Texas 2021 - 87th Regular

Texas House Bill HB4045 Compare Versions

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

Old	New	Differences
1	1	87R11251 SRA-D
2	2	By: Martinez H.B. No. 4045
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the cost, payment, and collection of health care
8	8	expenses.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle A, Title 4, Health and Safety Code, is
11	11	amended by adding Chapter 226 to read as follows:
12	12	CHAPTER 226. COST, PAYMENT, AND COLLECTION OF HEALTH CARE EXPENSES
13	13	FOR SERVICES PROVIDED BY CERTAIN HEALTH CARE FACILITIES AND
14	14	PROFESSIONALS
15	15	SUBCHAPTER A. GENERAL PROVISIONS
16	16	Sec. 226.001. PURPOSE. The purpose of this chapter is to
17	17	reduce burdensome medical debt and to protect patients in their
18	18	dealings with medical creditors, medical debt collectors, and
19	19	medical debt buyers in connection with medical debt.
20	20	Sec. 226.002. CONSTRUCTION OF CHAPTER. This chapter shall
21	21	be liberally construed to effect its purposes.
22	22	Sec. 226.003. DEFINITIONS. In this chapter:
23	23	(1) "Commission" means the Health and Human Services
24	24	Commission.
25	25	(2) "Consumer report" has the meaning assigned by
26	26	Section 603(d) of the Fair Credit Reporting Act (15 U.S.C. Section
27	27	1681a).
28	28	(3) "Consumer reporting agency" means a person who
29	29	regularly engages wholly or partly in the practice of assembling or
30	30	evaluating consumer credit information or other information on
31	31	individuals to furnish consumer reports to third parties for
32	32	monetary fees, for dues, or on a cooperative nonprofit basis.
33	33	(4) "Executive commissioner" means the executive
34	34	commissioner of the Health and Human Services Commission.
35	35	(5) "Health care facility":
36	36	(A) means:
37	37	(i) a hospital licensed under Chapter 241;
38	38	(ii) an outpatient clinic or facility
39	39	affiliated with or operating under the license of a hospital
40	40	described by Subparagraph (i);
41	41	(iii) an ambulatory surgical center
42	42	licensed under Chapter 243; or
43	43	(iv) a facility licensed in this state that
44	44	provides outpatient health care services and has revenues of at
45	45	least $20 million annually; and
46	46	(B) includes a health care professional licensed
47	47	in this state who provides health care services in one or more of
48	48	the facilities or other health care settings described by Paragraph
49	49	(A) and who bills patients independently.
50	50	(6) "Health care services" means services for the
51	51	diagnosis, prevention, treatment, cure, or relief of a physical,
52	52	dental, behavioral, substance use disorder or mental health
53	53	condition, illness, injury, or disease. The term includes any
54	54	procedures, products, devices, or medications.
55	55	(7) "Medical creditor" means a health care facility or
56	56	other entity that provides health care services and to whom an
57	57	individual:
58	58	(A) owes money for those services; or
59	59	(B) previously owed money for those services if
60	60	the medical debt has been purchased by a medical debt buyer.
61	61	(8) "Medical debt" means a debt arising from the
62	62	receipt of health care services.
63	63	(9) "Medical debt buyer" means a person who purchases
64	64	a medical debt for collection purposes from a medical creditor or
65	65	other subsequent owner of the medical debt, regardless of whether
66	66	the person collects the medical debt, hires a third party to collect
67	67	the medical debt, or hires an attorney to pursue collection
68	68	litigation in connection with the medical debt.
69	69	(10) "Medical debt collector" means a person who
70	70	regularly collects or attempts to collect, directly or indirectly,
71	71	a medical debt originally owed or due another or asserted to be owed
72	72	or due another. The term includes a medical debt buyer.
73	73	Sec. 226.004. RULES. (a) The executive commissioner shall
74	74	adopt rules to administer this chapter.
75	75	(b) In adopting rules under this section, the executive
76	76	commissioner shall consult with the Texas Medical Board, the State
77	77	Board of Dental Examiners, and the commissioner of insurance as
78	78	appropriate and necessary.
