Texas 2021 - 87th Regular

Texas Senate Bill SB1137 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 1137
	1	+	87R21308 JCG-D
	2	+	By: Kolkhorst, et al. S.B. No. 1137
	3	+	(Oliverson)
	4	+	Substitute the following for S.B. No. 1137: No.
2	5
3	6
	7	+	A BILL TO BE ENTITLED
4	8		AN ACT
5	9		relating to the required disclosure of prices for certain items and
6	10		services provided by certain medical facilities; providing
7	11		administrative penalties.
8	12		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	13		SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
10	14		amended by adding Chapter 327 to read as follows:
11	15		CHAPTER 327. DISCLOSURE OF PRICES
12	16		Sec. 327.001. DEFINITIONS. In this chapter:
13	17		(1) "Ancillary service" means a facility item or
14	18		service that a facility customarily provides as part of a shoppable
15	19		service.
16	20		(2) "Chargemaster" means the list of all facility
17	21		items or services maintained by a facility for which the facility
18	22		has established a charge.
19	23		(3) "Commission" means the Health and Human Services
20	24		Commission.
21	25		(4) "De-identified maximum negotiated charge" means
22	26		the highest charge that a facility has negotiated with all third
23	27		party payors for a facility item or service.
24	28		(5) "De-identified minimum negotiated charge" means
25	29		the lowest charge that a facility has negotiated with all third
26	30		party payors for a facility item or service.
27	31		(6) "Discounted cash price" means the charge that
28	32		applies to an individual who pays cash, or a cash equivalent, for a
29	33		facility item or service.
30	34		(7) "Facility" means a hospital licensed under Chapter
31	35		241.
32	36		(8) "Facility items or services" means all items and
33	37		services, including individual items and services and service
34	38		packages, that may be provided by a facility to a patient in
35	39		connection with an inpatient admission or an outpatient department
36	40		visit, as applicable, for which the facility has established a
37	41		standard charge, including:
38	42		(A) supplies and procedures;
39	43		(B) room and board;
40	44		(C) use of the facility and other areas, the
41	45		charges for which are generally referred to as facility fees;
42	46		(D) services of physicians and non-physician
43	47		practitioners, employed by the facility, the charges for which are
44	48		generally referred to as professional charges; and
45	49		(E) any other item or service for which a
46	50		facility has established a standard charge.
47	51		(9) "Gross charge" means the charge for a facility
48	52		item or service that is reflected on a facility's chargemaster,
49	53		absent any discounts.
50	54		(10) "Machine-readable format" means a digital
51	55		representation of information in a file that can be imported or read
52	56		into a computer system for further processing. The term includes
53	57		.XML, .JSON, and .CSV formats.
54	58		(11) "Payor-specific negotiated charge" means the
55	59		charge that a facility has negotiated with a third party payor for a
56	60		facility item or service.
57	61		(12) "Service package" means an aggregation of
58	62		individual facility items or services into a single service with a
59	63		single charge.
60	64		(13) "Shoppable service" means a service that may be
61	65		scheduled by a health care consumer in advance.
62	66		(14) "Standard charge" means the regular rate
63	67		established by the facility for a facility item or service provided
64	68		to a specific group of paying patients. The term includes all of
65	69		the following, as defined under this section:
66	70		(A) the gross charge;
67	71		(B) the payor-specific negotiated charge;
68	72		(C) the de-identified minimum negotiated charge;
69	73		(D) the de-identified maximum negotiated charge;
70	74		and
71	75		(E) the discounted cash price.
72	76		(15) "Third party payor" means an entity that is, by
73	77		statute, contract, or agreement, legally responsible for payment of
74	78		a claim for a facility item or service.
75	79		Sec. 327.002. PUBLIC AVAILABILITY OF PRICE INFORMATION
76	80		REQUIRED. Notwithstanding any other law, a facility must make
77	81		public:
78	82		(1) a digital file in a machine-readable format that
79	83		contains a list of all standard charges for all facility items or
80	84		services as described by Section 327.003; and
81	85		(2) a consumer-friendly list of standard charges for a
82	86		limited set of shoppable services as provided in Section 327.004.
