Texas 2023 - 88th Regular

Texas House Bill HB4035 Compare Versions

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1	1	88R13424 MCF-F
2	2	By: Hayes H.B. No. 4035
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to disclosure of certain health care costs.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Title 2, Health and Safety Code, is amended by
10	10	adding Subtitle J to read as follows:
11	11	SUBTITLE J. HEALTH CARE PRICE DISCLOSURES
12	12	CHAPTER 185. HEALTH CARE PRICE DISCLOSURES
13	13	Sec. 185.001. DEFINITIONS. In this chapter:
14	14	(1) "Facility" means a hospital, outpatient clinic,
15	15	birthing center, ambulatory surgical center, or other licensed
16	16	facility providing health care services. The term does not include
17	17	an emergency clinic, a freestanding emergency medical care
18	18	facility, or other facility providing only emergency care.
19	19	(2) "Patient" includes a prospective patient and a
20	20	personal representative of the patient.
21	21	(3) "Practitioner" means an individual who is licensed
22	22	to provide and provides medical or other health care services in
23	23	this state.
24	24	Sec. 185.002. PRICE DISCLOSURE OR ESTIMATE. (a) Before
25	25	providing a nonemergency health care service offered to the patient
26	26	by the facility or practitioner, a facility or practitioner shall
27	27	provide a price disclosure described by Subsection (b) or an
28	28	estimate described by Subsection (c) unless declined by the
29	29	patient.
30	30	(b) Except as provided by Subsection (c), a facility or
31	31	practitioner required to provide a price disclosure under
32	32	Subsection (a) shall disclose to the patient the amount, including
33	33	facility fees, that:
34	34	(1) the patient's health benefit plan will reimburse
35	35	the facility or practitioner for the service, if the facility or
36	36	practitioner is a participating provider under the patient's health
37	37	benefit plan; or
38	38	(2) the facility or practitioner will charge for the
39	39	service, if the facility or practitioner is not a participating
40	40	provider under the patient's health benefit plan.
41	41	(c) If a facility or practitioner is unable to quote a
42	42	specific amount under Subsection (b) because of the facility's or
43	43	practitioner's inability to predict the specific service the
44	44	patient will need, the facility or practitioner shall provide an
45	45	estimate of the amount, including facility fees, that:
46	46	(1) the patient's health benefit plan will reimburse
47	47	the facility or practitioner for the predicted service, if the
48	48	facility or practitioner is a participating provider under the
49	49	patient's health benefit plan; or
50	50	(2) the facility or practitioner will charge for the
51	51	predicted service, if the facility or practitioner is not a
52	52	participating provider under the patient's health benefit plan.
53	53	(d) A facility or practitioner that provides an estimate
54	54	described by Subsection (c) shall:
55	55	(1) disclose the incomplete nature of the estimate;
56	56	and
57	57	(2) inform the patient that the facility or
58	58	practitioner may be able to provide an updated estimate after the
59	59	facility or practitioner obtains additional information.
60	60	(e) Notwithstanding any other law, a facility or
61	61	practitioner that does not provide the price disclosure or estimate
62	62	required by this section before providing a health care service for
63	63	which the price disclosure or estimate is required may not bill the
64	64	patient or the patient's health benefit plan for the service.
65	65	Sec. 185.003. EFFECT OF OTHER LAW. A facility that provides
66	66	an estimate under Section 324.101(d) is not relieved of the
67	67	obligation to provide a price disclosure or estimate under Section
68	68	185.002.
69	69	Sec. 185.004. PATIENT INFORMATION. On request, a facility
70	70	or practitioner shall provide a patient with sufficient information
71	71	about a proposed nonemergency health care service to enable the
72	72	patient to determine the amount of the patient's personal liability
73	73	by using the patient's health benefit plan's toll-free telephone
74	74	number or Internet website. The facility or practitioner shall
75	75	provide the information to the patient based on the information
76	76	available to the facility or practitioner at the time of the
77	77	request. The facility or practitioner may assist the patient in
78	78	using the telephone number or website.
79	79	SECTION 2. Section 324.101, Health and Safety Code, is
80	80	amended by adding Subsection (d-1) and amending Subsection (e) to
81	81	read as follows:
82	82	(d-1) A facility that provides a price disclosure or
83	83	estimate under Section 185.002 is not relieved of the obligation to
84	84	provide an estimate under Subsection (d).
85	85	(e) A facility shall provide to the consumer at the
86	86	consumer's request an itemized statement in plain language of the
87	87	billed services if the consumer requests the statement not later
88	88	than the first anniversary of the date the person is discharged from
89	89	the facility. The facility shall provide the statement to the
90	90	consumer not later than the 10th business day after the date on
91	91	which the statement is requested.
92	92	SECTION 3. Chapter 185, Health and Safety Code, as added by
93	93	this Act, and Section 324.101(e), Health and Safety Code, as
94	94	amended by this Act, apply only to a service provided by a facility
95	95	or practitioner on or after January 1, 2024. A service provided
96	96	before January 1, 2024, is governed by the law as it existed
97	97	immediately before the effective date of this Act, and that law is
98	98	continued in effect for that purpose.
99	99	SECTION 4. This Act takes effect September 1, 2023.