79	79	SUBCHAPTER B. PRICE INFORMATION AND PAYMENTS
80	80	Sec. 226.051. PRICE INFORMATION ONLINE. (a) In this
81	81	section, "gross charges" means a health care facility's full
82	82	established price for a health care service that the facility
83	83	charges patients who do not have health benefit plan coverage
84	84	before applying any contractual allowances, discounts, or
85	85	deductions.
86	86	(b) A health care facility shall post price information of
87	87	the facility's health care services on its Internet website. The
88	88	information must be accessible from a link on the website's home
89	89	page, and at a minimum must:
90	90	(1) list the gross charges for each health care
91	91	service provided by the facility;
92	92	(2) list the Medicare reimbursement amount for the
93	93	health care service, next to the relevant gross charges; and
94	94	(3) use plain language titles or descriptions of
95	95	health care services that can be understood by the average
96	96	individual.
97	97	Sec. 226.052. ITEMIZED BILL. On a patient's written or oral
98	98	request and without charge, a medical creditor or medical debt
99	99	collector shall provide an itemized bill to the patient not later
100	100	than the 60th day after the date of the request. The bill must
101	101	contain:
102	102	(1) the name and address of the medical creditor;
103	103	(2) the date a health care service was provided;
104	104	(3) the date the medical debt was incurred, if
105	105	different from the date of service;
106	106	(4) a detailed list of the specific health care
107	107	services provided to the patient;
108	108	(5) a list of all health care professionals who
109	109	treated the patient;
110	110	(6) the amount of principal for any medical debt
111	111	incurred;
112	112	(7) any adjustment to the bill, such as negotiated
113	113	insurance rates or other discounts;
114	114	(8) the amount of any payments received from the
115	115	patient or any other person on the patient's behalf; and
116	116	(9) any interest or fees.
117	117	Sec. 226.053. INTEREST ON MEDICAL DEBT. (a)
118	118	Notwithstanding any agreement to the contrary or other law,
119	119	interest on medical debt is limited to the rate of interest equal to
120	120	the weekly average one-year constant maturity treasury yield, but
121	121	not less than two percent per year and not more than five percent
122	122	per year, as published by the Board of Governors of the Federal
123	123	Reserve System, for the calendar week preceding the date when the
124	124	patient was first provided with a bill for payment of the health
125	125	care services. If the Board of Governors of the Federal Reserve
126	126	System ceases to publish this interest rate, the executive
127	127	commissioner by rule shall substitute another measure for
128	128	determining a reasonable interest rate of not more than five
129	129	percent per year.
130	130	(b) Notwithstanding any agreement to the contrary or other
131	131	law, the rate of interest specified by Subsection (a) applies to a
132	132	judgment on medical debt.
133	133	Sec. 226.054. RECEIPT FOR PAYMENTS. Not later than the 10th
134	134	business day after the date payment of a medical debt is received,
135	135	the medical creditor or medical debt collector shall provide to the
136	136	person making the payment a receipt showing:
137	137	(1) the amount paid;
138	138	(2) the date payment is received;
139	139	(3) the outstanding balance of the patient's account
140	140	before the most recent payment;
141	141	(4) the new balance after application of the payment;
142	142	(5) the interest rate and interest accrued since the
143	143	last payment;
144	144	(6) the patient's account number;
145	145	(7) the name of the current owner of the debt and, if
146	146	different, the name of the medical creditor; and
147	147	(8) whether the payment is accepted as payment in full
148	148	of the debt.
149	149	Sec. 226.055. LIABILITY FOR MEDICAL DEBT. (a) Parents and
150	150	legal guardians are jointly liable for any medical debt incurred by
151	151	a child under 18 years of age.
152	152	(b) A spouse or other person is not liable for the medical
153	153	debt of a person 18 years of age or older. A person may consent to
154	154	assume liability, if the consent is:
155	155	(1) on a separate document signed by the person;
156	156	(2) not solicited in an emergency room or during an
157	157	emergency situation; and
158	158	(3) not required as a condition of providing emergency
159	159	or nonemergency health care services.
