Texas 2021 - 87th Regular

Texas Senate Bill SB2014 Compare Versions

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

Old	New	Differences
1	1	87R6927 JG-F
2	2	By: Buckingham S.B. No. 2014
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a health care entity's disclosure to patients and
8	8	prospective patients of charges for certain health care services,
9	9	goods, or procedures; authorizing administrative penalties.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Title 2, Health and Safety Code, is amended by
12	12	adding Subtitle J to read as follows:
13	13	SUBTITLE J. MEDICAL BILLING AND CHARGES
14	14	CHAPTER 185. CHARGE TRANSPARENCY
15	15	Sec. 185.001. DEFINITIONS. In this chapter:
16	16	(1) "Bundled health care services, goods, or
17	17	procedures" means the grouping of multiple health care services,
18	18	goods, or procedures provided by a health care entity or multiple
19	19	health care entities represented as a single charge.
20	20	(2) "Charge" means the dollar amount set by the health
21	21	care entity as the cost for a health care service, good, or
22	22	procedure, before any applicable discount or negotiated rate is
23	23	applied. The term does not include any applicable discount,
24	24	including a discount:
25	25	(A) for prompt payment;
26	26	(B) under a written charity care policy; or
27	27	(C) under a health care entity's contract with a
28	28	health benefit plan issuer.
29	29	(3) "Charge list" means:
30	30	(A) for a health care professional or provider, a
31	31	list of charges for the health care professional's or provider's
32	32	health care services, goods, or procedures that the professional or
33	33	provider billed at least 50 times in the preceding calendar year; or
34	34	(B) for a health care facility, a list of charges
35	35	for the health care facility's:
36	36	(i) outpatient health care services, goods,
37	37	or procedures that the facility billed at least 50 times in the
38	38	preceding calendar year; and
39	39	(ii) inpatient health care services, goods,
40	40	or procedures that exceed $500 and the facility billed at least 50
41	41	times in the preceding calendar year.
42	42	(4) "Health care entity" means:
43	43	(A) a health care professional;
44	44	(B) a health care provider; or
45	45	(C) a health care facility.
46	46	(5) "Health care facility" means a facility that
47	47	provides a health care service, good, or procedure in this state for
48	48	which a license, certificate, registration, or other authority
49	49	issued by this state is required. The term includes:
50	50	(A) an institutional health care provider;
51	51	(B) a hospital licensed under Chapter 241;
52	52	(C) an ambulatory surgical center licensed under
53	53	Chapter 243;
54	54	(D) a birthing center licensed under Chapter 244;
55	55	(E) a freestanding emergency medical care
56	56	facility licensed under Chapter 254; or
57	57	(F) a chemical dependency treatment facility
58	58	licensed under Chapter 464.
59	59	(6) "Health care professional" means an individual who
60	60	provides a health care service, good, or procedure in this state
61	61	under a license, certificate, registration, or other authority
62	62	issued by an agency of this state to diagnose, prevent, alleviate,
63	63	or cure a human illness or injury, including a physician, dentist,
64	64	or pharmacist.
65	65	(7) "Health care provider" means a person who provides
66	66	to patients in this state ancillary health care services, goods, or
67	67	procedures under a license, certificate, or registration issued by
68	68	this state or who is otherwise ordered or authorized by a health
69	69	care professional to diagnose, prevent, alleviate, or cure a human
70	70	illness or injury, including laboratory services, radiological
71	71	services, and durable medical equipment. The term does not include
72	72	a health care professional or a health care facility.
73	73	(8) "Patient" means an individual who is receiving or
74	74	has received a health care service, good, or procedure from a health
75	75	care entity. The term includes a personal representative of the
76	76	patient.
77	77	(9) "Personal representative" means:
78	78	(A) a parent, legal guardian, or relative; or
79	79	(B) an individual holding a medical power of
80	80	attorney for a patient or prospective patient.
81	81	(10) "Primary regulatory authority" means the state
82	82	agency that is primarily responsible for licensing, permitting,
83	83	registering, or otherwise regulating a health care entity.
84	84	(11) "Prospective patient" means an individual who is
85	85	considering obtaining a health care service, good, or procedure
86	86	from a health care entity. The term includes a personal
87	87	representative of a prospective patient.
88	88	Sec. 185.002. HEALTH CARE CHARGE LIST REQUIRED. (a) Each
89	89	health care entity shall compose and maintain a charge list under
90	90	this chapter.
91	91	(b) A health care entity is not required to include in the
92	92	entity's charge list the charges of health care services, goods, or
93	93	procedures provided by any other health care entity.
94	94	(c) A health care entity that bills bundled health care
95	95	services, goods, or procedures may, at the entity's discretion,
96	96	list the charges of the bundled health care services, goods, or
97	97	procedures in the entity's charge list.
