87R6927 JG-F
By: Buckingham S.B. No. 2014
A BILL TO BE ENTITLED
AN ACT
relating to a health care entity's disclosure to patients and
prospective patients of charges for certain health care services,
goods, or procedures; authorizing administrative penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Title 2, Health and Safety Code, is amended by
adding Subtitle J to read as follows:
SUBTITLE J. MEDICAL BILLING AND CHARGES
CHAPTER 185. CHARGE TRANSPARENCY
Sec. 185.001. DEFINITIONS. In this chapter:
(1) "Bundled health care services, goods, or
procedures" means the grouping of multiple health care services,
goods, or procedures provided by a health care entity or multiple
health care entities represented as a single charge.
(2) "Charge" means the dollar amount set by the health
care entity as the cost for a health care service, good, or
procedure, before any applicable discount or negotiated rate is
applied. The term does not include any applicable discount,
including a discount:
(A) for prompt payment;
(B) under a written charity care policy; or
(C) under a health care entity's contract with a
health benefit plan issuer.
(3) "Charge list" means:
(A) for a health care professional or provider, a
list of charges for the health care professional's or provider's
health care services, goods, or procedures that the professional or
provider billed at least 50 times in the preceding calendar year; or
(B) for a health care facility, a list of charges
for the health care facility's:
(i) outpatient health care services, goods,
or procedures that the facility billed at least 50 times in the
preceding calendar year; and
(ii) inpatient health care services, goods,
or procedures that exceed $500 and the facility billed at least 50
times in the preceding calendar year.
(4) "Health care entity" means:
(A) a health care professional;
(B) a health care provider; or
(C) a health care facility.
(5) "Health care facility" means a facility that
provides a health care service, good, or procedure in this state for
which a license, certificate, registration, or other authority
issued by this state is required. The term includes:
(A) an institutional health care provider;
(B) a hospital licensed under Chapter 241;
(C) an ambulatory surgical center licensed under
Chapter 243;
(D) a birthing center licensed under Chapter 244;
(E) a freestanding emergency medical care
facility licensed under Chapter 254; or
(F) a chemical dependency treatment facility
licensed under Chapter 464.
(6) "Health care professional" means an individual who
provides a health care service, good, or procedure in this state
under a license, certificate, registration, or other authority
issued by an agency of this state to diagnose, prevent, alleviate,
or cure a human illness or injury, including a physician, dentist,
or pharmacist.
(7) "Health care provider" means a person who provides
to patients in this state ancillary health care services, goods, or
procedures under a license, certificate, or registration issued by
this state or who is otherwise ordered or authorized by a health
care professional to diagnose, prevent, alleviate, or cure a human
illness or injury, including laboratory services, radiological
services, and durable medical equipment. The term does not include
a health care professional or a health care facility.
(8) "Patient" means an individual who is receiving or
has received a health care service, good, or procedure from a health
care entity. The term includes a personal representative of the
patient.
(9) "Personal representative" means:
(A) a parent, legal guardian, or relative; or
(B) an individual holding a medical power of
attorney for a patient or prospective patient.
(10) "Primary regulatory authority" means the state
agency that is primarily responsible for licensing, permitting,
registering, or otherwise regulating a health care entity.
(11) "Prospective patient" means an individual who is
considering obtaining a health care service, good, or procedure
from a health care entity. The term includes a personal
representative of a prospective patient.
Sec. 185.002. HEALTH CARE CHARGE LIST REQUIRED. (a) Each
health care entity shall compose and maintain a charge list under
this chapter.
(b) A health care entity is not required to include in the
entity's charge list the charges of health care services, goods, or
procedures provided by any other health care entity.
(c) A health care entity that bills bundled health care
services, goods, or procedures may, at the entity's discretion,
list the charges of the bundled health care services, goods, or
procedures in the entity's charge list.