83	87		Sec. 327.003. LIST OF STANDARD CHARGES REQUIRED. (a) A
84	88		facility shall:
85	89		(1) maintain a list of all standard charges for all
86	90		facility items or services in accordance with this section; and
87	91		(2) ensure the list required under Subdivision (1) is
88	92		available at all times to the public, including by posting the list
89	93		electronically in the manner provided by this section.
90	94		(b) The standard charges contained in the list required to
91	95		be maintained by a facility under Subsection (a) must reflect the
92	96		standard charges applicable to that location of the facility,
93	97		regardless of whether the facility operates in more than one
94	98		location or operates under the same license as another facility.
95	99		(c) The list required under Subsection (a) must include the
96	100		following items, as applicable:
97	101		(1) a description of each facility item or service
98	102		provided by the facility;
99	103		(2) the following charges for each individual facility
100	104		item or service when provided in either an inpatient setting or an
101	105		outpatient department setting, as applicable:
102	106		(A) the gross charge;
103	107		(B) the de-identified minimum negotiated charge;
104	108		(C) the de-identified maximum negotiated charge;
105	109		(D) the discounted cash price; and
106	110		(E) the payor-specific negotiated charge, listed
107	111		by the name of the third party payor and plan associated with the
108	112		charge and displayed in a manner that clearly associates the charge
109	113		with each third party payor and plan; and
110	114		(3) any code used by the facility for purposes of
111	115		accounting or billing for the facility item or service, including
112	116		the Current Procedural Terminology (CPT) code, the Healthcare
113	117		Common Procedure Coding System (HCPCS) code, the Diagnosis Related
114	118		Group (DRG) code, the National Drug Code (NDC), or other common
115	119		identifier.
116	120		(d) The information contained in the list required under
117	121		Subsection (a) must be published in a single digital file that is in
118	122		a machine-readable format.
119	123		(e) The list required under Subsection (a) must be displayed
120	124		in a prominent location on the home page of the facility's publicly
121	125		accessible Internet website or accessible by selecting a dedicated
122	126		link that is prominently displayed on the home page of the
123	127		facility's publicly accessible Internet website. If the facility
124	128		operates multiple locations and maintains a single Internet
125	129		website, the list required under Subsection (a) must be posted for
126	130		each location the facility operates in a manner that clearly
127	131		associates the list with the applicable location of the facility.
128	132		(f) The list required under Subsection (a) must:
129	133		(1) be available:
130	134		(A) free of charge;
131	135		(B) without having to establish a user account or
132	136		password;
133	137		(C) without having to submit personal
134	138		identifying information; and
135	139		(D) without having to overcome any other
136	140		impediment, including entering a code to access the list;
137	141		(2) be accessible to a common commercial operator of
138	142		an Internet search engine to the extent necessary for the search
139	143		engine to index the list and display the list as a result in
140	144		response to a search query of a user of the search engine;
141	145		(3) be formatted in a manner prescribed by the
142	146		commission;
143	147		(4) be digitally searchable; and
144	148		(5) use the following naming convention specified by
145	149		the Centers for Medicare and Medicaid Services, specifically:
146	150		<ein>_<facility-name>_standardcharges.[jsonxmlcsv]
147	151		(g) In prescribing the format of the list under Subsection
148	152		(f)(3), the commission shall:
149	153		(1) develop a template that each facility must use in
150	154		formatting the list; and
151	155		(2) in developing the template under Subdivision (1):
152	156		(A) consider any applicable federal guidelines
153	157		for formatting similar lists required by federal law or rule and
154	158		ensure that the design of the template enables health care
155	159		researchers to compare the charges contained in the lists
156	160		maintained by each facility; and
157	161		(B) design the template to be substantially
158	162		similar to the template used by the Centers for Medicare and
159	163		Medicaid Services for purposes similar to those of this chapter, if
160	164		the commission determines that designing the template in that
161	165		manner serves the purposes of Paragraph (A) and that the commission
162	166		benefits from developing and requiring that substantially similar
163	167		design.
