Texas 2025 - 89th Regular

Texas House Bill HB3321 Compare Versions

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

Old	New	Differences
1	1	89R6051 MPF-D
2	2	By: Oliverson H.B. No. 3321
3	3
4	4
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to certain health care entity or system transaction fees
10	10	and payment claims; providing administrative and civil penalties.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
13	13	amended by adding Chapter 328 to read as follows:
14	14	CHAPTER 328. HEALTH CARE ENTITY AND HEALTH CARE SYSTEM TRANSACTION
15	15	FEES AND PAYMENT CLAIMS
16	16	SUBCHAPTER A. GENERAL PROVISIONS
17	17	Sec. 328.001. DEFINITIONS. In this chapter:
18	18	(1) "Affiliate" means a person who is:
19	19	(A) employed by a hospital or health care system;
20	20	or
21	21	(B) under a professional services agreement,
22	22	faculty agreement, or management agreement with a hospital or
23	23	health care system that authorizes the hospital or health care
24	24	system to bill on behalf of the person.
25	25	(2) "Campus" means, with respect to a health care
26	26	entity:
27	27	(A) the entity's main buildings for providing
28	28	health care services;
29	29	(B) the physical area immediately adjacent to the
30	30	main buildings and other areas or structures not contiguous to the
31	31	main buildings but located not more than 250 yards from the main
32	32	buildings; and
33	33	(C) another area the Centers for Medicare and
34	34	Medicaid Services determines is a campus of a health care entity.
35	35	(3) "Commission" means the Health and Human Services
36	36	Commission.
37	37	(4) "Enrollee" means an individual who is covered
38	38	under a health benefit plan, including a multiple employer welfare
39	39	arrangement. The term does not include an individual who is covered
40	40	under a limited benefit plan, accident plan, indemnity plan,
41	41	limited scope dental or vision plan, or short-term limited-duration
42	42	insurance policy governed by Chapter 1509, Insurance Code.
43	43	(5) "Executive commissioner" means the executive
44	44	commissioner of the commission.
45	45	(6) "Facility fee" means a fee a health care entity or
46	46	health care system charges for outpatient health care services that
47	47	is:
48	48	(A) intended to compensate the entity or system
49	49	for operational expenses; and
50	50	(B) separate from a fee the entity or system
51	51	charges for professional health care services.
52	52	(7) "Freestanding emergency medical care facility"
53	53	has the meaning assigned by Section 254.001.
54	54	(8) "Health benefit plan issuer" means an insurer,
55	55	health maintenance organization, or other entity authorized to
56	56	provide health benefits coverage under the laws of this state.
57	57	(9) "Health care entity" means a group, professional
58	58	corporation, or other entity that provides health care services.
59	59	The term includes a hospital, medical clinic, medical group, home
60	60	health care agency, health infusion clinic, urgent care clinic, and
61	61	freestanding emergency medical care facility.
62	62	(10) "Health care system" means a system of health
63	63	care entities in this state that are under the common governance or
64	64	control of a corporate parent.
65	65	(11) "Hospital" means a health care facility licensed
66	66	under Chapter 241. The term includes a general hospital and special
67	67	hospital.
68	68	(12) "National provider identifier" means the
69	69	national provider identifier described by 45 C.F.R. Section
70	70	162.406.
71	71	Sec. 328.002. RULES. The executive commissioner shall
72	72	adopt rules to implement this chapter.
73	73	SUBCHAPTER B. FACILITY FEES FOR CERTAIN HEALTH CARE SERVICES
74	74	Sec. 328.051. PROHIBITED FACILITY FEES. A health care
75	75	entity or health care system may not charge a facility fee for:
76	76	(1) health care services provided at a location
77	77	outside of a campus associated with the entity or system; and
78	78	(2) outpatient health care services classified by a
79	79	Current Procedural Terminology code as performance of an evaluation
80	80	and management procedure, regardless of whether the services are
81	81	provided at a campus.
82	82	Sec. 328.052. FACILITY FEE NOTICE FOR EXISTING AFFILIATES.
83	83	(a) This section applies only to a health care entity that is an
84	84	affiliate of or owned by a hospital or health care system and that
85	85	charges a facility fee.
86	86	(b) A health care entity subject to this section shall:
87	87	(1) provide to a patient written notice:
88	88	(A) at the time a health care service appointment
89	89	is scheduled and before delivering the service:
90	90	(i) that the entity may charge a facility
91	91	fee; and
92	92	(ii) of the cost range of a potential
93	93	facility fee; and
94	94	(B) at the time a health care service appointment
95	95	is scheduled regarding:
96	96	(i) available complaint procedures for
97	97	improper billing;
98	98	(ii) available programs for eligible
99	99	patients to receive free or reduced cost health care services; and
100	100	(iii) the facility fee waiver process
101	101	authorized by Section 328.054; and
102	102	(2) post a sign that states:
103	103	(A) the entity may charge a facility fee in
104	104	addition to the cost for the health care service;
105	105	(B) the location within the entity's facility at
106	106	which the health care services are provided where a patient may
107	107	inquire about the entity's facility fees;
108	108	(C) the address of the entity's Internet webpage
109	109	that provides information about the entity's facility fees; and
110	110	(D) a toll-free telephone number available to the
111	111	patient that provides information about the entity's facility fees.
