| 1 | 1 | | By: Martinez Fischer H.B. No. 4444 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | A BILL TO BE ENTITLED |
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| 5 | 5 | | AN ACT |
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| 6 | 6 | | relating to consumer protections against surprise billing. |
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| 7 | 7 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 8 | 8 | | SECTION 1. Subchapter E, Chapter 17, Business & Commerce |
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| 9 | 9 | | Code, is amended by adding Section 17.464 to read as follows: |
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| 10 | 10 | | Sec. 17.464. SURPRISE BILLING. (a) In this section: |
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| 11 | 11 | | (1) "Emergency care" has the meaning assigned by |
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| 12 | 12 | | Section 1301.155. |
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| 13 | 13 | | (2) "Emergency care provider" means a physician, |
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| 14 | 14 | | health care practitioner, facility, or other health care provider |
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| 15 | 15 | | who provides emergency care. |
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| 16 | 16 | | (3) "Facility" has the meaning assigned by Section |
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| 17 | 17 | | 324.001, Health and Safety Code. |
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| 18 | 18 | | (4) "Facility-based provider" means a physician or |
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| 19 | 19 | | health care provider who provides health care services to patients |
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| 20 | 20 | | of a health care facility. |
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| 21 | 21 | | (5) "Health care practitioner" means an individual who |
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| 22 | 22 | | is licensed to provide health care services. |
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| 23 | 23 | | (6) "Participating provider" means a physician or |
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| 24 | 24 | | health care provider who has contracted with an eligible plan |
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| 25 | 25 | | administrator to provide services to enrollees. |
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| 26 | 26 | | (7) "Surprise bill" means a bill received by an |
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| 27 | 27 | | insured or enrollee for amounts in addition to the applicable |
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| 28 | 28 | | copayment, coinsurance, and deductible: |
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| 29 | 29 | | (A) for services furnished by an out-of-network |
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| 30 | 30 | | facility-based provider who performed the service at a facility |
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| 31 | 31 | | that is an in-network provider; or |
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| 32 | 32 | | (B) for emergency care services furnished by an |
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| 33 | 33 | | out-of-network provider. |
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| 34 | 34 | | (b) For purposes of Section 17.46(a), the term "false, |
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| 35 | 35 | | misleading, or deceptive acts or practices" includes a |
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| 36 | 36 | | facility-based provider that bills an enrollee receiving health |
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| 37 | 37 | | care services described by Subsection (a)(7), except for the |
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| 38 | 38 | | enrollee's responsibility under the enrollee's health plan, |
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| 39 | 39 | | including an applicable copayment, coinsurance, or deductible. |
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| 40 | 40 | | (c) The consumer protection division may not bring an action |
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| 41 | 41 | | under Section 17.47 for an act or practice described by Subsection |
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| 42 | 42 | | (b) if the bill sent to the enrollee is less than five hundred |
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| 43 | 43 | | dollars. |
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| 44 | 44 | | (d) In an action brought under Section 17.47 to enforce this |
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| 45 | 45 | | section, the consumer protection division may request, and the |
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| 46 | 46 | | trier of fact may award the recovery of: |
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| 47 | 47 | | (1) reasonable attorney's fees and court costs; and |
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| 48 | 48 | | (2) the reasonable expenses incurred by the division |
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| 49 | 49 | | in obtaining any remedy available under Section 17.47, including |
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| 50 | 50 | | the cost of investigation, witness fees, and deposition expenses. |
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| 51 | 51 | | SECTION 2. This Act takes effect September 1, 2019. |
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