Texas 2025 - 89th Regular

Texas Senate Bill SB1232 Compare Versions

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

Old	New	Differences
1	1	89R5574 MPF-F
2	2	By: Hancock S.B. No. 1232
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to certain health care transaction fees and payment claims
10	10	and inclusion of a national provider identifier on a payment claim;
11	11	providing an administrative penalty.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Subtitle G, Title 4, Health and Safety Code, is
14	14	amended by adding Chapter 328 to read as follows:
15	15	CHAPTER 328. FACILITY FEES
16	16	Sec. 328.001. DEFINITIONS. In this chapter:
17	17	(1) "Commission" means the Health and Human Services
18	18	Commission.
19	19	(2) "Executive commissioner" means the executive
20	20	commissioner of the commission.
21	21	(3) "Facility fee" means a fee a health care provider
22	22	charges that is:
23	23	(A) intended to compensate the health care
24	24	provider for operational expenses; and
25	25	(B) separate from a fee a health care provider
26	26	charges for professional medical services provided in a
27	27	provider-based facility.
28	28	(4) "Health care provider" means a hospital system,
29	29	hospital, provider-based facility, or other health care facility,
30	30	including a designee or affiliate of the facility.
31	31	(5) "Health care provider campus" means:
32	32	(A) the main buildings of a health care provider;
33	33	(B) the physical area immediately adjacent to the
34	34	main buildings and other areas or structures not contiguous to the
35	35	main buildings but located not more than 250 yards from the main
36	36	buildings; and
37	37	(C) any other area the Centers for Medicare and
38	38	Medicaid Services determine to be a health care provider campus.
39	39	(6) "Hospital" has the meaning assigned by Section
40	40	241.003.
41	41	(7) "National provider identifier" means the national
42	42	provider identifier described by 45 C.F.R. Part 162.
43	43	(8) "Preventative health services" means the
44	44	preventive health services described by 42 U.S.C. Section 300gg-13.
45	45	(9) "Provider-based facility" means a facility a
46	46	health care provider owns or operates, wholly or partly, where
47	47	health care services and supplies are provided.
48	48	(10) "Telehealth service" and "telemedicine medical
49	49	service" have the meanings assigned by Section 111.001, Occupations
50	50	Code.
51	51	(11) "Third party payor" means an insurance company,
52	52	health benefit plan sponsor, or entity other than a patient or
53	53	health care provider that pays for health care services and
54	54	supplies provided to a patient.
55	55	Sec. 328.002. PROHIBITED FACILITY FEES. A health care
56	56	provider may not charge a facility fee for:
57	57	(1) telehealth services or telemedicine medical
58	58	services; or
59	59	(2) preventative health services.
60	60	Sec. 328.003. REQUIRED NATIONAL PROVIDER IDENTIFIER. A
61	61	health care provider required or eligible to obtain a national
62	62	provider identifier under federal law shall apply for and obtain a
63	63	national provider identifier for:
64	64	(1) the provider; and
65	65	(2) each provider-based facility the health care
66	66	provider owns or manages or with which the health care provider is
67	67	otherwise affiliated.
68	68	Sec. 328.004. INCLUSION OF NATIONAL PROVIDER IDENTIFIER ON
69	69	HEALTH CARE PROVIDER CLAIM. (a) A health care provider or
70	70	provider-based facility required to obtain a unique national
71	71	provider identifier under Section 328.003 shall include the
72	72	national provider identifier of the facility where the health care
73	73	services and supplies were provided on each claim for reimbursement
74	74	or payment, including any facility fee charged, for the provided
75	75	health care services or supplies.
76	76	(b) A health care provider or provider-based facility
77	77	required to obtain a unique national provider identifier may charge
78	78	a facility fee for providing health care services or supplies only
79	79	if the claim for reimbursement or payment for the services or
80	80	supplies includes the national provider identifier of the facility
81	81	where the services or supplies were provided.
82	82	Sec. 328.005. PROHIBITED REIMBURSEMENT. A health benefit
83	83	plan issuer or third party payor may not pay a facility fee charge
84	84	on a health care provider's claim for reimbursement for provided
85	85	health care services or supplies unless the claim includes the
86	86	unique national provider identifier for the facility where the
87	87	health care services or supplies were provided.
88	88	Sec. 328.006. NOTICE OF FACILITY FEE. (a) A health care
89	89	provider shall provide to a patient written notice of a facility fee
90	90	charged for a health care service or supply provided to the patient
91	91	at a provider-based facility that:
92	92	(1) is at a location other than the health care
93	93	provider campus;
94	94	(2) provides services organizationally and
95	95	functionally integrated with the provider; and
96	96	(3) provides outpatient preventative health services,
97	97	diagnostic health services, treatment services, or emergency care.
98	98	(b) Except as provided by Subsection (c), the written notice
99	99	required under Subsection (a) must be provided to the patient not
100	100	later than the 10th day before the date scheduled for provision of
101	101	the health care service or supply.
102	102	(c) A health care provider shall provide the written notice
103	103	required under Subsection (a) on the date the health care service or
104	104	supply is provided if the provision of the health care service or
105	105	supply is scheduled less than 10 days before that date.
106	106	(d) The written notice required under Subsection (a) must
107	107	include:
108	108	(1) the amount of the facility fee;
109	109	(2) the purpose of the facility fee; and
110	110	(3) information on whether a patient's health benefit
111	111	plan covers the facility fee.
112	112	(e) Before a health care provider may begin charging a
113	113	facility fee for provision of a health care service or supply at a
114	114	newly built provider-based facility, at a provider-based facility
115	115	that did not previously charge a facility fee, or for a health care
116	116	service or supply that did not previously include a facility fee
117	117	charge, the provider must notify all contracted health benefit plan
118	118	issuers and third party payors of the provider's intent to begin
119	119	charging facility fees at the facility or for the service or supply.
120	120	(f) A health care provider may not charge a patient a
121	121	facility fee at a provider-based facility or for a health care
122	122	service or supply unless the provider provides notice as required
123	123	by this section.
124	124	Sec. 328.007. ENFORCEMENT. (a) The commission shall
125	125	assess an administrative penalty in an amount not to exceed $1,000
126	126	against a health care provider that violates this chapter or a rule
127	127	adopted under this chapter.
128	128	(b) This section does not create a private cause of action
129	129	against a provider for legal or equitable relief.
130	130	Sec. 328.008. RULES. The executive commissioner may adopt
131	131	rules to implement this chapter.
132	132	SECTION 2. (a) Except as provided by Subsection (b) of this
133	133	section, this Act takes effect September 1, 2025.
134	134	(b) Section 328.005, Health and Safety Code, as added by
135	135	this Act, takes effect January 1, 2026.