Sec. 185.003. EXPRESSION OF CHARGES. Each charge listed on
a charge list required under this chapter must be accompanied by one
of the following at the discretion of the health care entity:
(1) a description in plain English of the associated
health care service, good, or procedure; or
(2) the applicable standard billing code along with a
description of the associated health care service, good, or
procedure.
Sec. 185.004. CHARGE LIST AVAILABILITY. (a) A health care
entity shall make its charge list available to patients and
prospective patients by:
(1) posting the charge list on the entity's Internet
website; or
(2) providing access to the charge list on request at
the entity's office, facility, or other practice site.
(b) A health care entity that maintains a waiting area shall
post a clear and conspicuous notice of the availability of its
charge list in the waiting area and in any registration, admission,
or business office in which patients or prospective patients are
reasonably expected to seek service. The notice must include a
statement describing the method used to make the charge list
available under Subsection (a).
(c) When a health care entity makes the charge list
available to patients and prospective patients, the list must be
accompanied by a notice that substantially states the following:
"NOTICE: THE CHARGES CONTAINED WITHIN THIS CHARGE LIST ARE
SUBJECT TO CHANGE.
"YOUR BILL, INCLUDING ACTUAL OR TOTAL CHARGES, WILL VARY
BASED ON MANY FACTORS, INCLUDING YOUR MEDICAL CONDITION, ANY
UNKNOWN MEDICAL CONDITIONS YOU MAY HAVE, YOUR DIAGNOSIS AND
RECOMMENDED TREATMENT PROTOCOLS, AND OTHER FACTORS ASSOCIATED WITH
PERFORMANCE OF THE HEALTH CARE SERVICE OR PROCEDURE OR THE
PROVISION OF THE HEALTH CARE GOOD.
"THE CHARGES CONTAINED IN THIS CHARGE LIST MAY DIFFER FROM
THE AMOUNT TO BE PAID BY YOU OR YOUR THIRD-PARTY PAYOR, IF
APPLICABLE. YOU MAY BE ELIGIBLE FOR A DISCOUNT FROM THE AMOUNTS
STATED ON THE CHARGE LIST. REGARDLESS OF YOUR HEALTH BENEFIT PLAN
COVERAGE, YOU MAY INQUIRE ABOUT THE AVAILABILITY OF DISCOUNTS.
"YOU MAY BE PERSONALLY LIABLE FOR PAYMENT FOR THE HEALTH CARE
SERVICE, GOOD, OR PROCEDURE, DEPENDING ON YOUR HEALTH BENEFIT PLAN
COVERAGE. YOU SHOULD CONTACT YOUR HEALTH BENEFIT PLAN ISSUER, IF
YOU HAVE COVERAGE, FOR ACCURATE INFORMATION REGARDING THE PLAN
STRUCTURE, BENEFIT COVERAGE, DEDUCTIBLES, COPAYMENTS, COINSURANCE,
AND OTHER PLAN PROVISIONS, SUCH AS NETWORK AVAILABILITY, THAT MAY
IMPACT YOUR OUT-OF-POCKET RESPONSIBILITY FOR PAYMENT FOR HEALTH
CARE SERVICES, GOODS, OR PROCEDURES, INCLUDING THOSE CONTAINED IN
THIS CHARGE LIST."
Sec. 185.005. EXEMPTION. A health care entity that owns or
is an employee of an entity that has fewer than three full-time
equivalent employees is exempt from the requirements of this
chapter.
Sec. 185.006. DISCOUNTS AND ADDITIONS. This chapter does
not prohibit a health care entity from:
(1) offering or providing discounts from the amounts
stated on the charge list or accepting less than the amount of a
charge on the charge list as payment in full;
(2) offering or providing additional, different, or a
higher complexity level of health care services, goods, or
procedures for an additional or different amount;
(3) departing from the amounts on the charge list for a
reason specified in the notice required by Section 185.004; or
(4) changing a charge on the charge list at any time,
provided that the charge list is updated with the effective date to
reflect the change.
