Bill Text: TX SB1684 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to the cost, payment, and collection of health care expenses.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2021-03-24 - Referred to Business & Commerce [SB1684 Detail]
Download: Texas-2021-SB1684-Introduced.html
87R11251 SRA-D | ||
By: Powell | S.B. No. 1684 |
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relating to the cost, payment, and collection of health care | ||
expenses. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle A, Title 4, Health and Safety Code, is | ||
amended by adding Chapter 226 to read as follows: | ||
CHAPTER 226. COST, PAYMENT, AND COLLECTION OF HEALTH CARE EXPENSES | ||
FOR SERVICES PROVIDED BY CERTAIN HEALTH CARE FACILITIES AND | ||
PROFESSIONALS | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 226.001. PURPOSE. The purpose of this chapter is to | ||
reduce burdensome medical debt and to protect patients in their | ||
dealings with medical creditors, medical debt collectors, and | ||
medical debt buyers in connection with medical debt. | ||
Sec. 226.002. CONSTRUCTION OF CHAPTER. This chapter shall | ||
be liberally construed to effect its purposes. | ||
Sec. 226.003. DEFINITIONS. In this chapter: | ||
(1) "Commission" means the Health and Human Services | ||
Commission. | ||
(2) "Consumer report" has the meaning assigned by | ||
Section 603(d) of the Fair Credit Reporting Act (15 U.S.C. Section | ||
1681a). | ||
(3) "Consumer reporting agency" means a person who | ||
regularly engages wholly or partly in the practice of assembling or | ||
evaluating consumer credit information or other information on | ||
individuals to furnish consumer reports to third parties for | ||
monetary fees, for dues, or on a cooperative nonprofit basis. | ||
(4) "Executive commissioner" means the executive | ||
commissioner of the Health and Human Services Commission. | ||
(5) "Health care facility": | ||
(A) means: | ||
(i) a hospital licensed under Chapter 241; | ||
(ii) an outpatient clinic or facility | ||
affiliated with or operating under the license of a hospital | ||
described by Subparagraph (i); | ||
(iii) an ambulatory surgical center | ||
licensed under Chapter 243; or | ||
(iv) a facility licensed in this state that | ||
provides outpatient health care services and has revenues of at | ||
least $20 million annually; and | ||
(B) includes a health care professional licensed | ||
in this state who provides health care services in one or more of | ||
the facilities or other health care settings described by Paragraph | ||
(A) and who bills patients independently. | ||
(6) "Health care services" means services for the | ||
diagnosis, prevention, treatment, cure, or relief of a physical, | ||
dental, behavioral, substance use disorder or mental health | ||
condition, illness, injury, or disease. The term includes any | ||
procedures, products, devices, or medications. | ||
(7) "Medical creditor" means a health care facility or | ||
other entity that provides health care services and to whom an | ||
individual: | ||
(A) owes money for those services; or | ||
(B) previously owed money for those services if | ||
the medical debt has been purchased by a medical debt buyer. | ||
(8) "Medical debt" means a debt arising from the | ||
receipt of health care services. | ||
(9) "Medical debt buyer" means a person who purchases | ||
a medical debt for collection purposes from a medical creditor or | ||
other subsequent owner of the medical debt, regardless of whether | ||
the person collects the medical debt, hires a third party to collect | ||
the medical debt, or hires an attorney to pursue collection | ||
litigation in connection with the medical debt. | ||
(10) "Medical debt collector" means a person who | ||
regularly collects or attempts to collect, directly or indirectly, | ||
a medical debt originally owed or due another or asserted to be owed | ||
or due another. The term includes a medical debt buyer. | ||
Sec. 226.004. RULES. (a) The executive commissioner shall | ||
adopt rules to administer this chapter. | ||
(b) In adopting rules under this section, the executive | ||
commissioner shall consult with the Texas Medical Board, the State | ||
Board of Dental Examiners, and the commissioner of insurance as | ||
appropriate and necessary. | ||