160	160	SUBCHAPTER C. MEDICAL DEBT COLLECTIONS
161	161	Sec. 226.101. PROHIBITED COLLECTION ACTIONS. To collect a
162	162	medical debt, a medical creditor or medical debt collector may not:
163	163	(1) cause an individual's arrest;
164	164	(2) cause an individual to be the subject of a capias
165	165	as defined by Article 23.01, Code of Criminal Procedure; or
166	166	(3) foreclose on an individual's real property.
167	167	Sec. 226.102. EXTRAORDINARY COLLECTION ACTIONS. (a) In
168	168	this section, "extraordinary collection action," with respect to a
169	169	patient, means:
170	170	(1) selling the patient's medical debt to another
171	171	party, unless, before the sale, the medical creditor enters into a
172	172	written agreement with the medical debt buyer providing that:
173	173	(A) the medical debt buyer may not engage in an
174	174	extraordinary collection action as provided by this section to
175	175	obtain payment of the debt; and
176	176	(B) the medical debt collector may not charge
177	177	interest on the debt at a rate in excess of the limit prescribed by
178	178	Section 226.053;
179	179	(2) reporting adverse information about the patient to
180	180	a consumer reporting agency; or
181	181	(3) initiating an action that requires a legal or
182	182	judicial process, including:
183	183	(A) placing a lien on the patient's property;
184	184	(B) seizing the patient's bank account or any
185	185	other personal property; or
186	186	(C) bringing a civil action against the patient.
187	187	(b) Except as provided by Section 226.103, a medical
188	188	creditor or medical debt collector may not engage in an
189	189	extraordinary collection action against a patient until the 180th
190	190	day after the date the first bill for an amount owed for receipt of
191	191	health care services has been sent to the patient.
192	192	(c) At least 30 days before taking an extraordinary
193	193	collection action, a medical creditor or medical debt collector
194	194	shall provide to the patient a notice containing:
195	195	(1) the extraordinary collection actions that will be
196	196	initiated to obtain payment; and
197	197	(2) a deadline after which extraordinary collection
198	198	actions will be initiated, which may not be earlier than the 30th
199	199	day after the date notice is provided.
200	200	(d) A health care facility or medical debt collector
201	201	collecting medical debt for services provided at a health care
202	202	facility may not use any extraordinary collection action not
203	203	described in the facility's billing and collections policy.
204	204	Sec. 226.103. REPORTING TO CONSUMER REPORTING AGENCY. (a)
205	205	A medical creditor or medical debt collector may not communicate
206	206	with or report information to a consumer reporting agency regarding
207	207	a patient's medical debt during the one-year period beginning on
208	208	the date when the patient was first given a bill for the health care
209	209	service to which the debt pertains.
210	210	(b) After expiration of the one-year period prescribed by
211	211	Subsection (a), a medical creditor or medical debt collector shall
212	212	give the patient at least one additional bill before reporting the
213	213	medical debt to a consumer reporting agency. The amount reported
214	214	must be the same as the amount stated in the additional bill, and
215	215	the bill must state that the debt is being reported to a consumer
216	216	reporting agency.
217	217	(c) A medical debt collector shall also provide the notice
218	218	required by 15 U.S.C. Section 1692g before reporting a medical debt
219	219	to a consumer reporting agency.
220	220	Sec. 226.104. COLLECTION OF MEDICAL DEBT DURING HEALTH
221	221	BENEFIT PLAN REVIEW PROHIBITED. (a) In this section:
222	222	(1) "External review" means a review of an adverse
223	223	benefit determination conducted under Chapter 4201, Insurance
224	224	Code, a federal external review process as described by 42 U.S.C.
225	225	Section 300gg-19, a review conducted under 29 U.S.C. Section 1133,
226	226	a Medicare appeals process, a Medicaid appeals process, or another
227	227	applicable external appeals process.
228	228	(2) "Internal review" means a review of an adverse
229	229	benefit determination conducted by a health benefit plan issuer or
230	230	other insurer.
231	231	(b) A medical creditor or medical debt collector that knows
232	232	or should have known about an internal review, external review, or
233	233	other appeal of a health benefit plan decision that concerns a
234	234	medical debt and is pending or was pending during the 60 days
235	235	preceding the date of the review or appeal may not:
236	236	(1) provide information regarding unpaid charges for
237	237	health care services to a consumer reporting agency;
238	238	(2) communicate with the patient regarding the medical
239	239	debt for the purpose of seeking to collect the debt; or
240	240	(3) initiate a lawsuit or arbitration proceeding
241	241	against the patient regarding the medical debt.