Sec. 185.007. DELEGATION. A health care entity's
responsibilities under this chapter may be performed by the
entity's employer, employee, or other authorized delegate.
Sec. 185.008. ENFORCEMENT. (a) Each primary regulatory
authority of a health care entity shall enforce this chapter in
accordance with this section. If the applicable primary regulatory
authority's enforcement process is complaint-based, a complaint
must be filed in order for the primary regulatory authority to
enforce this chapter.
(b) A health care entity that violates any applicable
requirement of this chapter must be provided with an opportunity to
correct the violation under Subsection (d).
(c) A primary regulatory authority that determines a health
care entity has violated this chapter shall notify the entity of the
violation.
(d) If the health care entity corrects the violation not
later than the 30th business day after the date the health care
entity receives notice under Subsection (c):
(1) the primary regulatory authority may not impose a
fine, reprimand, administrative penalty, or other discipline on the
health care entity; and
(2) the violation is confidential and not subject to
Chapter 552, Government Code.
(e) The primary regulatory authority may assess an
administrative penalty for a health care entity's violation of this
chapter in the same manner as if the entity had violated the law
under which the entity holds a license, certificate, registration,
or other authority only if the entity:
(1) was provided notice of one or more violations
under this chapter in the 12-month period preceding the notice of
the most recent violation; or
(2) failed to correct the violation before the 31st
business day after the date the entity received notice of the
violation.
(f) The amount of penalties assessed against a health care
entity under this section may not exceed:
(1) $250 for a single violation;
(2) $500 for all violations occurring in a 12-month
period for a health care professional; or
(3) $5,000 for all violations occurring in a 12-month
period for a health care provider or health care facility.
(g) All violations that are related to, arise from, or are
discovered based on the same event or complaint shall be considered
to be a single violation for purposes of this section. Each day a
violation continues does not constitute a separate violation.
(h) Notwithstanding any other law, this section and the law
referenced by this section provide the sole and exclusive remedy
and enforcement mechanism for a violation of this chapter.
Sec. 185.009. CONTINUING EDUCATION CREDIT. A health care
professional is entitled to claim two hours of the continuing
education credit, including half a credit hour of ethics, with the
appropriate primary regulatory authority for each year of
compliance with this chapter.
Sec. 185.010. OUT-OF-NETWORK DISPUTE RESOLUTION.
Notwithstanding any other law, a health care professional who is in
compliance with this chapter at the time that a health care service,
good, or procedure is provided is exempt from the mediation
process, findings, penalties, and all related provisions,
including the informal settlement teleconference under Chapter
1467, Insurance Code, if:
(1) the dispute concerns the provision of a health
care service, good, or procedure listed in the health care
professional's charge list; and
(2) the amount billed for that service, good, or
procedure is less than or equal to the amount stated in the charge
list.
Sec. 185.011. CHARGE LIST PROTECTIONS. (a)
Notwithstanding any other law, this chapter does not create a cause
of action or create a standard of care, obligation, or duty that
provides a basis for a cause of action.
(b) Except as otherwise provided by Section 185.008, a
charge list under this chapter or evidence of a violation of this
chapter is not admissible in any civil, judicial, or administrative
proceeding unless the health care entity voluntarily consents in
writing.
(c) Notwithstanding any other law, a health care entity is
not liable for damages related to charges on the entity's charge
list in an action under Chapter 15 or 17, Business & Commerce Code.
Sec. 185.012. FREE MARKET PROTECTIONS. This chapter does
not authorize a governmental agency or other government-created
entity to approve, disapprove, or limit a health care entity's:
(1) charge for a health care service, good, or
procedure; or
(2) change to any charge.
SECTION 2. Sections 185.008(a)-(g), Health and Safety Code,
as added by this Act, apply only to conduct that occurs on or after
January 1, 2022.
SECTION 3. This Act takes effect September 1, 2021.