164	168		(h) The facility must update the list required under
165	169		Subsection (a) at least once each year. The facility must clearly
166	170		indicate the date on which the list was most recently updated,
167	171		either on the list or in a manner that is clearly associated with
168	172		the list.
169	173		Sec. 327.004. CONSUMER-FRIENDLY LIST OF SHOPPABLE
170	174		SERVICES. (a) Except as provided by Subsection (c), a facility
171	175		shall maintain and make publicly available a list of the standard
172	176		charges described by Sections 327.003(c)(2)(B), (C), (D), and (E)
173	177		for each of at least 300 shoppable services provided by the
174	178		facility. The facility may select the shoppable services to be
175	179		included in the list, except that the list must include:
176	180		(1) the 70 services specified as shoppable services by
177	181		the Centers for Medicare and Medicaid Services; or
178	182		(2) if the facility does not provide all of the
179	183		shoppable services described by Subdivision (1), as many of those
180	184		shoppable services the facility does provide.
181	185		(b) In selecting a shoppable service for purposes of
182	186		inclusion in the list required under Subsection (a), a facility
183	187		must:
184	188		(1) consider how frequently the facility provides the
185	189		service and the facility's billing rate for that service; and
186	190		(2) prioritize the selection of services that are
187	191		among the services most frequently provided by the facility.
188	192		(c) If a facility does not provide 300 shoppable services,
189	193		the facility must maintain a list of the total number of shoppable
190	194		services that the facility provides in a manner that otherwise
191	195		complies with the requirements of Subsection (a).
192	196		(d) The list required under Subsection (a) or (c), as
193	197		applicable, must:
194	198		(1) include:
195	199		(A) a plain-language description of each
196	200		shoppable service included on the list;
197	201		(B) the payor-specific negotiated charge that
198	202		applies to each shoppable service included on the list and any
199	203		ancillary service, listed by the name of the third party payor and
200	204		plan associated with the charge and displayed in a manner that
201	205		clearly associates the charge with the third party payor and plan;
202	206		(C) the discounted cash price that applies to
203	207		each shoppable service included on the list and any ancillary
204	208		service or, if the facility does not offer a discounted cash price
205	209		for one or more of the shoppable or ancillary services on the list,
206	210		the gross charge for the shoppable service or ancillary service, as
207	211		applicable;
208	212		(D) the de-identified minimum negotiated charge
209	213		that applies to each shoppable service included on the list and any
210	214		ancillary service;
211	215		(E) the de-identified maximum negotiated charge
212	216		that applies to each shoppable service included on the list and any
213	217		ancillary service; and
214	218		(F) any code used by the facility for purposes of
215	219		accounting or billing for each shoppable service included on the
216	220		list and any ancillary service, including the Current Procedural
217	221		Terminology (CPT) code, the Healthcare Common Procedure Coding
218	222		System (HCPCS) code, the Diagnosis Related Group (DRG) code, the
219	223		National Drug Code (NDC), or other common identifier; and
220	224		(2) if applicable:
221	225		(A) state each location at which the facility
222	226		provides the shoppable service and whether the standard charges
223	227		included in the list apply at that location to the provision of that
224	228		shoppable service in an inpatient setting, an outpatient department
225	229		setting, or in both of those settings, as applicable; and
226	230		(B) indicate if one or more of the shoppable
227	231		services specified by the Centers for Medicare and Medicaid
228	232		Services is not provided by the facility.
229	233		(e) The list required under Subsection (a) or (c), as
230	234		applicable, must be:
231	235		(1) displayed in the manner prescribed by Section
232	236		327.003(e) for the list required under that section;
233	237		(2) available:
234	238		(A) free of charge;
235	239		(B) without having to register or establish a
236	240		user account or password;
237	241		(C) without having to submit personal
238	242		identifying information; and
239	243		(D) without having to overcome any other
240	244		impediment, including entering a code to access the list;
241	245		(3) searchable by service description, billing code,
242	246		and payor;
243	247		(4) updated in the manner prescribed by Section
244	248		327.003(h) for the list required under that section;
245	249		(5) accessible to a common commercial operator of an
246	250		Internet search engine to the extent necessary for the search
247	251		engine to index the list and display the list as a result in
248	252		response to a search query of a user of the search engine; and
249	253		(6) formatted in a manner that is consistent with the
250	254		format prescribed by the commission under Section 327.003(f)(3).