242	242	(c) If a medical debt has already been reported to a
243	243	consumer reporting agency and the medical creditor or medical debt
244	244	collector who reported the information learns of an internal
245	245	review, external review, or other appeal of a health benefit plan
246	246	decision that concerns the debt and is pending or was pending during
247	247	the 60 days preceding the date of the review or appeal, the creditor
248	248	or collector shall instruct the consumer reporting agency to delete
249	249	information about the debt.
250	250	(d) A medical creditor described by Subsection (b) may not
251	251	refer, sell, or send the medical debt to a medical debt collector,
252	252	including selling the debt to a medical debt buyer.
253	253	Sec. 226.105. FORGIVEN COST-SHARING AMOUNTS RELATED TO
254	254	HEALTH BENEFIT PLAN COVERAGE NOT BREACH OF CONTRACT. Forgiveness
255	255	of a patient's copayment, coinsurance, deductible, facility fee,
256	256	out-of-network charge, or other cost-sharing amounts related to a
257	257	patient's health benefit plan coverage is not a breach of contract
258	258	or other violation of an agreement between the medical creditor and
259	259	the health benefit plan issuer or payor.
260	260	SUBCHAPTER D. ENFORCEMENT AND REMEDIES
261	261	Sec. 226.151. DECEPTIVE TRADE PRACTICE. A violation of
262	262	this chapter constitutes a deceptive trade practice in addition to
263	263	the practices described by Subchapter E, Chapter 17, Business &
264	264	Commerce Code, and is actionable under that subchapter.
265	265	Sec. 226.152. INJUNCTIVE RELIEF. An individual may bring
266	266	an action for injunctive relief or other appropriate equitable
267	267	relief to enforce compliance with this chapter.
268	268	Sec. 226.153. WAIVER OF RIGHTS OR REMEDIES PROHIBITED. (a)
269	269	An agreement between a patient and a health care facility or medical
270	270	debt collector may not contain a provision that, before a dispute
271	271	arises, waives or has the effect of waiving the rights of a patient
272	272	to resolve the dispute by:
273	273	(1) obtaining:
274	274	(A) injunctive, declaratory, or other equitable
275	275	relief;
276	276	(B) monetary damages; or
277	277	(C) attorney's fees and costs; or
278	278	(2) requesting a hearing at which the patient can
279	279	present evidence in person.
280	280	(b) A provision that violates Subsection (a) is void and
281	281	unenforceable.
282	282	(c) A waiver by a patient or other individual of any
283	283	protection provided by or any right of the patient or other
284	284	individual granted under this chapter is void and unenforceable.
285	285	(d) The remedies provided by this section are not exclusive
286	286	remedies, and a patient is not required to exhaust any
287	287	administrative remedies provided by this chapter or any other
288	288	applicable law.
289	289	Sec. 226.154. COMPLAINT PROCESS. (a) The commission shall
290	290	establish a complaint process by which a patient or other member of
291	291	the public may file a complaint against a medical creditor or
292	292	medical debt collector who violates this chapter.
293	293	(b) A complaint filed under this section is public
294	294	information, except for the name or address of a complainant or
295	295	other personal identifying information.
296	296	SECTION 2. As soon as practicable after the effective date
297	297	of this Act, the executive commissioner of the Health and Human
298	298	Services Commission shall adopt rules as required to administer,
299	299	implement, and enforce Chapter 226, Health and Safety Code, as
300	300	added by this Act, including rules relating to establishing a
301	301	complaint process as required by Section 226.154, Health and Safety
302	302	Code, as added by this Act.
303	303	SECTION 3. The changes in law made by this Act apply only to
304	304	a health care service provided on or after the effective date of
305	305	this Act. A health care service provided before the effective date
306	306	of this Act is governed by the law in effect on the date the service
307	307	was provided, and the former law is continued in effect for that
308	308	purpose.
309	309	SECTION 4. This Act takes effect September 1, 2021.