Bill Text: TX SB2195 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to a health care entity making available to patients and prospective patients charges for certain health care services, goods, or procedures; authorizing administrative penalties.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2017-03-29 - Referred to Business & Commerce [SB2195 Detail]
Download: Texas-2017-SB2195-Introduced.html
85R13176 SCL-F | ||
By: Buckingham | S.B. No. 2195 |
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relating to a health care entity making available to patients and | ||
prospective patients charges for certain health care services, | ||
goods, or procedures; authorizing administrative penalties. | ||
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. MEDICAL BILLING AND CHARGES | ||
CHAPTER 185. CHARGE TRANSPARENCY | ||
Sec. 185.001. DEFINITIONS. In this chapter: | ||
(1) "Bundled health care services, goods, or | ||
procedures" means the grouping of multiple health care services, | ||
goods, or procedures provided by a health care entity or multiple | ||
health care entities represented as a single charge. | ||
(2) "Charge" means the dollar amount set by the health | ||
care entity for a health care service, good, or procedure, before | ||
any applicable discount or negotiated rate is applied. The term | ||
does not include any applicable discount, including a discount: | ||
(A) for a prompt payment; | ||
(B) based on a written charity care policy; or | ||
(C) under a health care entity's contract with a | ||
health benefit plan issuer. | ||
(3) "Charge list" means: | ||
(A) for a health care professional or provider, a | ||
list of charges for the health care professional's or provider's | ||
health care services, goods, or procedures that are billed at least | ||
50 times in the preceding calendar year; or | ||
(B) for a health care facility, a list of charges | ||
for the health care facility's: | ||
(i) outpatient health care services, goods, | ||
or procedures that are billed at least 50 times in the preceding | ||
calendar year; and | ||
(ii) inpatient health care services, goods, | ||
or procedures that exceed $500 and are billed at least 50 times in | ||
the preceding calendar year. | ||
(4) "Health care entity" means: | ||
(A) a health care professional; | ||
(B) a health care provider; or | ||
(C) a health care facility. | ||
(5) "Health care facility" means a facility that | ||
provides a health care service, good, or procedure in this state for | ||
which a license, certificate, registration, or other authority | ||
issued by this state is required. The term includes: | ||
(A) an institutional health care provider; | ||
(B) a hospital licensed under Chapter 241; | ||
(C) an ambulatory surgical center licensed under | ||
Chapter 243; | ||
(D) a birthing center licensed under Chapter 244; | ||
(E) a freestanding emergency medical care | ||
facility licensed under Chapter 254; or | ||
(F) a chemical dependency treatment facility | ||
licensed under Chapter 464. | ||
(6) "Health care professional" means an individual who | ||
provides a health care service, good, or procedure in this state | ||
under a license, certificate, registration, or other authority | ||
issued by an agency of this state to diagnose, prevent, alleviate, | ||
or cure a human illness or injury, including a physician, dentist, | ||
or pharmacist. | ||
(7) "Health care provider" means a person who provides | ||
to patients in this state ancillary health care services, goods, or | ||
procedures under a license, certificate, or registration issued by | ||
this state or who is otherwise ordered or authorized by a health | ||
care professional to diagnose, prevent, alleviate, or cure a human | ||
illness or injury, including laboratory services, radiological | ||
services, and durable medical equipment. The term does not include | ||
a health care professional or a health care facility. | ||
(8) "Patient" means an individual who is receiving or | ||
has received a health care service, good, or procedure from a health | ||
care entity. The term includes a personal representative of the | ||
patient. | ||
(9) "Personal representative" means: | ||
(A) a parent, legal guardian, or relative; or | ||
(B) an individual holding a medical power | ||
attorney for a patient or prospective patient. | ||
(10) "Primary regulatory authority" means the state | ||
agency that is primarily responsible for licensing, permitting, | ||
registering, or otherwise regulating a health care entity. | ||
(11) "Prospective patient" means an individual who is | ||
considering receiving a health care service, good, or procedure | ||
from a health care entity. The term includes a personal | ||
representative of a prospective patient. | ||
Sec. 185.002. HEALTH CARE CHARGE LIST. (a) Each health | ||
care entity shall compose and maintain a charge list under this | ||
chapter. | ||
(b) The charges in a charge list maintained by a health care | ||
entity are not required to include the charges of health care | ||
services, goods, or procedures provided by any other health care | ||
entity. | ||
(c) If a health care entity bills bundled health care | ||
services, goods, or procedures, the health care entity may, at the | ||
health care entity's discretion, list the charges of the bundled | ||
health care services, goods, or procedures in the health care | ||
entity's charge list. | ||
Sec. 185.003. EXPRESSION OF CHARGES. For purposes of the | ||
charge list required under this chapter, each charge listed must be | ||
accompanied by one of the following at the discretion of the health | ||
care entity: | ||
(1) a description in plain English of the associated | ||
health care service, good, or procedure; or | ||
