88R13424 MCF-F
By: Hayes H.B. No. 4035
A BILL TO BE ENTITLED
AN ACT
relating to disclosure of certain health care costs.
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. HEALTH CARE PRICE DISCLOSURES
CHAPTER 185. HEALTH CARE PRICE DISCLOSURES
Sec. 185.001. DEFINITIONS. In this chapter:
(1) "Facility" means a hospital, outpatient clinic,
birthing center, ambulatory surgical center, or other licensed
facility providing health care services. The term does not include
an emergency clinic, a freestanding emergency medical care
facility, or other facility providing only emergency care.
(2) "Patient" includes a prospective patient and a
personal representative of the patient.
(3) "Practitioner" means an individual who is licensed
to provide and provides medical or other health care services in
this state.
Sec. 185.002. PRICE DISCLOSURE OR ESTIMATE. (a) Before
providing a nonemergency health care service offered to the patient
by the facility or practitioner, a facility or practitioner shall
provide a price disclosure described by Subsection (b) or an
estimate described by Subsection (c) unless declined by the
patient.
(b) Except as provided by Subsection (c), a facility or
practitioner required to provide a price disclosure under
Subsection (a) shall disclose to the patient the amount, including
facility fees, that:
(1) the patient's health benefit plan will reimburse
the facility or practitioner for the service, if the facility or
practitioner is a participating provider under the patient's health
benefit plan; or
(2) the facility or practitioner will charge for the
service, if the facility or practitioner is not a participating
provider under the patient's health benefit plan.
(c) If a facility or practitioner is unable to quote a
specific amount under Subsection (b) because of the facility's or
practitioner's inability to predict the specific service the
patient will need, the facility or practitioner shall provide an
estimate of the amount, including facility fees, that:
(1) the patient's health benefit plan will reimburse
the facility or practitioner for the predicted service, if the
facility or practitioner is a participating provider under the
patient's health benefit plan; or
(2) the facility or practitioner will charge for the
predicted service, if the facility or practitioner is not a
participating provider under the patient's health benefit plan.
(d) A facility or practitioner that provides an estimate
described by Subsection (c) shall:
(1) disclose the incomplete nature of the estimate;
and
(2) inform the patient that the facility or
practitioner may be able to provide an updated estimate after the
facility or practitioner obtains additional information.
(e) Notwithstanding any other law, a facility or
practitioner that does not provide the price disclosure or estimate
required by this section before providing a health care service for
which the price disclosure or estimate is required may not bill the
patient or the patient's health benefit plan for the service.
Sec. 185.003. EFFECT OF OTHER LAW. A facility that provides
an estimate under Section 324.101(d) is not relieved of the
obligation to provide a price disclosure or estimate under Section
185.002.
Sec. 185.004. PATIENT INFORMATION. On request, a facility
or practitioner shall provide a patient with sufficient information
about a proposed nonemergency health care service to enable the
patient to determine the amount of the patient's personal liability
by using the patient's health benefit plan's toll-free telephone
number or Internet website. The facility or practitioner shall
provide the information to the patient based on the information
available to the facility or practitioner at the time of the
request. The facility or practitioner may assist the patient in
using the telephone number or website.
SECTION 2. Section 324.101, Health and Safety Code, is
amended by adding Subsection (d-1) and amending Subsection (e) to
read as follows:
(d-1) A facility that provides a price disclosure or
estimate under Section 185.002 is not relieved of the obligation to
provide an estimate under Subsection (d).
(e) A facility shall provide to the consumer at the
consumer's request an itemized statement in plain language of the
billed services if the consumer requests the statement not later
than the first anniversary of the date the person is discharged from
the facility. The facility shall provide the statement to the
consumer not later than the 10th business day after the date on
which the statement is requested.
SECTION 3. Chapter 185, Health and Safety Code, as added by
this Act, and Section 324.101(e), Health and Safety Code, as
amended by this Act, apply only to a service provided by a facility
or practitioner on or after January 1, 2024. A service provided
before January 1, 2024, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2023.