TX
Texas House Bill HB2556

Texas 2025 - 89th Regular

Texas House Bill HB2556 Compare Versions

OldNewDifferences
1-89R23495 MPF-F
1+89R5574 MPF-F
22 By: Frank H.B. No. 2556
3- Substitute the following for H.B. No. 2556:
4- By: VanDeaver C.S.H.B. No. 2556
53
64
75
86
97 A BILL TO BE ENTITLED
108 AN ACT
11- relating to certain health care transaction fees and payment
12- claims; providing an administrative penalty.
9+ relating to certain health care transaction fees and payment claims
10+ and inclusion of a national provider identifier on a payment claim;
11+ providing an administrative penalty.
1312 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1413 SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
1514 amended by adding Chapter 328 to read as follows:
1615 CHAPTER 328. FACILITY FEES
1716 Sec. 328.001. DEFINITIONS. In this chapter:
1817 (1) "Commission" means the Health and Human Services
1918 Commission.
2019 (2) "Executive commissioner" means the executive
2120 commissioner of the commission.
2221 (3) "Facility fee" means a fee a health care provider
23- charges to compensate the health care provider for operational,
24- administrative, or management expenses that is separate from a fee
25- a health care provider charges in relation to professional medical
26- services provided by a physician, including a membership fee,
27- subscription fee, or other administrative fee. The term does not
28- include a direct fee, as that term is defined by Section 162.251,
29- Occupations Code, charged by an independent physician or physician
30- group for providing direct primary care, as that term is defined by
31- that section.
22+ charges that is:
23+ (A) intended to compensate the health care
24+ provider for operational expenses; and
25+ (B) separate from a fee a health care provider
26+ charges for professional medical services provided in a
27+ provider-based facility.
3228 (4) "Health care provider" means a hospital system,
33- hospital, provider-based outpatient facility, or other health care
34- facility, including:
35- (A) a designee or affiliate of a health care
36- facility;
37- (B) an entity that facilitates the provision of
38- or that provides health care services and that is owned or operated
39- by or affiliated with a health insurance company;
40- (C) a health care facility that is owned or
41- operated by or affiliated with a private equity fund; or
42- (D) a physician or physician group that is owned,
43- operated, or managed by or affiliated with a corporation.
29+ hospital, provider-based facility, or other health care facility,
30+ including a designee or affiliate of the facility.
4431 (5) "Health care provider campus" means:
4532 (A) the main buildings of a health care provider;
4633 (B) the physical area immediately adjacent to the
4734 main buildings and other areas or structures not contiguous to the
4835 main buildings but located not more than 250 yards from the main
4936 buildings; and
5037 (C) any other area the Centers for Medicare and
5138 Medicaid Services determine to be a health care provider campus.
5239 (6) "Hospital" has the meaning assigned by Section
5340 241.003.
54- (7) "Hospital-owned facility" means a clinic or other
55- facility that provides health care services and:
56- (A) is owned or operated by, in whole or in part,
57- a hospital; and
58- (B) is not located on the hospital's health care
59- provider campus.
60- (8) "Independent physician or physician group" means a
61- physician practice or physician group that is not employed, owned,
62- operated, or managed by or affiliated with a health care provider.
63- (9) "National provider identifier" means a national
64- provider identifier number, as that term is defined by Section
65- 532.0152, Government Code.
66- (10) "Place of service code" means a two-digit code
67- maintained by the Centers for Medicare and Medicaid Services or an
68- alphanumeric indicator that is placed on a health care provider's
69- or independent physician or physician group's claim for
70- reimbursement or payment to indicate the setting in which a health
71- care service was provided.
72- (11) "Provider-based outpatient facility" means a
73- facility a health care provider owns or operates, wholly or partly,
74- where outpatient health care services and supplies are provided.
75- (12) "Telehealth service" and "telemedicine medical
41+ (7) "National provider identifier" means the national
42+ provider identifier described by 45 C.F.R. Part 162.
43+ (8) "Preventative health services" means the
44+ preventive health services described by 42 U.S.C. Section 300gg-13.
45+ (9) "Provider-based facility" means a facility a
46+ health care provider owns or operates, wholly or partly, where
47+ health care services and supplies are provided.
48+ (10) "Telehealth service" and "telemedicine medical
7649 service" have the meanings assigned by Section 111.001, Occupations
77- Code, except the terms do not include a telehealth service or
78- telemedicine medical service provided by a hospital or
79- provider-based outpatient facility to a patient physically located
80- at the hospital or provider-based outpatient facility at the time
81- the service is provided.
