Bill Text: TX HB4035 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to disclosure of certain health care costs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2023-03-20 - Referred to Health Care Reform, Select [HB4035 Detail]
Download: Texas-2023-HB4035-Introduced.html
| 88R13424 MCF-F | ||
| By: Hayes | H.B. No. 4035 | |
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| relating to disclosure of certain health care costs. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Title 2, Health and Safety Code, is amended by | ||
| adding Subtitle J to read as follows: | ||
| SUBTITLE J. HEALTH CARE PRICE DISCLOSURES | ||
| CHAPTER 185. HEALTH CARE PRICE DISCLOSURES | ||
| Sec. 185.001. DEFINITIONS. In this chapter: | ||
| (1) "Facility" means a hospital, outpatient clinic, | ||
| birthing center, ambulatory surgical center, or other licensed | ||
| facility providing health care services. The term does not include | ||
| an emergency clinic, a freestanding emergency medical care | ||
| facility, or other facility providing only emergency care. | ||
| (2) "Patient" includes a prospective patient and a | ||
| personal representative of the patient. | ||
| (3) "Practitioner" means an individual who is licensed | ||
| to provide and provides medical or other health care services in | ||
| this state. | ||
| Sec. 185.002. PRICE DISCLOSURE OR ESTIMATE. (a) Before | ||
| providing a nonemergency health care service offered to the patient | ||
| by the facility or practitioner, a facility or practitioner shall | ||
| provide a price disclosure described by Subsection (b) or an | ||
| estimate described by Subsection (c) unless declined by the | ||
| patient. | ||
| (b) Except as provided by Subsection (c), a facility or | ||
| practitioner required to provide a price disclosure under | ||
| Subsection (a) shall disclose to the patient the amount, including | ||
| facility fees, that: | ||
| (1) the patient's health benefit plan will reimburse | ||
| the facility or practitioner for the service, if the facility or | ||
| practitioner is a participating provider under the patient's health | ||
| benefit plan; or | ||
| (2) the facility or practitioner will charge for the | ||
| service, if the facility or practitioner is not a participating | ||
| provider under the patient's health benefit plan. | ||
| (c) If a facility or practitioner is unable to quote a | ||
| specific amount under Subsection (b) because of the facility's or | ||
| practitioner's inability to predict the specific service the | ||
| patient will need, the facility or practitioner shall provide an | ||
| estimate of the amount, including facility fees, that: | ||
| (1) the patient's health benefit plan will reimburse | ||
| the facility or practitioner for the predicted service, if the | ||
| facility or practitioner is a participating provider under the | ||
| patient's health benefit plan; or | ||
| (2) the facility or practitioner will charge for the | ||
| predicted service, if the facility or practitioner is not a | ||
| participating provider under the patient's health benefit plan. | ||
| (d) A facility or practitioner that provides an estimate | ||
| described by Subsection (c) shall: | ||
| (1) disclose the incomplete nature of the estimate; | ||
| and | ||
| (2) inform the patient that the facility or | ||
| practitioner may be able to provide an updated estimate after the | ||
| facility or practitioner obtains additional information. | ||
| (e) Notwithstanding any other law, a facility or | ||
| practitioner that does not provide the price disclosure or estimate | ||
| required by this section before providing a health care service for | ||
| which the price disclosure or estimate is required may not bill the | ||
| patient or the patient's health benefit plan for the service. | ||
| Sec. 185.003. EFFECT OF OTHER LAW. A facility that provides | ||
| an estimate under Section 324.101(d) is not relieved of the | ||
| obligation to provide a price disclosure or estimate under Section | ||
| 185.002. | ||
| Sec. 185.004. PATIENT INFORMATION. On request, a facility | ||
| or practitioner shall provide a patient with sufficient information | ||
| about a proposed nonemergency health care service to enable the | ||
| patient to determine the amount of the patient's personal liability | ||
| by using the patient's health benefit plan's toll-free telephone | ||
| number or Internet website. The facility or practitioner shall | ||
| provide the information to the patient based on the information | ||
| available to the facility or practitioner at the time of the | ||
| request. The facility or practitioner may assist the patient in | ||
| using the telephone number or website. | ||
| SECTION 2. Section 324.101, Health and Safety Code, is | ||
| amended by adding Subsection (d-1) and amending Subsection (e) to | ||
| read as follows: | ||
| (d-1) A facility that provides a price disclosure or | ||
| estimate under Section 185.002 is not relieved of the obligation to | ||
| provide an estimate under Subsection (d). | ||
| (e) A facility shall provide to the consumer at the | ||
| consumer's request an itemized statement in plain language of the | ||
| billed services if the consumer requests the statement not later | ||
| than the first anniversary of the date the person is discharged from | ||
| the facility. The facility shall provide the statement to the | ||
| consumer not later than the 10th business day after the date on | ||
| which the statement is requested. | ||
| SECTION 3. Chapter 185, Health and Safety Code, as added by | ||
| this Act, and Section 324.101(e), Health and Safety Code, as | ||
| amended by this Act, apply only to a service provided by a facility | ||
| or practitioner on or after January 1, 2024. A service provided | ||
| before January 1, 2024, is governed by the law as it existed | ||
| immediately before the effective date of this Act, and that law is | ||
| continued in effect for that purpose. | ||
| SECTION 4. This Act takes effect September 1, 2023. | ||