251	255		(f) Notwithstanding any other provision of this section, a
252	256		facility is considered to meet the requirements of this section if
253	257		the facility maintains, as determined by the commission, an
254	258		Internet-based price estimator tool that:
255	259		(1) provides a cost estimate for each shoppable
256	260		service and any ancillary service included on the list maintained
257	261		by the facility under Subsection (a);
258	262		(2) allows a person to obtain an estimate of the amount
259	263		the person will be obligated to pay the facility if the person
260	264		elects to use the facility to provide the service; and
261	265		(3) is:
262	266		(A) prominently displayed on the facility's
263	267		publicly accessible Internet website; and
264	268		(B) accessible to the public:
265	269		(i) without charge; and
266	270		(ii) without having to register or
267	271		establish a user account or password.
268	272		Sec. 327.005. REPORTING REQUIREMENT. Each time a facility
269	273		updates a list as required under Sections 327.003(h) and
270	274		327.004(e)(4), the facility shall submit the updated list to the
271	275		commission. The commission may prescribe the form in which the
272	276		updated list must be submitted to the commission.
273	277		Sec. 327.006. MONITORING AND ENFORCEMENT. (a) The
274	278		commission shall monitor each facility's compliance with the
275	279		requirements of this chapter using any of the following methods:
276	280		(1) evaluating complaints made by persons to the
277	281		commission regarding noncompliance with this chapter;
278	282		(2) reviewing any analysis prepared regarding
279	283		noncompliance with this chapter;
280	284		(3) auditing the Internet websites of facilities for
281	285		compliance with this chapter; and
282	286		(4) confirming that each facility submitted the lists
283	287		required under Section 327.005.
284	288		(b) If the commission determines that a facility is not in
285	289		compliance with a provision of this chapter, the commission may
286	290		take any of the following actions, without regard to the order of
287	291		the actions:
288	292		(1) provide a written notice to the facility that
289	293		clearly explains the manner in which the facility is not in
290	294		compliance with this chapter;
291	295		(2) request a corrective action plan from the facility
292	296		if the facility has materially violated a provision of this
293	297		chapter, as determined under Section 327.007; and
294	298		(3) impose an administrative penalty on the facility
295	299		and publicize the penalty on the commission's Internet website if
296	300		the facility fails to:
297	301		(A) respond to the commission's request to submit
298	302		a corrective action plan; or
299	303		(B) comply with the requirements of a corrective
300	304		action plan submitted to the commission.
301	305		Sec. 327.007. MATERIAL VIOLATION; CORRECTIVE ACTION PLAN.
302	306		(a) A facility materially violates this chapter if the facility
303	307		fails to:
304	308		(1) comply with the requirements of Section 327.002;
305	309		or
306	310		(2) publicize the facility's standard charges in the
307	311		form and manner required by Sections 327.003 and 327.004.
308	312		(b) If the commission determines that a facility has
309	313		materially violated this chapter, the commission may issue a notice
310	314		of material violation to the facility and request that the facility
311	315		submit a corrective action plan. The notice must indicate the form
312	316		and manner in which the corrective action plan must be submitted to
313	317		the commission, and clearly state the date by which the facility
314	318		must submit the plan.
315	319		(c) A facility that receives a notice under Subsection (b)
316	320		must:
317	321		(1) submit a corrective action plan in the form and
318	322		manner, and by the specified date, prescribed by the notice of
319	323		violation; and
320	324		(2) as soon as practicable after submission of a
321	325		corrective action plan to the commission, act to comply with the
322	326		plan.