82- (13) "Third party payor" means an insurance company,
83- health benefit plan sponsor, health benefit plan issuer, or entity
84- other than a patient or health care provider that pays for health
85- care services and supplies provided to a patient.
50+ Code.
51+ (11) "Third party payor" means an insurance company,
52+ health benefit plan sponsor, or entity other than a patient or
53+ health care provider that pays for health care services and
54+ supplies provided to a patient.
8655 Sec. 328.002. PROHIBITED FACILITY FEES. A health care
87- provider may not charge a facility fee for telehealth services or
88- telemedicine medical services.
89- Sec. 328.003. REQUIRED PLACE OF SERVICE CODE. A health care
90- provider shall include a valid place of service code for the setting
91- where a health care service was provided on each claim for
92- reimbursement submitted for the health care service provided by the
93- provider.
94- Sec. 328.004. REQUIRED NATIONAL PROVIDER IDENTIFIER. (a)
95- On or after January 1, 2031, a health care provider required or
96- eligible to obtain a national provider identifier under federal law
97- shall apply for and obtain a national provider identifier for:
98- (1) the provider;
99- (2) each provider-based outpatient facility the
100- health care provider owns or manages or with which the health care
101- provider is otherwise affiliated; and
102- (3) if the provider is a hospital, each hospital-owned
103- facility.
104- (b) This section expires September 1, 2029.
105- Sec. 328.005. NOTICE OF FACILITY FEE. (a) A health care
56+ provider may not charge a facility fee for:
57+ (1) telehealth services or telemedicine medical
58+ services; or
59+ (2) preventative health services.
60+ Sec. 328.003. REQUIRED NATIONAL PROVIDER IDENTIFIER. A
61+ health care provider required or eligible to obtain a national
62+ provider identifier under federal law shall apply for and obtain a
63+ national provider identifier for:
64+ (1) the provider; and
65+ (2) each provider-based facility the health care
66+ provider owns or manages or with which the health care provider is
67+ otherwise affiliated.
68+ Sec. 328.004. INCLUSION OF NATIONAL PROVIDER IDENTIFIER ON
69+ HEALTH CARE PROVIDER CLAIM. (a) A health care provider or
70+ provider-based facility required to obtain a unique national
71+ provider identifier under Section 328.003 shall include the
72+ national provider identifier of the facility where the health care
73+ services and supplies were provided on each claim for reimbursement
74+ or payment, including any facility fee charged, for the provided
75+ health care services or supplies.
76+ (b) A health care provider or provider-based facility
77+ required to obtain a unique national provider identifier may charge
78+ a facility fee for providing health care services or supplies only
79+ if the claim for reimbursement or payment for the services or
80+ supplies includes the national provider identifier of the facility
81+ where the services or supplies were provided.
82+ Sec. 328.005. PROHIBITED REIMBURSEMENT. A health benefit
83+ plan issuer or third party payor may not pay a facility fee charge
84+ on a health care provider's claim for reimbursement for provided
85+ health care services or supplies unless the claim includes the
86+ unique national provider identifier for the facility where the
87+ health care services or supplies were provided.
88+ Sec. 328.006. NOTICE OF FACILITY FEE. (a) A health care
10689 provider shall provide to a patient written notice of a facility fee
10790 charged for a health care service or supply provided to the patient
108- at:
109- (1) if the provider is a hospital, a hospital-owned
110- facility; or
111- (2) a provider-based outpatient facility that:
112- (A) is at a location other than the health care
91+ at a provider-based facility that:
92+ (1) is at a location other than the health care
11393 provider campus;
114- (B) provides services organizationally and
94+ (2) provides services organizationally and
11595 functionally integrated with the provider; and
116- (C) provides outpatient preventative health
117- services, diagnostic health services, treatment services, or
118- emergency care.
96+ (3) provides outpatient preventative health services,
97+ diagnostic health services, treatment services, or emergency care.
11998 (b) Except as provided by Subsection (c), the written notice
12099 required under Subsection (a) must be provided to the patient not
121100 later than the 10th day before the date scheduled for provision of
122- the health care service or supply or in accordance with Section
123- 324.101 or 45 C.F.R. Section 149.610, as applicable.
101+ the health care service or supply.
124102 (c) A health care provider shall provide the written notice
125103 required under Subsection (a) on the date the health care service or
126104 supply is provided if the provision of the health care service or
127- supply is scheduled less than 10 days before that date or in
128- accordance with Section 324.101 or 45 C.F.R. Section 149.610, as
129- applicable.
105+ supply is scheduled less than 10 days before that date.
