89R2858 MCF-F
By: Hughes S.B. No. 1219
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
the total amount a facility will accept as payment in full,
inclusive of all payment sources, 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 Subsections
(d-1) and (d-2) 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 from the facility. 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 in person, by e-mail, or through an online patient portal,
as chosen by the consumer [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 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 the estimate provided under Subsection (d) by
more than five percent unless the additional charges are:
(1) related to complications arising during the
procedure or service and not reasonably avoidable in provision of
the procedure or service by the medical provider while exercising
reasonable medical judgment; or
(2) as a result of a change of diagnosis not
discoverable before the procedure or service and documented in the
patient's chart.
(d-2) If the final billed charges exceed the amount
specified in an estimate provided under Subsection (d) by more than
five percent, the facility must provide to the patient a written
statement describing:
(1) the difference in the final billed amount and the
estimate amount; and
(2) a plain-language explanation describing 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 or other financially responsible party;
(B) report the consumer to a credit bureau; or
(C) pursue an action against the consumer; and
(2) is subject to 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.