98	98	Sec. 185.003. EXPRESSION OF CHARGES. Each charge listed on
99	99	a charge list required under this chapter must be accompanied by one
100	100	of the following at the discretion of the health care entity:
101	101	(1) a description in plain English of the associated
102	102	health care service, good, or procedure; or
103	103	(2) the applicable standard billing code along with a
104	104	description of the associated health care service, good, or
105	105	procedure.
106	106	Sec. 185.004. CHARGE LIST AVAILABILITY. (a) A health care
107	107	entity shall make its charge list available to patients and
108	108	prospective patients by:
109	109	(1) posting the charge list on the entity's Internet
110	110	website; or
111	111	(2) providing access to the charge list on request at
112	112	the entity's office, facility, or other practice site.
113	113	(b) A health care entity that maintains a waiting area shall
114	114	post a clear and conspicuous notice of the availability of its
115	115	charge list in the waiting area and in any registration, admission,
116	116	or business office in which patients or prospective patients are
117	117	reasonably expected to seek service. The notice must include a
118	118	statement describing the method used to make the charge list
119	119	available under Subsection (a).
120	120	(c) When a health care entity makes the charge list
121	121	available to patients and prospective patients, the list must be
122	122	accompanied by a notice that substantially states the following:
123	123	"NOTICE: THE CHARGES CONTAINED WITHIN THIS CHARGE LIST ARE
124	124	SUBJECT TO CHANGE.
125	125	"YOUR BILL, INCLUDING ACTUAL OR TOTAL CHARGES, WILL VARY
126	126	BASED ON MANY FACTORS, INCLUDING YOUR MEDICAL CONDITION, ANY
127	127	UNKNOWN MEDICAL CONDITIONS YOU MAY HAVE, YOUR DIAGNOSIS AND
128	128	RECOMMENDED TREATMENT PROTOCOLS, AND OTHER FACTORS ASSOCIATED WITH
129	129	PERFORMANCE OF THE HEALTH CARE SERVICE OR PROCEDURE OR THE
130	130	PROVISION OF THE HEALTH CARE GOOD.
131	131	"THE CHARGES CONTAINED IN THIS CHARGE LIST MAY DIFFER FROM
132	132	THE AMOUNT TO BE PAID BY YOU OR YOUR THIRD-PARTY PAYOR, IF
133	133	APPLICABLE. YOU MAY BE ELIGIBLE FOR A DISCOUNT FROM THE AMOUNTS
134	134	STATED ON THE CHARGE LIST. REGARDLESS OF YOUR HEALTH BENEFIT PLAN
135	135	COVERAGE, YOU MAY INQUIRE ABOUT THE AVAILABILITY OF DISCOUNTS.
136	136	"YOU MAY BE PERSONALLY LIABLE FOR PAYMENT FOR THE HEALTH CARE
137	137	SERVICE, GOOD, OR PROCEDURE, DEPENDING ON YOUR HEALTH BENEFIT PLAN
138	138	COVERAGE. YOU SHOULD CONTACT YOUR HEALTH BENEFIT PLAN ISSUER, IF
139	139	YOU HAVE COVERAGE, FOR ACCURATE INFORMATION REGARDING THE PLAN
140	140	STRUCTURE, BENEFIT COVERAGE, DEDUCTIBLES, COPAYMENTS, COINSURANCE,
141	141	AND OTHER PLAN PROVISIONS, SUCH AS NETWORK AVAILABILITY, THAT MAY
142	142	IMPACT YOUR OUT-OF-POCKET RESPONSIBILITY FOR PAYMENT FOR HEALTH
143	143	CARE SERVICES, GOODS, OR PROCEDURES, INCLUDING THOSE CONTAINED IN
144	144	THIS CHARGE LIST."
145	145	Sec. 185.005. EXEMPTION. A health care entity that owns or
146	146	is an employee of an entity that has fewer than three full-time
147	147	equivalent employees is exempt from the requirements of this
148	148	chapter.
149	149	Sec. 185.006. DISCOUNTS AND ADDITIONS. This chapter does
150	150	not prohibit a health care entity from:
151	151	(1) offering or providing discounts from the amounts
152	152	stated on the charge list or accepting less than the amount of a
153	153	charge on the charge list as payment in full;
154	154	(2) offering or providing additional, different, or a
155	155	higher complexity level of health care services, goods, or
156	156	procedures for an additional or different amount;
157	157	(3) departing from the amounts on the charge list for a
158	158	reason specified in the notice required by Section 185.004; or
159	159	(4) changing a charge on the charge list at any time,
160	160	provided that the charge list is updated with the effective date to
161	161	reflect the change.
