By: Taylor S.B. No. 2415
A BILL TO BE ENTITLED
AN ACT
relating to the regulation of freestanding emergency medical care
facilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 108.002(10), Health and Safety Code, is
amended to read as follows:
(10) "Health care facility" means:
(A) a hospital;
(B) an ambulatory surgical center licensed under
Chapter 243;
(C) a chemical dependency treatment facility
licensed under Chapter 464;
(D) a renal dialysis facility;
(E) a birthing center;
(F) a rural health clinic;
(G) a federally qualified health center as
defined by 42 U.S.C. Section 1396d(l)(2)(B); [or]
(H) a freestanding [free-standing] imaging
center; or
(I) a freestanding emergency medical care
facility licensed under Chapter 254.
SECTION 2. Section 241.252, Health and Safety Code, is
amended by amending Subsections (b), (c), and (e) and adding
Subsection (f) to read as follows:
Sec. 241.252. NOTICE OF FEES. (a) In this section,
"provider network" has the meaning assigned by Section 1456.001,
Insurance Code.
(b) A facility described by Section 241.251 shall post
notice that:
(1) states:
(A) the facility is a freestanding emergency
medical care facility;
(B) the facility charges rates comparable to a
hospital emergency room and may charge a facility fee;
(C) a facility or a physician providing medical
care at the facility may not be an out-of-network [a participating]
provider for [in] the patient's health benefit plan provider
network; and
(D) a physician providing medical care at the
facility may bill separately from the facility for the medical care
provided to a patient; and
(2) either:
(A) lists the health benefit plans in which the
facility is a network participating provider in the health benefit
plan's provider network; or
(B) states the facility is an out-of-network [not
a participating]provider for all [in any] health benefit plans
[plan provider network].
(c) The notice required by this section must be posted
prominently and conspicuously:
(1) at the primary entrance to the facility;
(2) in each patient treatment room;
(3) at each location within the facility at which a
person pays for health care services; and
(4) on the home page of the facility's Internet website
or on a different page available through a hyperlink hat is:
(A) entitled "Insurance Information"; and
(B) located prominently on the home page.
(e) Notwithstanding Subsection (c), a facility that is a
network [participating] provider in one or more health benefit plan
provider networks complies with Subsection (b)(2) if the facility:
(1) provides notice on the facility's Internet website
listing the health benefit plans in which the facility is a network
[participating] provider in the health benefit plan's provider
network; and
(2) provides to a patient written confirmation of
whether the facility is a network [participating] provider in the
patient's health benefit plan's provider network.
(f) A facility may not add to or alter the language of a
notice required by this section.
SECTION 3. Subchapter J, Chapter 241, Health and Safety
Code, is amended by adding Sections 241.253 and 241.254 to read as
follows:
Sec. 241.253 DISCLOSURE STATEMENT REQUIRED. (a) In
addition to the notice required under Section 241.252, a facility
shall provide to a patient or a patient's legally authorized
representative a written disclosure statement in accordance with
this section that:
(1) lists the facility's observation and facility fees
that may result from the patient's visit; and
(2) lists the health benefit plans in which the
facility is a network provider in the health benefit plan's
provider network or states that the facility is an out-of-network
provider for all health benefit plans.
(b) A facility shall provide the disclosure statement
before providing health care services to the patient unless the
patient's medical condition requires immediate medical
intervention. If the patient's medical condition requires
immediate medical intervention, the facility shall provide the
disclosure statement as soon as practicable.
(c) The disclosure statement must be:
(1) printed in at least 16-point boldface type;
(2) in a contrasting color using a font that is easily
readable; and
(3) in English and Spanish.
(d) The disclosure statement:
(1) must include:
(A) the name and contact information of the
facility; and
(B) a place for the patient or the patient's
legally authorized representative and an employee of the facility
to sign and date the disclosure statement;
(2) may include information on the facility's
procedures for seeking reimbursement from the patient's health
benefit plan; and
(3) must state, as applicable:
"This facility charges a facility fee for medical treatment.
The average facility fee for patient treatment is $____."
"This facility charges an observation fee for medical
treatment. The average observation fee for patient treatment is
$____."
(e) A facility may include only the information described by
Subsection (d) in the required disclosure statement and may not
include any additional information in the statement. The facility
annually shall update the statement.
(f) A facility shall provide each patient with a physical
copy of the disclosure statement even if the patient refuses or is
unable to sign the statement. If a patient refuses or is unable to
sign the statement, as required by this section, the facility shall
indicate in the patient's file that the patient failed to sign.
(g) A facility shall retain a copy of a signed disclosure
statement provided under this section until the first anniversary
of the date on which the disclosure was signed.
Sec. 241.254 CERTAIN ADVERTISING PROHIBITED. (a) A
facility may not advertise or hold itself out as a network provider,
including by stating that the facility "takes" or "accepts" any
insurer, health maintenance organization, health benefit plan, or
health benefit plan network, unless the facility is a network
provider of a health benefit plan issuer.
(b) A facility may not post the name or logo of a health
benefit plan issuer in any signage or marketing materials if the
facility is an out-of-network provider for any of the issuer's
health benefit plans.
(c) A violation of this section is a false, misleading, or
deceptive act or practice under Subchapter E, Chapter 17, Business &
Commerce Code, and is actionable under that subchapter.