SUBCHAPTER B. PRICE INFORMATION AND PAYMENTS | ||
Sec. 226.051. PRICE INFORMATION ONLINE. (a) In this | ||
section, "gross charges" means a health care facility's full | ||
established price for a health care service that the facility | ||
charges patients who do not have health benefit plan coverage | ||
before applying any contractual allowances, discounts, or | ||
deductions. | ||
(b) A health care facility shall post price information of | ||
the facility's health care services on its Internet website. The | ||
information must be accessible from a link on the website's home | ||
page, and at a minimum must: | ||
(1) list the gross charges for each health care | ||
service provided by the facility; | ||
(2) list the Medicare reimbursement amount for the | ||
health care service, next to the relevant gross charges; and | ||
(3) use plain language titles or descriptions of | ||
health care services that can be understood by the average | ||
individual. | ||
Sec. 226.052. ITEMIZED BILL. On a patient's written or oral | ||
request and without charge, a medical creditor or medical debt | ||
collector shall provide an itemized bill to the patient not later | ||
than the 60th day after the date of the request. The bill must | ||
contain: | ||
(1) the name and address of the medical creditor; | ||
(2) the date a health care service was provided; | ||
(3) the date the medical debt was incurred, if | ||
different from the date of service; | ||
(4) a detailed list of the specific health care | ||
services provided to the patient; | ||
(5) a list of all health care professionals who | ||
treated the patient; | ||
(6) the amount of principal for any medical debt | ||
incurred; | ||
(7) any adjustment to the bill, such as negotiated | ||
insurance rates or other discounts; | ||
(8) the amount of any payments received from the | ||
patient or any other person on the patient's behalf; and | ||
(9) any interest or fees. | ||
Sec. 226.053. INTEREST ON MEDICAL DEBT. (a) | ||
Notwithstanding any agreement to the contrary or other law, | ||
interest on medical debt is limited to the rate of interest equal to | ||
the weekly average one-year constant maturity treasury yield, but | ||
not less than two percent per year and not more than five percent | ||
per year, as published by the Board of Governors of the Federal | ||
Reserve System, for the calendar week preceding the date when the | ||
patient was first provided with a bill for payment of the health | ||
care services. If the Board of Governors of the Federal Reserve | ||
System ceases to publish this interest rate, the executive | ||
commissioner by rule shall substitute another measure for | ||
determining a reasonable interest rate of not more than five | ||
percent per year. | ||
(b) Notwithstanding any agreement to the contrary or other | ||
law, the rate of interest specified by Subsection (a) applies to a | ||
judgment on medical debt. | ||
Sec. 226.054. RECEIPT FOR PAYMENTS. Not later than the 10th | ||
business day after the date payment of a medical debt is received, | ||
the medical creditor or medical debt collector shall provide to the | ||
person making the payment a receipt showing: | ||
(1) the amount paid; | ||
(2) the date payment is received; | ||
(3) the outstanding balance of the patient's account | ||
before the most recent payment; | ||
(4) the new balance after application of the payment; | ||
(5) the interest rate and interest accrued since the | ||
last payment; | ||
(6) the patient's account number; | ||
(7) the name of the current owner of the debt and, if | ||
different, the name of the medical creditor; and | ||
(8) whether the payment is accepted as payment in full | ||
of the debt. | ||
Sec. 226.055. LIABILITY FOR MEDICAL DEBT. (a) Parents and | ||
legal guardians are jointly liable for any medical debt incurred by | ||
a child under 18 years of age. | ||
(b) A spouse or other person is not liable for the medical | ||
debt of a person 18 years of age or older. A person may consent to | ||
assume liability, if the consent is: | ||
(1) on a separate document signed by the person; | ||
(2) not solicited in an emergency room or during an | ||
emergency situation; and | ||
(3) not required as a condition of providing emergency | ||
or nonemergency health care services. | ||
SUBCHAPTER C. MEDICAL DEBT COLLECTIONS | ||
