By: Hickland H.B. No. 1314
A BILL TO BE ENTITLED
AN ACT
relating to price estimates and billing requirements for certain
health care facilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 324.001, Health and Safety Code, is
amended by adding Subdivision (5-a) to read as follows:
(5-a) "Estimate" means a written statement outlining a
consumer's total expected billed charges for a nonemergency
elective medical service or procedure.
SECTION 2. Section 324.101, Health and Safety Code, is
amended by amending Subsections (d) and (g) and adding Subsection
(d-1) to read as follows:
(d) A consumer who presents to a [The] facility a valid
medical order [shall provide an estimate of the facility's charges]
for any elective inpatient admission or nonemergency outpatient
surgical procedure or other service is entitled to receive on
request and before the scheduling of the admission, [or] procedure,
or service an estimate of the facility's charges for the admission,
procedure, or service. Not later than 24 hours after receiving a
request for an estimate under this subsection, the facility shall
provide the [The] estimate to the requesting consumer by e-mail
[must be provided not later than the 10th business day after the
date on which the estimate is requested]. The facility must advise
the consumer that:
(1) the request for an estimate of billed charges may
result in a delay in the scheduling and provision of the inpatient
admission, outpatient surgical procedure, or other service;
(2) the actual charges for an inpatient admission,
outpatient surgical procedure, or other service will vary based on
the person's medical condition and other factors associated with
performance of the procedure or service;
(3) the actual charges for an inpatient admission,
outpatient surgical procedure, or other service may differ from the
amount to be paid by the consumer or the consumer's third-party
payor;
(4) the consumer may be personally liable for payment
for the inpatient admission, outpatient surgical procedure, or
other service depending on the consumer's health benefit plan
coverage; and
(5) the consumer should contact the consumer's health
benefit plan for accurate information regarding the plan structure,
benefit coverage, deductibles, copayments, coinsurance, and other
plan provisions that may impact the consumer's liability for
payment for the inpatient admission, outpatient surgical
procedure, or other service.
(d-1) A facility's final billed charges may not exceed the
amount specified in an estimate by more than five percent unless the
additional charges are related to complications that arose during
the procedure or service or as a result of a change of diagnosis
that is documented in the patient's chart. If the final billed
charges exceed the amount specified in an estimate by more than five
percent, the facility shall provide to the patient a written
statement describing:
(1) the difference in the billed charge amount and the
estimate amount; and
(2) the complications or change of diagnosis that
resulted in the difference.
(g) A facility that violates [in violation of] this section:
(1) may not:
(A) collect or take any collection action against
a consumer;
(B) report the consumer to a credit bureau; or
(C) pursue an action against the consumer; and
(2) is subject to an enforcement action by the
appropriate licensing agency.
SECTION 3. Subchapter B, Chapter 324, Health and Safety
Code, is repealed.
SECTION 4. The changes in law made to Chapter 324, Health
and Safety Code, apply only to a request for an estimate made on or
after the effective date of this Act. A request for an estimate
made before the effective date of this Act is governed by the law in
effect at the time the request was made, and the former law is
continued in effect for that purpose.
SECTION 5. This Act takes effect September 1, 2025.