SECTION 4. Section 254.104, Health and Safety Code, is
amended to read as follows:
Sec. 254.104. FREESTANDING EMERGENCY MEDICAL CARE FACILITY
LICENSING FUND. All fees and administrative penalties collected
under this chapter shall be deposited in the state treasury to the
credit of the freestanding emergency medical care facility
licensing fund and may be appropriated to the department only to
administer and enforce this chapter.
SECTION 5. Section 254.155, Health and Safety Code, is
amended by amending Subsections (a), (b), and (d) and adding
Subsection (e) to read as follows:
(a) A facility shall post notice that:
(1) states:
(A) the facility is a freestanding emergency
medical care facility;
(B) the facility charges rates comparable to a
hospital emergency room and may charge a facility fee;
(C) a facility or a physician providing medical
care at the facility may [not] be an out-of-network [a
participating] provider for [in] the patient's health benefit plan
provider network; and
(D) a physician providing medical care at the
facility may bill separately from the facility for the medical care
provided to a patient; and
(2) either:
(A) lists the health benefit plans in which the
facility is a network [participating] provider in the health
benefit plan's provider network; or
(B) states the facility is an out-of-network [not
a participating] provider for all [in any] health benefit plans
[plan provider network].
(b) The notice required by this section must be posted
prominently and conspicuously:
(1) at the primary entrance to the facility;
(2) in each patient treatment room;
(3) at each location within the facility at which a
person pays for health care services; and
(4) on the home page of the facility's Internet website
or on a different page available through a hyperlink that is:
(A) entitled "Insurance Information"; and
(B) located prominently on the home page.
(d) Notwithstanding Subsection (b), a facility that is a
network [participating] provider in one or more health benefit plan
provider networks complies with Subsection (a)(2) if the facility:
(1) provides notice on the facility's Internet website
listing the health benefit plans in which the facility is a network
[participating] provider in the health benefit plan's provider
network; and
(2) provides to a patient written confirmation of
whether the facility is a network [participating] provider in the
patient's health benefit plan's provider network.
(e) A facility may not add to or alter the language of a
notice required by this section.
SECTION 6. Subchapter D, Chapter 254, Health and Safety
Code, is amended by adding Sections 254.156 and 254.157 to read as
follows:
Sec. 254.156. DISCLOSURE STATEMENT REQUIRED. (a) In
addition to the notice required under Section 254.155, a facility
shall provide to a patient or a patient's legally authorized
representative a written disclosure statement in accordance with
this section that:
(1) lists the facility's observation and facility fees
that may result from the patient's visit; and
(2) lists the health benefit plans in which the
facility is a network provider in the health benefit plan's
provider network or states that the facility is an out-of-network
provider for all health benefit plans.
(b) A facility shall provide the disclosure statement
before providing health care services to the patient unless the
patient's medical condition requires immediate medical
intervention. If the patient's medical condition requires
immediate medical intervention, the facility shall provide the
disclosure statement as soon as practicable.
(c) The disclosure statement must be:
(1) printed in at least 16-point boldface type;
(2) in a contrasting color using a font that is easily
readable; and
(3) in English and Spanish.
(d) The disclosure statement:
(1) must include:
(A) the name and contact information of the
facility; and
(B) a place for the patient or the patient's
legally authorized representative and an employee of the facility
to sign and date the disclosure statement;
(2) may include information on the facility's
procedures for seeking reimbursement from the patient's health
benefit plan; and
(3) must state, as applicable:
"This facility charges a facility fee for medical treatment.
The average facility fee for patient treatment is $____."
"This facility charges an observation fee for medical
treatment. The average observation fee for patient treatment is
$____."
(e) A facility may include only the information described by
Subsection (d) in the required disclosure statement and may not
include any additional information in the statement. The facility
annually shall update the statement.
(f) A facility shall provide each patient with a physical
copy of the disclosure statement even if the patient refuses or is
unable to sign the statement. If a patient refuses or is unable to
sign the statement, as required by this section, the facility shall
indicate in the patient's file that the patient failed to sign.
(g) A facility shall retain a copy of a signed disclosure
statement provided under this section until the first anniversary
of the date on which the disclosure was signed.
Sec. 254.157. CERTAIN ADVERTISING PROHIBITED. (a) A
facility may not advertise or hold itself out as a network provider,
including by stating that the facility "takes" or "accepts" any
insurer, health maintenance organization, health benefit plan, or
health benefit plan network, unless the facility is a network
provider of a health benefit plan issuer.
(b) A facility may not post the name or logo of a health
benefit plan issuer in any signage or marketing materials if the
facility is an out-of-network provider for any of the issuer's
health benefit plans.
(c) A violation of this section is a false, misleading, or
deceptive act or practice under Subchapter E, Chapter 17, Business &
Commerce Code, and is actionable under that subchapter.
SECTION 7. Sections 254.205(a) and (c), Health and Safety
Code, are amended to read as follows:
(a) The department may impose an administrative penalty on a
person licensed under this chapter who violates this chapter or a
rule or order adopted under this chapter. A penalty collected under
this section or Section 254.206 shall be deposited in the state
treasury to the credit of the freestanding emergency medical care
facility licensing [in the general revenue] fund described by
Section 254.104.
(c) The [amount of the] penalty [may not exceed $1,000] for
each violation may be in an amount not to exceed the maximum amount
provided by this subsection, and each day a violation continues or
occurs is a separate violation for purposes of imposing the [a]
penalty. The total amount of the penalty assessed for a violation
continuing or occurring on separate days under this subsection may
not exceed $25,000 [$5,000].
SECTION 8. This Act takes effect September 1, 2019.