Sec. 226.101. PROHIBITED COLLECTION ACTIONS. To collect a | ||
medical debt, a medical creditor or medical debt collector may not: | ||
(1) cause an individual's arrest; | ||
(2) cause an individual to be the subject of a capias | ||
as defined by Article 23.01, Code of Criminal Procedure; or | ||
(3) foreclose on an individual's real property. | ||
Sec. 226.102. EXTRAORDINARY COLLECTION ACTIONS. (a) In | ||
this section, "extraordinary collection action," with respect to a | ||
patient, means: | ||
(1) selling the patient's medical debt to another | ||
party, unless, before the sale, the medical creditor enters into a | ||
written agreement with the medical debt buyer providing that: | ||
(A) the medical debt buyer may not engage in an | ||
extraordinary collection action as provided by this section to | ||
obtain payment of the debt; and | ||
(B) the medical debt collector may not charge | ||
interest on the debt at a rate in excess of the limit prescribed by | ||
Section 226.053; | ||
(2) reporting adverse information about the patient to | ||
a consumer reporting agency; or | ||
(3) initiating an action that requires a legal or | ||
judicial process, including: | ||
(A) placing a lien on the patient's property; | ||
(B) seizing the patient's bank account or any | ||
other personal property; or | ||
(C) bringing a civil action against the patient. | ||
(b) Except as provided by Section 226.103, a medical | ||
creditor or medical debt collector may not engage in an | ||
extraordinary collection action against a patient until the 180th | ||
day after the date the first bill for an amount owed for receipt of | ||
health care services has been sent to the patient. | ||
(c) At least 30 days before taking an extraordinary | ||
collection action, a medical creditor or medical debt collector | ||
shall provide to the patient a notice containing: | ||
(1) the extraordinary collection actions that will be | ||
initiated to obtain payment; and | ||
(2) a deadline after which extraordinary collection | ||
actions will be initiated, which may not be earlier than the 30th | ||
day after the date notice is provided. | ||
(d) A health care facility or medical debt collector | ||
collecting medical debt for services provided at a health care | ||
facility may not use any extraordinary collection action not | ||
described in the facility's billing and collections policy. | ||
Sec. 226.103. REPORTING TO CONSUMER REPORTING AGENCY. (a) | ||
A medical creditor or medical debt collector may not communicate | ||
with or report information to a consumer reporting agency regarding | ||
a patient's medical debt during the one-year period beginning on | ||
the date when the patient was first given a bill for the health care | ||
service to which the debt pertains. | ||
(b) After expiration of the one-year period prescribed by | ||
Subsection (a), a medical creditor or medical debt collector shall | ||
give the patient at least one additional bill before reporting the | ||
medical debt to a consumer reporting agency. The amount reported | ||
must be the same as the amount stated in the additional bill, and | ||
the bill must state that the debt is being reported to a consumer | ||
reporting agency. | ||
(c) A medical debt collector shall also provide the notice | ||
required by 15 U.S.C. Section 1692g before reporting a medical debt | ||
to a consumer reporting agency. | ||
Sec. 226.104. COLLECTION OF MEDICAL DEBT DURING HEALTH | ||
BENEFIT PLAN REVIEW PROHIBITED. (a) In this section: | ||
(1) "External review" means a review of an adverse | ||
benefit determination conducted under Chapter 4201, Insurance | ||
Code, a federal external review process as described by 42 U.S.C. | ||
Section 300gg-19, a review conducted under 29 U.S.C. Section 1133, | ||
a Medicare appeals process, a Medicaid appeals process, or another | ||
applicable external appeals process. | ||
(2) "Internal review" means a review of an adverse | ||
benefit determination conducted by a health benefit plan issuer or | ||
other insurer. | ||
(b) A medical creditor or medical debt collector that knows | ||
or should have known about an internal review, external review, or | ||
other appeal of a health benefit plan decision that concerns a | ||
medical debt and is pending or was pending during the 60 days | ||
preceding the date of the review or appeal may not: | ||