112	112	(c) The sign required by Subsection (b)(2) must be:
113	113	(1) posted prominently and conspicuously at each
114	114	location in the health care entity's facility where health care
115	115	services are provided and for which a facility fee is charged and at
116	116	the location where an individual registers or checks in for the
117	117	services;
118	118	(2) posted in English and the 15 other foreign
119	119	languages most commonly spoken in this state; and
120	120	(3) available in an alternative format for individuals
121	121	with a disability who require an auxiliary aid for communication.
122	122	(d) A health care entity that requests payment from a
123	123	patient after providing a health care service for which a facility
124	124	fee is charged shall submit with the payment request the written,
125	125	itemized bill required by Section 185.002 that also includes:
126	126	(1) a specific notation of the facility fee charge;
127	127	and
128	128	(2) contact information for the entity representative
129	129	through which the patient may appeal the facility fee charge.
130	130	(e) A health care entity shall, to the extent practicable,
131	131	provide the notice required by Subsection (b)(1) and the itemized
132	132	billing information required by Subsection (d) to the patient in
133	133	the patient's preferred language and in plain language.
134	134	Sec. 328.053. FACILITY FEE NOTICE FOR AFFILIATES. (a) A
135	135	health care entity shall, on becoming an affiliate of a hospital or
136	136	health care system, provide written notice to any patient who
137	137	received health care services from the entity in the 12 months
138	138	preceding the date the facility became an affiliate of:
139	139	(1) the name, address, and telephone number of the
140	140	affiliated hospital or system;
141	141	(2) the date on which the entity may begin charging a
142	142	facility fee for the affiliated hospital or system;
143	143	(3) the prohibition on the entity charging a patient a
144	144	facility fee for the affiliated hospital or system before the date
145	145	described by Subdivision (2); and
146	146	(4) the patient's opportunity to contact the patient's
147	147	health benefit plan issuer for additional information regarding a
148	148	facility fee, including the patient's financial responsibility for
149	149	the facility fee.
150	150	(b) A health care entity and the affiliated hospital or
151	151	health care system may not charge a patient a facility fee for a
152	152	health care service provided before the 30th day after the date the
153	153	entity provides the notice required by Subsection (a).
154	154	Sec. 328.054. FACILITY FEE WAIVER PROCESS. (a) Each health
155	155	care entity and health care system that charges a facility fee shall
156	156	develop a process by which a patient may apply for a waiver to
157	157	wholly or partly reduce the costs of the facility fee. The process
158	158	must provide a patient:
159	159	(1) a period of not less than 30 days for the patient
160	160	to apply for the waiver that begins the day after the date the
161	161	patient receives the notice described by Section 328.052(b)(1); and
162	162	(2) information on the waiver process in the patient's
163	163	preferred language and with any auxiliary aid necessary for the
164	164	patient to complete the process.
165	165	(b) Each health care entity and health care system that
166	166	charges facility fees shall provide waivers described by Subsection
167	167	(a) to patients in accordance with rules adopted by the executive
168	168	commissioner.
169	169	Sec. 328.055. FACILITY FEE ANNUAL REPORT. (a) Each health
170	170	care entity and health care system shall annually submit a written
171	171	report to the commission on the facility fees charged by the entity
172	172	or system during the preceding year. The report must include:
173	173	(1) the name and mailing address of the entity or
174	174	system;
175	175	(2) the number of patient visits for which the entity
176	176	or system charged a facility fee;
177	177	(3) regarding the facility fee waiver process
178	178	established under Section 328.054:
179	179	(A) the number of waiver requests the entity or
180	180	system received;
181	181	(B) the number of waiver requests the entity or
182	182	system approved and denied; and
183	183	(C) the average dollar amount of an approved
184	184	waiver request and the percentage of the fee compared to the total
185	185	cost for the provided health care service;
186	186	(4) the number of appeals described by Section
187	187	328.052(d)(2) the entity or system received, approved, and denied;
188	188	(5) the total number of, total dollar amount of, and
189	189	cost range of facility fees paid by:
190	190	(A) Medicare or Medicaid;
191	191	(B) any private insurance plan; and
192	192	(C) a patient;
193	193	(6) the total amount billed and total revenue received
194	194	from facility fees;
195	195	(7) the 10 health care services, identified by Current
196	196	Procedural Terminology code, that generated the greatest amount of
197	197	facility fee gross revenue for the entity or system, including
198	198	information for each service on:
199	199	(A) the total number the entity or system
200	200	provided;
201	201	(B) the total net and gross revenue the entity or
202	202	system received; and
203	203	(C) the amount of gross revenue derived from
204	204	facility fees;
205	205	(8) the 10 health care services, identified by Current
206	206	Procedural Terminology code, for which facility fees were charged
207	207	that provided the greatest total number of patients for the entity
208	208	or system and the total net and gross revenue the entity or system
209	209	received for each service; and
210	210	(9) any other information related to facility fees the
211	211	commission determines necessary.