323	327		(d) A corrective action plan submitted to the commission
324	328		must:
325	329		(1) describe in detail the corrective action the
326	330		facility will take to address any violation identified by the
327	331		commission in the notice provided under Subsection (b); and
328	332		(2) provide a date by which the facility will complete
329	333		the corrective action described by Subdivision (1).
330	334		(e) A corrective action plan is subject to review and
331	335		approval by the commission. After the commission reviews and
332	336		approves a facility's corrective action plan, the commission may
333	337		monitor and evaluate the facility's compliance with the plan.
334	338		(f) A facility is considered to have failed to respond to
335	339		the commission's request to submit a corrective action plan if the
336	340		facility fails to submit a corrective action plan:
337	341		(1) in the form and manner specified in the notice
338	342		provided under Subsection (b); or
339	343		(2) by the date specified in the notice provided under
340	344		Subsection (b).
341	345		(g) A facility is considered to have failed to comply with a
342	346		corrective action plan if the facility fails to address a violation
343	347		within the specified period of time contained in the plan.
344	348		Sec. 327.008. ADMINISTRATIVE PENALTY. (a) The commission
345	349		may impose an administrative penalty on a facility in accordance
346	350		with Chapter 241 if the facility fails to:
347	351		(1) respond to the commission's request to submit a
348	352		corrective action plan; or
349	353		(2) comply with the requirements of a corrective
350	354		action plan submitted to the commission.
351	355		(b) The commission may impose an administrative penalty on a
352	356		facility for a violation of each requirement of this chapter. The
353	357		commission shall set the penalty in an amount sufficient to ensure
354	358		compliance by facilities with the provisions of this chapter
355	359		subject to the limitations prescribed by Subsection (c).
356	360		(c) For a facility with one of the following total gross
357	361		revenues as reported to the Centers for Medicare and Medicaid
358	362		Services or to another entity designated by commission rule in the
359	363		year preceding the year in which a penalty is imposed, the penalty
360	364		imposed by the commission may not exceed:
361	365		(1) $10 for each day the facility violated this
362	366		chapter, if the facility's total gross revenue is less than
363	367		$10,000,000;
364	368		(2) $100 for each day the facility violated this
365	369		chapter, if the facility's total gross revenue is $10,000,000 or
366	370		more and less than $100,000,000; and
367	371		(3) $1,000 for each day the facility violated this
368	372		chapter, if the facility's total gross revenue is $100,000,000 or
369	373		more.
370	374		(d) Each day a violation continues is considered a separate
371	375		violation.
372	376		(e) In determining the amount of the penalty, the commission
373	377		shall consider:
374	378		(1) previous violations by the facility's operator;
375	379		(2) the seriousness of the violation;
376	380		(3) the demonstrated good faith of the facility's
377	381		operator; and
378	382		(4) any other matters as justice may require.
379	383		(f) An administrative penalty collected under this chapter
380	384		shall be deposited to the credit of an account in the general
381	385		revenue fund administered by the commission. Money in the account
382	386		may be appropriated only to the commission.
383	387		Sec. 327.009. LEGISLATIVE RECOMMENDATIONS. The commission
384	388		may propose to the legislature recommendations for amending this
385	389		chapter, including recommendations in response to amendments by the
386	390		Centers for Medicare and Medicaid Services to 45 C.F.R. Part 180.
387	391		SECTION 2. This Act takes effect September 1, 2021.
388		-	______________________________ ______________________________
389		-	President of the Senate Speaker of the House
390		-	I hereby certify that S.B. No. 1137 passed the Senate on
391		-	March 31, 2021, by the following vote: Yeas 31, Nays 0; and that
392		-	the Senate concurred in House amendment on May 27, 2021, by the
393		-	following vote: Yeas 31, Nays 0.
394		-	______________________________
395		-	Secretary of the Senate
396		-	I hereby certify that S.B. No. 1137 passed the House, with
397		-	amendment, on May 20, 2021, by the following vote: Yeas 145,
398		-	Nays 0, one present not voting.
399		-	______________________________
400		-	Chief Clerk of the House
401		-	Approved:
402		-	______________________________
403		-	Date
404		-	______________________________
405		-	Governor