89R5574 MPF-F
By: Hancock S.B. No. 1232
A BILL TO BE ENTITLED
AN ACT
relating to certain health care transaction fees and payment claims
and inclusion of a national provider identifier on a payment claim;
providing an administrative penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
amended by adding Chapter 328 to read as follows:
CHAPTER 328. FACILITY FEES
Sec. 328.001. DEFINITIONS. In this chapter:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Executive commissioner" means the executive
commissioner of the commission.
(3) "Facility fee" means a fee a health care provider
charges that is:
(A) intended to compensate the health care
provider for operational expenses; and
(B) separate from a fee a health care provider
charges for professional medical services provided in a
provider-based facility.
(4) "Health care provider" means a hospital system,
hospital, provider-based facility, or other health care facility,
including a designee or affiliate of the facility.
(5) "Health care provider campus" means:
(A) the main buildings of a health care provider;
(B) the physical area immediately adjacent to the
main buildings and other areas or structures not contiguous to the
main buildings but located not more than 250 yards from the main
buildings; and
(C) any other area the Centers for Medicare and
Medicaid Services determine to be a health care provider campus.
(6) "Hospital" has the meaning assigned by Section
241.003.
(7) "National provider identifier" means the national
provider identifier described by 45 C.F.R. Part 162.
(8) "Preventative health services" means the
preventive health services described by 42 U.S.C. Section 300gg-13.
(9) "Provider-based facility" means a facility a
health care provider owns or operates, wholly or partly, where
health care services and supplies are provided.
(10) "Telehealth service" and "telemedicine medical
service" have the meanings assigned by Section 111.001, Occupations
Code.
(11) "Third party payor" means an insurance company,
health benefit plan sponsor, or entity other than a patient or
health care provider that pays for health care services and
supplies provided to a patient.
Sec. 328.002. PROHIBITED FACILITY FEES. A health care
provider may not charge a facility fee for:
(1) telehealth services or telemedicine medical
services; or
(2) preventative health services.
Sec. 328.003. REQUIRED NATIONAL PROVIDER IDENTIFIER. A
health care provider required or eligible to obtain a national
provider identifier under federal law shall apply for and obtain a
national provider identifier for:
(1) the provider; and
(2) each provider-based facility the health care
provider owns or manages or with which the health care provider is
otherwise affiliated.
Sec. 328.004. INCLUSION OF NATIONAL PROVIDER IDENTIFIER ON
HEALTH CARE PROVIDER CLAIM. (a) A health care provider or
provider-based facility required to obtain a unique national
provider identifier under Section 328.003 shall include the
national provider identifier of the facility where the health care
services and supplies were provided on each claim for reimbursement
or payment, including any facility fee charged, for the provided
health care services or supplies.
(b) A health care provider or provider-based facility
required to obtain a unique national provider identifier may charge
a facility fee for providing health care services or supplies only
if the claim for reimbursement or payment for the services or
supplies includes the national provider identifier of the facility
where the services or supplies were provided.
Sec. 328.005. PROHIBITED REIMBURSEMENT. A health benefit
plan issuer or third party payor may not pay a facility fee charge
on a health care provider's claim for reimbursement for provided
health care services or supplies unless the claim includes the
unique national provider identifier for the facility where the
health care services or supplies were provided.
Sec. 328.006. NOTICE OF FACILITY FEE. (a) A health care
provider shall provide to a patient written notice of a facility fee
charged for a health care service or supply provided to the patient
at a provider-based facility that:
(1) is at a location other than the health care
provider campus;
(2) provides services organizationally and
functionally integrated with the provider; and
(3) provides outpatient preventative health services,
diagnostic health services, treatment services, or emergency care.
(b) Except as provided by Subsection (c), the written notice
required under Subsection (a) must be provided to the patient not
later than the 10th day before the date scheduled for provision of
the health care service or supply.
(c) A health care provider shall provide the written notice
required under Subsection (a) on the date the health care service or
supply is provided if the provision of the health care service or
supply is scheduled less than 10 days before that date.
(d) The written notice required under Subsection (a) must
include:
(1) the amount of the facility fee;
(2) the purpose of the facility fee; and
(3) information on whether a patient's health benefit
plan covers the facility fee.
(e) Before a health care provider may begin charging a
facility fee for provision of a health care service or supply at a
newly built provider-based facility, at a provider-based facility
that did not previously charge a facility fee, or for a health care
service or supply that did not previously include a facility fee
charge, the provider must notify all contracted health benefit plan
issuers and third party payors of the provider's intent to begin
charging facility fees at the facility or for the service or supply.
(f) A health care provider may not charge a patient a
facility fee at a provider-based facility or for a health care
service or supply unless the provider provides notice as required
by this section.
Sec. 328.007. ENFORCEMENT. (a) The commission shall
assess an administrative penalty in an amount not to exceed $1,000
against a health care provider that violates this chapter or a rule
adopted under this chapter.
(b) This section does not create a private cause of action
against a provider for legal or equitable relief.
Sec. 328.008. RULES. The executive commissioner may adopt
rules to implement this chapter.
SECTION 2. (a) Except as provided by Subsection (b) of this
section, this Act takes effect September 1, 2025.
(b) Section 328.005, Health and Safety Code, as added by
this Act, takes effect January 1, 2026.