Bill Text: TX SB1445 | 2015-2016 | 84th Legislature | Introduced

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Bill Title: Relating to regulation of certain segments of the health care system.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2015-03-18 - Referred to Business & Commerce [SB1445 Detail]

Download: Texas-2015-SB1445-Introduced.html

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84R12079 PMO-F
By: Estes S.B. No. 1445

A BILL TO BE ENTITLED
AN ACT
relating to regulation of certain segments of the health care
system.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1451, Insurance Code, is amended by
adding Subchapter K to read as follows:
SUBCHAPTER K. HOSPITALS, HOSPITAL SYSTEMS, HEALTH CARE FACILITIES,
AND PHYSICIAN GROUP PRACTICES
Sec. 1451.501. DEFINITIONS. In this chapter:
(1) "Affiliate" means an affiliate as described by
Section 823.003.
(2) "Health care facility" has the meaning assigned by
Section 1456.001.
(3) "Health care provider" has the meaning assigned by
Section 1301.001.
(4) "Hospital" and "hospital system" have the meanings
assigned by Section 74.001, Civil Practice and Remedies Code.
(5) "Physician group practice" has the meaning
assigned by Section 157.051, Occupations Code.
Sec. 1451.502. APPLICABILITY OF SUBCHAPTER. This
subchapter applies only to a hospital, hospital system, health care
facility, or physician group practice that contracts with an
insurer for payment of claims or reimbursement under a health
benefit plan issued by the insurer.
Sec. 1451.503. CONFLICT WITH OTHER LAWS. To the extent this
subchapter conflicts with other law, the other law controls.
Sec. 1451.504. CERTAIN CONTRACTING PROVISIONS PROHIBITED.
A contract between an insurer and a hospital, hospital system,
health care facility, or physician group practice may not restrict
the ability of an insurer to furnish information to an insured
concerning the cost of a procedure or quality of care at the
hospital, hospital system, health care facility, or physician group
practice.
Sec. 1451.505. CONTRACT NEGOTIATIONS. To promote
competition between hospitals, hospital systems, health care
facilities, and physician group practices the commissioner shall
adopt reasonable rules establishing minimum standards, including
standards relating to information sharing, negotiating teams, and
firewalls for negotiating teams, for contract negotiations between
an insurer and a hospital, hospital system, health care facility,
or physician group practice that is owned by or affiliated with an
entity that owns other hospitals, hospital systems, health care
facilities, or physician group practices.
Sec. 1451.506. TRANSPARENCY. The commissioner shall adopt
reasonable rules establishing minimum standards related to
disclosures a hospital, hospital system, health care facility, or
physician group practice must make to an insured relating to the
amount or charge or estimate of the amount or charge, including any
facility fees, for an admission to or procedure or service
performed at the hospital, hospital system, health care facility,
or physician group practice for which the insured may be
financially responsible.
Sec. 1451.507. DISCLOSURE OF REFERRALS. The commissioner
shall adopt reasonable rules establishing minimum standards,
including the existence and nature of the affiliation, for
disclosures a health care provider must make on referral of an
insured to an affiliated provider.
Sec. 1451.508. NOTICE OF FACILITY FEE CHARGES. (a) The
commissioner shall adopt reasonable rules requiring a hospital or
hospital system to provide to an insured written notice of the
amount or estimate of the amount of a professional fee, if any,
including a facility fee, that the hospital or hospital system may
charge, in addition to and separate from the professional fee
charged by the physician or health care provider who treats the
insured, for a service provided at the hospital or hospital
system's hospital-based facility.
(b) The commissioner shall adopt reasonable rules requiring
certain information be included in the notice described by
Subsection (a), including an explanation that the insured may incur
financial liability that is greater than the insured might incur if
the service provided at the hospital or hospital system's
hospital-based facility was not provided at the hospital or
facility.
(c) The commissioner shall adopt reasonable rules
prescribing the manner and time of delivery of the notice described
by Subsection (a) and requiring the notice be provided to the
insured in plain language and in a form that may be reasonably
understood by an insured who does not possess special knowledge
regarding hospital or health system facility fee charges.
(d) Subsections (a), (b), and (c) do not apply to the child
health plan program operated under Chapter 62, Health and Safety
Code, the health benefits plan for children operated under Chapter
63, Health and Safety Code, the state Medicaid program, or a managed
care organization that contracts with the Health and Human Services
Commission to provide health care services to recipients through a
managed care plan.
(e) The commissioner shall adopt reasonable rules requiring
an insurer to contract only with hospital-based facilities that
prominently and publicly display written notice that the facility
is a hospital-based facility and clearly holds itself out to the
public and insureds as being a hospital-based facility.
Sec. 1451.509. MARKET CONCENTRATION. (a) The commissioner
shall adopt rules requiring hospitals, hospital systems, health
care facilities, and physician group practices and physicians and
health care providers practicing at the hospitals, hospital
systems, health care facilities, and physician group practices to
report information concerning:
(1) any merger or acquisition in which the hospital,
hospital system, health care facility, physician group practice,
physician, or health care provider is involved; or
(2) any material change to the business or corporate
structure of the hospital, hospital system, health care facility,
physician group practice, physician, or health care provider.
(b) The information required under Subsection (a) must
include information identifying the parties to and nature of the
merger or acquisition or describing the material change to the
business or corporate structure of the hospital, hospital system,
health care facility, physician group practice, physician, or
health care provider.
(c) The commissioner shall compile and provide to the
attorney general the information required under this section for
review and analysis. The attorney general shall review and analyze
the information provided by the commissioner and make
recommendations, as necessary, to the legislature for legislative
action related to the review and analysis conducted under this
subsection.
Sec. 1451.510. ANNUAL HEARING AND REPORT. (a) The attorney
general shall hold an annual public hearing concerning the impact
of the rules adopted under this subchapter on health care provider
costs and cost trends, including health care costs paid by the
state.
(b) On request of the attorney general, the commissioner
shall provide to the attorney general information related to the
subject matter of the hearing.
(c) The attorney general shall prepare an annual report
based on the findings from the hearing conducted under Subsection
(a) and submit the report to the legislature not later than December
31 of the year in which the hearing is held.
SECTION 2. (a) The changes in law made by this Act apply
only to a contract executed or renewed on or after January 1, 2016.
A contract entered into or renewed before January 1, 2016, is
governed by the law as it existed immediately before that date, and
that law is continued in effect for that purpose.
(b) The commissioner of insurance shall provide to the
attorney general the information reported and compiled under
Section 1451.509, Insurance Code, as added by this Act, not later
than September 1, 2017. The attorney general shall submit
recommendations under that section not later than December 31,
2017.
(c) The attorney general shall hold the initial annual
public hearing required under Section 1451.510, Insurance Code, as
added by this Act, not later than December 31, 2017.
SECTION 3. This Act takes effect September 1, 2015.