(1) provide information regarding unpaid charges for | ||
health care services to a consumer reporting agency; | ||
(2) communicate with the patient regarding the medical | ||
debt for the purpose of seeking to collect the debt; or | ||
(3) initiate a lawsuit or arbitration proceeding | ||
against the patient regarding the medical debt. | ||
(c) If a medical debt has already been reported to a | ||
consumer reporting agency and the medical creditor or medical debt | ||
collector who reported the information learns of an internal | ||
review, external review, or other appeal of a health benefit plan | ||
decision that concerns the debt and is pending or was pending during | ||
the 60 days preceding the date of the review or appeal, the creditor | ||
or collector shall instruct the consumer reporting agency to delete | ||
information about the debt. | ||
(d) A medical creditor described by Subsection (b) may not | ||
refer, sell, or send the medical debt to a medical debt collector, | ||
including selling the debt to a medical debt buyer. | ||
Sec. 226.105. FORGIVEN COST-SHARING AMOUNTS RELATED TO | ||
HEALTH BENEFIT PLAN COVERAGE NOT BREACH OF CONTRACT. Forgiveness | ||
of a patient's copayment, coinsurance, deductible, facility fee, | ||
out-of-network charge, or other cost-sharing amounts related to a | ||
patient's health benefit plan coverage is not a breach of contract | ||
or other violation of an agreement between the medical creditor and | ||
the health benefit plan issuer or payor. | ||
SUBCHAPTER D. ENFORCEMENT AND REMEDIES | ||
Sec. 226.151. DECEPTIVE TRADE PRACTICE. A violation of | ||
this chapter constitutes a deceptive trade practice in addition to | ||
the practices described by Subchapter E, Chapter 17, Business & | ||
Commerce Code, and is actionable under that subchapter. | ||
Sec. 226.152. INJUNCTIVE RELIEF. An individual may bring | ||
an action for injunctive relief or other appropriate equitable | ||
relief to enforce compliance with this chapter. | ||
Sec. 226.153. WAIVER OF RIGHTS OR REMEDIES PROHIBITED. (a) | ||
An agreement between a patient and a health care facility or medical | ||
debt collector may not contain a provision that, before a dispute | ||
arises, waives or has the effect of waiving the rights of a patient | ||
to resolve the dispute by: | ||
(1) obtaining: | ||
(A) injunctive, declaratory, or other equitable | ||
relief; | ||
(B) monetary damages; or | ||
(C) attorney's fees and costs; or | ||
(2) requesting a hearing at which the patient can | ||
present evidence in person. | ||
(b) A provision that violates Subsection (a) is void and | ||
unenforceable. | ||
(c) A waiver by a patient or other individual of any | ||
protection provided by or any right of the patient or other | ||
individual granted under this chapter is void and unenforceable. | ||
(d) The remedies provided by this section are not exclusive | ||
remedies, and a patient is not required to exhaust any | ||
administrative remedies provided by this chapter or any other | ||
applicable law. | ||
Sec. 226.154. COMPLAINT PROCESS. (a) The commission shall | ||
establish a complaint process by which a patient or other member of | ||
the public may file a complaint against a medical creditor or | ||
medical debt collector who violates this chapter. | ||
(b) A complaint filed under this section is public | ||
information, except for the name or address of a complainant or | ||
other personal identifying information. | ||
SECTION 2. As soon as practicable after the effective date | ||
of this Act, the executive commissioner of the Health and Human | ||
Services Commission shall adopt rules as required to administer, | ||
implement, and enforce Chapter 226, Health and Safety Code, as | ||
added by this Act, including rules relating to establishing a | ||
complaint process as required by Section 226.154, Health and Safety | ||
Code, as added by this Act. | ||
SECTION 3. The changes in law made by this Act apply only to | ||
a health care service provided on or after the effective date of | ||
this Act. A health care service provided before the effective date | ||
of this Act is governed by the law in effect on the date the service | ||
was provided, and the former law is continued in effect for that | ||
purpose. | ||
SECTION 4. This Act takes effect September 1, 2021. |