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A BILL TO BE ENTITLED
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AN ACT
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relating to the disclosure by health care practitioners and |
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facilities of patient liability for payment for certain health care |
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services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Chapter 1456, Insurance Code, is |
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amended to read as follows: |
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CHAPTER 1456. DISCLOSURE OF PROVIDER STATUS AND PATIENT LIABILITY |
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SECTION 2. Section 1456.003(a), Insurance Code, is amended |
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to read as follows: |
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(a) Each health benefit plan that provides health care |
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through a provider network shall provide notice to its enrollees |
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that: |
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(1) a facility-based physician or other health care |
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practitioner may not be included in the health benefit plan's |
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provider network; and |
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(2) subject to Subchapter D, Chapter 324, Health and |
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Safety Code, a health care practitioner described by Subdivision |
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(1) may balance bill the enrollee for amounts not paid by the health |
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benefit plan. |
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SECTION 3. Section 1456.007, Insurance Code, is amended to |
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read as follows: |
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Sec. 1456.007. HEALTH BENEFIT PLAN ESTIMATE OF CHARGES. A |
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health benefit plan that must comply with this chapter under |
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Section 1456.002 shall, on the request of an enrollee, provide an |
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estimate of payments that will be made for any health care service |
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or supply and shall also specify any applicable deductibles, |
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copayments, or coinsurance[, or other amounts for which the
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enrollee is responsible]. The estimate must be provided not later |
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than the 10th business day after the date on which the estimate was |
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requested. A health benefit plan must advise the enrollee that: |
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(1) the actual payment and charges for the services or |
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supplies will vary based upon the enrollee's actual medical |
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condition and other factors associated with performance of medical |
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services; and |
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(2) subject to Subchapter D, Chapter 324, Health and |
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Safety Code, the enrollee may be personally liable for the payment |
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of services or supplies based upon the enrollee's health benefit |
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plan coverage. |
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SECTION 4. Chapter 324, Health and Safety Code, is amended |
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by adding Subchapter D to read as follows: |
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SUBCHAPTER D. PRICE DISCLOSURE |
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Sec. 324.151. DEFINITIONS. Notwithstanding Section |
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324.001, in this subchapter: |
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(1) "Health care facility" means a hospital, emergency |
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clinic, outpatient clinic, birthing center, ambulatory surgical |
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center, or other facility providing health care services. |
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(2) "Health care practitioner" means an individual who |
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is licensed to provide and provides health care services. |
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Sec. 324.152. PRICE DISCLOSURE BY HEALTH CARE PRACTITIONERS |
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AND FACILITIES. (a) At least three business days before providing a |
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health care service other than emergency care, as defined by |
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Section 1301.155, Insurance Code, to a patient, a health care |
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practitioner or facility must disclose to the patient the price |
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that will be accepted as payment in full for the service. The |
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disclosure required by this section must be provided in writing in a |
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readily understandable manner. |
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(b) Notwithstanding another provision of this subchapter, |
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Chapter 1456, Insurance Code, or any other law, a health care |
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practitioner or facility that does not make a disclosure required |
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by this section before providing a health care service may not: |
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(1) attempt to collect from the patient, by lawsuit or |
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otherwise, any billed amount that would otherwise be owed by the |
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patient for the service; |
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(2) transfer or sell to a third party the right to |
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collect any billed amount that would otherwise be owed by the |
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patient for the service; or |
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(3) furnish adverse information to a consumer |
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reporting agency regarding any billed amount that would otherwise |
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be owed by the patient for the service. |
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Sec. 324.153. DUPLICATIVE ESTIMATE NOT REQUIRED. A |
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facility that receives a request for an estimate under Section |
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324.101(d) may provide, instead of an estimate, the price |
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disclosure required by this subchapter. A facility that provides |
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an estimate under Section 324.101(d) is not relieved of the |
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obligation to provide a price disclosure under this subchapter. |
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Sec. 324.154. PATIENT HELD HARMLESS. In addition to any |
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other remedy provided by this subchapter or other law, a health care |
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practitioner or facility shall hold a patient harmless from any |
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damages resulting from the practitioner's or facility's violation |
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of this subchapter. |
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SECTION 5. The change in law made by this Act applies only |
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to a service provided by a health care practitioner or facility on |
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or after January 1, 2016. A service provided by a health care |
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practitioner or facility before January 1, 2016, is governed by the |
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law in effect immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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SECTION 6. This Act takes effect September 1, 2015. |