of the facility's or
43	43	practitioner's inability to predict the specific service the
44	44	patient will need, the facility or practitioner shall provide an
45	45	estimate of the amount, including facility fees, that:
46	46	(1) the patient's health benefit plan will reimburse
47	47	the facility or practitioner for the predicted service, if the
48	48	facility or practitioner is a participating provider under the
49	49	patient's health benefit plan; or
50	50	(2) the facility or practitioner will charge for the
51	51	predicted service, if the facility or practitioner is not a
52	52	participating provider under the patient's health benefit plan.
53	53	(d) A facility or practitioner that provides an estimate
54	54	described by Subsection (c) shall:
55	55	(1) disclose the incomplete nature of the estimate;
56	56	and
57	57	(2) inform the patient that the facility or
58	58	practitioner may be able to provide an updated estimate after the
59	59	facility or practitioner obtains additional information.
60	60	(e) Notwithstanding any other law, a facility or
61	61	practitioner that does not provide the price disclosure or estimate
62	62	required by this section before providing a health care service for
63	63	which the price disclosure or estimate is required may not bill the
64	64	patient or the patient's health benefit plan for the service.
65	65	Sec. 185.003. EFFECT OF OTHER LAW. A facility that provides
66	66	an estimate under Section 324.101(d) is not relieved of the
67	67	obligation to provide a price disclosure or estimate under Section
68	68	185.002.
69	69	Sec. 185.004. PATIENT INFORMATION. On request, a facility
70	70	or practitioner shall provide a patient with sufficient information
71	71	about a proposed nonemergency health care service to enable the
72	72	patient to determine the amount for which the patient will be
73	73	personally liable by using the patient's health benefit plan's
74	74	toll-free telephone number or Internet website. The facility or
75	75	practitioner shall provide the information to the patient based on
76	76	the information that is available to the facility or practitioner
77	77	at the time of the request. The facility or practitioner may assist
78	78	the patient in using the telephone number or website.
79	79	SECTION 2. Section 324.101, Health and Safety Code, is
80	80	amended by adding Subsection (d-1) and amending Subsection (e) to
81	81	read as follows:
82	82	(d-1) A facility that provides a price disclosure or
83	83	estimate under Section 185.002 is not relieved of the obligation to
84	84	provide an estimate under Subsection (d).
85	85	(e) A facility shall provide to the consumer at the
86	86	consumer's request an itemized statement in plain language of the
87	87	billed services if the consumer requests the statement not later
88	88	than the first anniversary of the date the person is discharged from
89	89	the facility. The facility shall provide the statement to the
90	90	consumer not later than the 10th business day after the date on
91	91	which the statement is requested.
92	92	SECTION 3. The heading to Chapter 1456, Insurance Code, is
93	93	amended to read as follows:
94	94	CHAPTER 1456. DISCLOSURE OF PROVIDER STATUS AND COSTS OF HEALTH
95	95	CARE SERVICES; SHARED SAVINGS
96	96	SECTION 4. Section 1456.003, Insurance Code, is amended by
97	97	amending Subsection (a) and adding Subsection (a-1) to read as
98	98	follows:
99	99	(a) Each health benefit plan that provides health care
100	100	through a provider network shall provide notice to its enrollees
101	101	that:
102	102	(1) a facility-based physician or other health care
103	103	practitioner may not be included in the health benefit plan's
104	104	provider network; and
105	105	(2) subject to Chapter 185, Health and Safety Code, a
106	106	health care practitioner described by Subdivision (1) may balance
107	107	bill the enrollee for amounts not paid by the health benefit plan.
108	108	(a-1) A health benefit plan shall provide notice to its
109	109	enrollees that an enrollee may be eligible for a cost-sharing
110	110	payment to the enrollee if the enrollee elects to receive a health
111	111	care service that costs less than the average amount quoted for that
112	112	service by the health benefit plan's telephone number or website
113	113	established for that purpose.
114	114	SECTION 5. Sections 1456.006 and 1456.007, Insurance Code,
115	115	are amended to read as follows:
116	116	Sec. 1456.006. COMMISSIONER RULES; FORM OF DISCLOSURE. The
117	117	commissioner by rule may prescribe specific requirements for the
118	118	disclosure required under Section 1456.003. The form of the
119	119	disclosure under Section 1456.003(a) must be substantially as
120	120	follows:
121	121	NOTICE: "ALTHOUGH HEALTH CARE SERVICES MAY BE OR HAVE BEEN
122	122	PROVIDED TO YOU AT A HEALTH CARE FACILITY THAT IS A MEMBER OF THE
123	123	PROVIDER NETWORK USED BY YOUR HEALTH BENEFIT PLAN, OTHER
124	124	PROFESSIONAL SERVICES MAY BE OR HAVE BEEN PROVIDED AT OR THROUGH THE
125	125	FACILITY BY PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS WHO ARE
126	126	NOT MEMBERS OF THAT NETWORK. YOU MAY BE RESPONSIBLE FOR PAYMENT OF
127	127	ALL OR PART OF THE FEES FOR THOSE PROFESSIONAL SERVICES THAT ARE NOT
128	128	PAID OR COVERED BY YOUR HEALTH BENEFIT PLAN."
129	129	Sec. 1456.007. HEALTH BENEFIT PLAN ESTIMATE OF CHARGES.