212	212	(b) The commission shall publish the information reported
213	213	under Subsection (a) on a publicly accessible web page on the
214	214	commission's Internet website.
215	215	SUBCHAPTER C. HEALTH CARE TRANSACTION TRANSPARENCY
216	216	Sec. 328.101. REQUIRED NATIONAL PROVIDER IDENTIFIER. (a)
217	217	Each health care entity or health care system shall apply for,
218	218	obtain, and use a unique national provider identifier for:
219	219	(1) each campus; and
220	220	(2) each location owned or operated by the entity or
221	221	system that is outside of the entity's or system's campus.
222	222	(b) A health care entity must demonstrate the entity has
223	223	complied with Subsection (a) as a condition for renewal of a license
224	224	required under this title.
225	225	Sec. 328.102. INCLUSION OF NATIONAL PROVIDER IDENTIFIER ON
226	226	PAYMENT CLAIMS. A health care entity shall include the national
227	227	provider identifier of the campus or location where the health care
228	228	services were provided on each bill or claim for reimbursement for
229	229	the health care services provided to a patient.
230	230	Sec. 328.103. PROHIBITED BILLING AND REIMBURSEMENT. (a) A
231	231	health care entity may not bill a patient or submit a claim for
232	232	reimbursement to the patient's health benefit plan issuer for
233	233	health care services provided to the patient at a location outside
234	234	of an entity campus unless the bill or claim:
235	235	(1) includes the national provider identifier of the
236	236	location where the services were provided; and
237	237	(2) uses the current version of the form CMS-1500 or
238	238	837P, as applicable.
239	239	(b) A patient and health benefit plan issuer are not
240	240	required to pay a health care entity's bill or claim for
241	241	reimbursement for health care services provided to the patient at a
242	242	location that is outside of the entity's campus unless the bill or
243	243	claim complies with Subsection (a).
244	244	(c) An enrollee is only financially responsible for cost
245	245	sharing required under the enrollee's health benefit plan for a
246	246	health care service provided at a location outside of the campus of
247	247	a health care entity.
248	248	SUBCHAPTER D. ENFORCEMENT
249	249	Sec. 328.151. AUDIT. (a) The commission may audit a health
250	250	care entity to verify compliance with this chapter.
251	251	(b) Each health care entity shall make available, on written
252	252	request of the commission, copies of any books, documents, records,
253	253	or other data that are necessary to complete the audit.
254	254	(c) Each health care entity shall retain copies of
255	255	information described by Subsection (b) until the fourth
256	256	anniversary of the date the health care services were provided.
257	257	(d) The commission shall publish the audit report on the
258	258	commission's Internet website.
259	259	Sec. 328.152. DECEPTIVE TRADE PRACTICE. A violation of
260	260	this chapter or a rule adopted under this chapter is a deceptive
261	261	trade practice under Chapter 17, Business & Commerce Code, and is
262	262	actionable under that chapter.
263	263	Sec. 328.153. DISCIPLINARY ACTION. (a) The commission,
264	264	after notice and hearing, may take disciplinary action against a
265	265	health care entity that violates this chapter or a rule adopted
266	266	under this chapter, including:
267	267	(1) assessing an administrative penalty in an amount
268	268	not less than $1,000;
269	269	(2) revocation, suspension, or denial of issuance of a
270	270	license required under this title;
271	271	(3) conditional or probationary issuance of or renewal
272	272	of a license required under this title; and
273	273	(4) referral of the matter to the attorney general for
274	274	imposition of a civil penalty against the entity.
275	275	(b) If, following an investigation and hearing conducted
276	276	under Subsection (a), the commission determines the health care
277	277	entity violated this chapter, the commission may recover from the
278	278	entity reasonable investigative costs the commission incurred in
279	279	conducting the investigation.
280	280	(c) If a health care entity is determined to have violated
281	281	this chapter or a rule adopted under this chapter, the entity shall
282	282	publish on the main page of the entity's Internet website
283	283	information on the violation, including the amount of any civil or
284	284	administrative penalty, conditions on licensure, and the actions
285	285	taken by the entity to remedy the violation.
286	286	SECTION 2. (a) As soon as practicable after the effective
287	287	date of this Act but not later than January 1, 2026, the executive
288	288	commissioner of the Health and Human Services Commission shall
289	289	adopt rules as required by Chapter 328, Health and Safety Code, as
290	290	added by this Act.
291	291	(b) Notwithstanding Chapter 328, Health and Safety Code, as
292	292	added by this Act, a health care entity, as defined by Section
293	293	328.001, Health and Safety Code, as added by this Act, is not
294	294	required to comply with that chapter until January 1, 2026.
295	295	SECTION 3. This Act takes effect September 1, 2025.