130106 (d) The written notice required under Subsection (a) must
131107 include:
132- (1) the amount of the facility fee or, if the exact
133- health care service or supply to be provided is not known, an
134- explanation that the patient may incur a cost-share or coinsurance
135- expense that would not occur if the service or supply is provided by
136- an independent physician or physician group;
108+ (1) the amount of the facility fee;
137109 (2) the purpose of the facility fee; and
138- (3) if the third party payor of a patient's health
139- benefit plan provides the information to a health care provider
140- before the date the notice is required, information on whether the
141- health benefit plan covers the facility fee.
110+ (3) information on whether a patient's health benefit
111+ plan covers the facility fee.
142112 (e) Before a health care provider may begin charging a
143113 facility fee for provision of a health care service or supply at a
144- newly built provider-based outpatient facility, at a
145- provider-based outpatient facility or hospital-owned facility that
146- did not previously charge a facility fee, or for a health care
114+ newly built provider-based facility, at a provider-based facility
115+ that did not previously charge a facility fee, or for a health care
147116 service or supply that did not previously include a facility fee
148- charge, the provider must notify all contracted third party payors
149- of the provider's intent to begin charging facility fees not later
150- than the 90th day before the date the provider begins charging the
151- facility fee.
152- (f) A health care provider may not charge a patient or third
153- party payor a facility fee at a provider-based outpatient facility
154- or hospital-owned facility unless the provider provides notice as
155- required by this section.
156- Sec. 328.006. ENFORCEMENT. (a) The commission or
157- appropriate state regulatory authority with jurisdiction over a
158- health care provider shall assess an administrative penalty in an
159- amount not to exceed $1,000 for each violation against a health care
160- provider that violates this chapter or a rule adopted under this
161- chapter.
117+ charge, the provider must notify all contracted health benefit plan
118+ issuers and third party payors of the provider's intent to begin
119+ charging facility fees at the facility or for the service or supply.
120+ (f) A health care provider may not charge a patient a
121+ facility fee at a provider-based facility or for a health care
122+ service or supply unless the provider provides notice as required
123+ by this section.
124+ Sec. 328.007. ENFORCEMENT. (a) The commission shall
125+ assess an administrative penalty in an amount not to exceed $1,000
126+ against a health care provider that violates this chapter or a rule
127+ adopted under this chapter.
162128 (b) This section does not create a private cause of action
163129 against a provider for legal or equitable relief.
164- Sec. 328.007. RULES. (a) The executive commissioner may
165- adopt rules to implement this chapter.
166- (b) The executive head of a state regulatory authority with
167- jurisdiction over a health care provider may adopt rules regarding
168- the duties of a health care provider under this chapter and
169- disciplinary action to be taken against a health care provider that
170- violates this chapter.
171- SECTION 2. (a) In this section, "third party payor" and
172- "independent physician or physician group" have the meanings
173- assigned by Section 328.001, Health and Safety Code, as added by
174- this Act.
175- (b) The University of Texas Health Science Center at
176- Houston, using the Texas All Payor Claims Database established
177- under Subchapter I, Chapter 38, Insurance Code, and in cooperation
178- with the Health and Human Services Commission and the Department of
179- State Health Services, shall conduct a study on health care
180- facility fees charged in this state.
181- (c) The study must include:
182- (1) a description by third party payor type of a
183- patient's cost-sharing obligation for health care facility fees;
184- (2) a comparison, in the aggregate, of the cost of
185- health care services provided by health care professionals
186- affiliated with a health system and independent physicians or
187- physician groups, including a comparison of the charges for
188- professional fees when a health care facility fee is included in a
189- patient's statement of charges; and
190- (3) a comparison, in the aggregate, of any trends in
191- total spending and a patient's cost-sharing obligation for specific
192- health care services, including those services reported using a
193- Current Procedural Terminology code as performance of an evaluation
194- and management procedure, for claims for reimbursement submitted by
195- an individual health care provider or a health care facility.
196- (d) Not later than December 1, 2026, The University of Texas
197- Health Science Center at Houston shall submit to the legislature a
198- written report on the findings of the study conducted under this
199- section.
200- (e) This section expires September 1, 2027.
201- SECTION 3. (a) Except as provided by Subsection (b) of this
130+ Sec. 328.008. RULES. The executive commissioner may adopt
131+ rules to implement this chapter.
132+ SECTION 2. (a) Except as provided by Subsection (b) of this
202133 section, this Act takes effect September 1, 2025.
203134 (b) Section 328.005, Health and Safety Code, as added by
204135 this Act, takes effect January 1, 2026.