162	162	Sec. 185.007. DELEGATION. A health care entity's
163	163	responsibilities under this chapter may be performed by the
164	164	entity's employer, employee, or other authorized delegate.
165	165	Sec. 185.008. ENFORCEMENT. (a) Each primary regulatory
166	166	authority of a health care entity shall enforce this chapter in
167	167	accordance with this section. If the applicable primary regulatory
168	168	authority's enforcement process is complaint-based, a complaint
169	169	must be filed in order for the primary regulatory authority to
170	170	enforce this chapter.
171	171	(b) A health care entity that violates any applicable
172	172	requirement of this chapter must be provided with an opportunity to
173	173	correct the violation under Subsection (d).
174	174	(c) A primary regulatory authority that determines a health
175	175	care entity has violated this chapter shall notify the entity of the
176	176	violation.
177	177	(d) If the health care entity corrects the violation not
178	178	later than the 30th business day after the date the health care
179	179	entity receives notice under Subsection (c):
180	180	(1) the primary regulatory authority may not impose a
181	181	fine, reprimand, administrative penalty, or other discipline on the
182	182	health care entity; and
183	183	(2) the violation is confidential and not subject to
184	184	Chapter 552, Government Code.
185	185	(e) The primary regulatory authority may assess an
186	186	administrative penalty for a health care entity's violation of this
187	187	chapter in the same manner as if the entity had violated the law
188	188	under which the entity holds a license, certificate, registration,
189	189	or other authority only if the entity:
190	190	(1) was provided notice of one or more violations
191	191	under this chapter in the 12-month period preceding the notice of
192	192	the most recent violation; or
193	193	(2) failed to correct the violation before the 31st
194	194	business day after the date the entity received notice of the
195	195	violation.
196	196	(f) The amount of penalties assessed against a health care
197	197	entity under this section may not exceed:
198	198	(1) $250 for a single violation;
199	199	(2) $500 for all violations occurring in a 12-month
200	200	period for a health care professional; or
201	201	(3) $5,000 for all violations occurring in a 12-month
202	202	period for a health care provider or health care facility.
203	203	(g) All violations that are related to, arise from, or are
204	204	discovered based on the same event or complaint shall be considered
205	205	to be a single violation for purposes of this section. Each day a
206	206	violation continues does not constitute a separate violation.
207	207	(h) Notwithstanding any other law, this section and the law
208	208	referenced by this section provide the sole and exclusive remedy
209	209	and enforcement mechanism for a violation of this chapter.
210	210	Sec. 185.009. CONTINUING EDUCATION CREDIT. A health care
211	211	professional is entitled to claim two hours of the continuing
212	212	education credit, including half a credit hour of ethics, with the
213	213	appropriate primary regulatory authority for each year of
214	214	compliance with this chapter.
215	215	Sec. 185.010. OUT-OF-NETWORK DISPUTE RESOLUTION.
216	216	Notwithstanding any other law, a health care professional who is in
217	217	compliance with this chapter at the time that a health care service,
218	218	good, or procedure is provided is exempt from the mediation
219	219	process, findings, penalties, and all related provisions,
220	220	including the informal settlement teleconference under Chapter
221	221	1467, Insurance Code, if:
222	222	(1) the dispute concerns the provision of a health
223	223	care service, good, or procedure listed in the health care
224	224	professional's charge list; and
225	225	(2) the amount billed for that service, good, or
226	226	procedure is less than or equal to the amount stated in the charge
227	227	list.
228	228	Sec. 185.011. CHARGE LIST PROTECTIONS. (a)
229	229	Notwithstanding any other law, this chapter does not create a cause
230	230	of action or create a standard of care, obligation, or duty that
231	231	provides a basis for a cause of action.
232	232	(b) Except as otherwise provided by Section 185.008, a
233	233	charge list under this chapter or evidence of a violation of this
234	234	chapter is not admissible in any civil, judicial, or administrative
235	235	proceeding unless the health care entity voluntarily consents in
236	236	writing.
237	237	(c) Notwithstanding any other law, a health care entity is
238	238	not liable for damages related to charges on the entity's charge
239	239	list in an action under Chapter 15 or 17, Business & Commerce Code.
240	240	Sec. 185.012. FREE MARKET PROTECTIONS. This chapter does
241	241	not authorize a governmental agency or other government-created
242	242	entity to approve, disapprove, or limit a health care entity's:
243	243	(1) charge for a health care service, good, or
244	244	procedure; or
245	245	(2) change to any charge.
246	246	SECTION 2. Sections 185.008(a)-(g), Health and Safety Code,
247	247	as added by this Act, apply only to conduct that occurs on or after
248	248	January 1, 2022.
249	249	SECTION 3. This Act takes effect September 1, 2021.