130	130	(a) A health benefit plan that must comply with this chapter under
131	131	Section 1456.002 shall, on the request of an enrollee, provide a
132	132	binding [an] estimate of payments that will be made for any health
133	133	care service or supply and shall also specify any deductibles,
134	134	copayments, coinsurance, or other amounts for which the enrollee is
135	135	responsible, based on the information available to the health
136	136	benefit plan at the time the estimate was requested. The estimate
137	137	must be provided not later than the 10th business day after the date
138	138	on which the estimate was requested. A health benefit plan must
139	139	advise the enrollee that:
140	140	(1) the actual payment and charges for the services or
141	141	supplies may [will] vary based upon the enrollee's actual medical
142	142	condition and other factors associated with performance of medical
143	143	services, including any factors unknown to or unforeseeable by the
144	144	health benefit plan or provider at the time the estimate was
145	145	requested; and
146	146	(2) subject to Subsection (b) and Chapter 185, Health
147	147	and Safety Code, the enrollee may be personally liable for the
148	148	payment of services or supplies based upon the enrollee's health
149	149	benefit plan coverage.
150	150	(b) Except as provided by Subsection (c), a health benefit
151	151	plan may not require an enrollee to pay more than the amount
152	152	estimated under Subsection (a) for a health care service or supply
153	153	that was actually provided.
154	154	(c) A health benefit plan may require an enrollee to pay any
155	155	deductibles, copayments, coinsurance, or other amounts disclosed
156	156	in the enrollee's policy, certificate of coverage, or evidence of
157	157	coverage for an unforeseen health care service or supply that
158	158	arises out of the provision of the proposed health care service or
159	159	supply.
160	160	SECTION 6. Chapter 1456, Insurance Code, is amended by
161	161	adding Sections 1456.008, 1456.009, and 1456.010 to read as
162	162	follows:
163	163	Sec. 1456.008. PRICE DISCLOSURE TELEPHONE NUMBER AND
164	164	WEBSITE. (a) A health benefit plan shall establish and operate a
165	165	toll-free telephone number and publicly accessible Internet
166	166	website for an enrollee to:
167	167	(1) request and obtain the average amount paid under
168	168	the health benefit plan to a provider in the health benefit plan
169	169	provider network for a particular health care service or supply in
170	170	the preceding 12 months in the enrollee's geographic rating area;
171	171	and
172	172	(2) request an estimate described by Section 1456.007.
173	173	(b) A health benefit plan shall maintain a written record of
174	174	the average amount quoted to an enrollee under Subsection (a)(1).
175	175	Sec. 1456.009. SHARED SAVINGS. (a) Except as provided by
176	176	Subsection (b), if an enrollee elects and receives a health care
177	177	service or supply the total cost of which is less than the average
178	178	amount quoted under Section 1456.008, a health benefit plan shall
179	179	pay to the enrollee the lesser of:
180	180	(1) 50 percent of the difference between the average
181	181	amount and the actual cost, minus any applicable deductible,
182	182	copayment, or coinsurance; or
183	183	(2) $7,500.
184	184	(b) A health benefit plan is not required to pay an enrollee
185	185	under Subsection (a) if the plan's saved cost is $50 or less.
186	186	(c) A health benefit plan shall pay an enrollee not later
187	187	than the 30th day after the day on which the enrollee submits a
188	188	claim for shared savings under this section.
189	189	(d) If an enrollee elects and receives a health care service
190	190	or supply from a provider outside the health benefit plan provider
191	191	network the total cost of which is less than the average amount
192	192	quoted under Section 1456.008, a health benefit plan may hold the
193	193	enrollee responsible only for any deductible, copayment, or
194	194	coinsurance that would be due if the service were provided by a
195	195	provider in the health benefit plan provider network.
196	196	Sec. 1456.010. SHARED SAVINGS REPORTING. Not later than
197	197	February 1 of each year, a health benefit plan shall submit to the
198	198	commissioner a report for the preceding calendar year stating:
199	199	(1) the total number of requests for a binding
200	200	estimate received for the plan under Section 1456.007;
201	201	(2) the total number of health care services or
202	202	supplies for which an enrollee is eligible for a payment under
203	203	Section 1456.009 and the average cost of each service or supply by
204	204	category;
205	205	(3) the difference between the average cost of health
206	206	care services or supplies for which an enrollee is eligible for a
207	207	payment under Section 1456.009 and the average amount for the same
208	208	service or supply quoted under Section 1456.008;
209	209	(4) the total payments made under Section 1456.009 to
210	210	enrollees; and
211	211	(5) the total number and percentage of the health
212	212	benefit plan's enrollees who received a payment under Section
213	213	1456.009.
214	214	SECTION 7. (a) Chapter 185, Health and Safety Code, as
215	215	added by this Act, and Section 324.101(e), Health and Safety Code,
216	216	as amended by this Act, apply only to a service provided by a
217	217	facility or practitioner on or after January 1, 2018. A service
218	218	provided before January 1, 2018, is governed by the law as it
219	219	existed immediately before the effective date of this Act, and that
220	220	law is continued in effect for that purpose.
221	221	(b) Chapter 1456, Insurance Code, as amended by this Act,
222	222	applies only to a health benefit plan delivered, issued for
223	223	delivery, or renewed on or after January 1, 2018. A health benefit
224	224	plan delivered, issued for delivery, or renewed before January 1,
225	225	2018, is governed by the law as it existed immediately before the
226	226	effective date of this Act, and that law is continued in effect for
227	227	that purpose.
228	228	SECTION 8. This Act takes effect September 1, 2017.