(2) the applicable standard billing code along with a | ||
description of the associated health care service, good, or | ||
procedure. | ||
Sec. 185.004. CHARGE LIST AVAILABILITY. (a) A health care | ||
entity shall make its charge list available to patients and | ||
prospective patients by: | ||
(1) posting the charge list on an Internet website; or | ||
(2) providing access to the charge list at the health | ||
care entity's office, facility, or other practice site on request. | ||
(b) A health care entity that maintains a waiting area shall | ||
post a clear and conspicuous notice of the availability of its | ||
charge list in the waiting area and in any registration, admission, | ||
or business office in which patients or prospective patients are | ||
reasonably expected to seek service. The notice described in this | ||
subsection shall include a statement describing the method | ||
described by Subsection (a) used to make the charge list available. | ||
(c) When the charge list is made available to patients and | ||
prospective patients, the charge list must be accompanied by a | ||
notice that substantially states the following: | ||
"NOTICE: THE CHARGES CONTAINED WITHIN THIS CHARGE LIST ARE | ||
SUBJECT TO CHANGE. | ||
"YOUR BILL, INCLUDING ACTUAL OR TOTAL CHARGES, WILL VARY | ||
BASED ON MANY FACTORS, INCLUDING YOUR MEDICAL CONDITION, ANY | ||
UNKNOWN MEDICAL CONDITIONS YOU MAY HAVE, YOUR DIAGNOSIS AND | ||
RECOMMENDED TREATMENT PROTOCOLS, AND OTHER FACTORS ASSOCIATED WITH | ||
PERFORMANCE OF THE HEALTH CARE SERVICE OR PROCEDURE OR THE | ||
PROVISION OF THE HEALTH CARE GOOD. | ||
"THE CHARGES CONTAINED WITHIN THIS CHARGE LIST MAY DIFFER | ||
FROM THE AMOUNT TO BE PAID BY YOU OR YOUR THIRD-PARTY PAYOR, IF | ||
APPLICABLE. YOU MAY BE ELIGIBLE FOR A DISCOUNT FROM THE AMOUNTS | ||
STATED ON THE CHARGE LIST. REGARDLESS OF YOUR INSURANCE STATUS, YOU | ||
MAY INQUIRE ABOUT THE AVAILABILITY OF DISCOUNTS. | ||
"YOU MAY BE PERSONALLY LIABLE FOR PAYMENT FOR THE HEALTH CARE | ||
SERVICE, GOOD, OR PROCEDURE, DEPENDING ON YOUR HEALTH BENEFIT PLAN | ||
COVERAGE. YOU SHOULD CONTACT YOUR HEALTH BENEFIT PLAN, IF YOU HAVE | ||
COVERAGE, FOR ACCURATE INFORMATION REGARDING THE PLAN STRUCTURE, | ||
BENEFIT COVERAGE, DEDUCTIBLES, COPAYMENTS, COINSURANCE, AND OTHER | ||
PLAN PROVISIONS, SUCH AS NETWORK AVAILABILITY, THAT MAY IMPACT YOUR | ||
OUT-OF-POCKET RESPONSIBILITY FOR PAYMENT FOR HEALTH CARE SERVICES, | ||
GOODS, OR PROCEDURES, INCLUDING THOSE CONTAINED IN THIS CHARGE | ||
LIST." | ||
Sec. 185.005. EXEMPTION. A health care entity is exempt | ||
from the requirements of this chapter if the health care entity owns | ||
or is an employee of an entity that has fewer than three full-time | ||
equivalent employees. | ||
Sec. 185.006. DISCOUNTS AND ADDITIONS. This chapter does | ||
not prohibit a health care entity from: | ||
(1) offering or providing lawful discounts from the | ||
amounts stated on the charge list or lawfully accepting less than | ||
the amount of a charge on the charge list as payment in full; | ||
(2) offering or providing additional, different, or a | ||
higher complexity level of health care services, goods, or | ||
procedures for an additional or different amount; | ||
(3) departing from the amounts on the charge list for a | ||
reason specified in the notice required by Section 185.004; or | ||
(4) changing a charge on the charge list at any time, | ||
provided that the charge list is updated with the effective date to | ||
reflect the change. | ||
Sec. 185.007. DELEGATION. A health care entity's | ||
responsibilities under this chapter may be performed by the health | ||
care entity's employer, employee, or other authorized delegate. | ||
Sec. 185.008. ENFORCEMENT. (a) Each primary regulatory | ||
authority of a health care entity shall enforce this chapter in | ||
accordance with this section. If the applicable primary regulatory | ||
authority's enforcement process is complaint-based, a complaint | ||
must be filed in order for the primary regulatory authority to | ||
enforce this chapter. | ||
(b) A health care entity that violates any applicable | ||
requirement of this chapter must be provided with an opportunity to | ||
correct the violation under Subsection (d). | ||
(c) The applicable primary regulatory authority shall | ||
notify the health care entity if the primary regulatory authority | ||
determines that the health care entity has violated this chapter. | ||
(d) If the health care entity corrects the violation not | ||
later than the 30th business day after the date the health care | ||
entity receives notice under Subsection (c): | ||
(1) the applicable primary regulatory authority may | ||
not impose a fine, reprimand, administrative penalty, or other | ||
discipline on the health care entity; and | ||
(2) the violation is confidential and not subject to | ||
Chapter 552, Government Code. | ||
(e) The primary regulatory authority may only assess an | ||
administrative penalty for a violation of this chapter in the same | ||
manner as if the health care entity had violated the law under which | ||
the health care entity holds a license, certificate, registration, | ||
or other authority if: | ||
(1) the health care entity has received notice of one | ||
or more violations under this chapter in the 12-month period | ||
preceding the notice of the most recent violation; or | ||
(2) the health care entity fails to correct the | ||
violation before the 31st business day after the date the health | ||
care entity receives notice that the health care entity has | ||
violated this chapter. | ||
(f) The amount of penalties assessed against a health care | ||
entity under this section may not exceed: | ||
(1) $250 for a single violation; | ||
(2) $500 for all violations occurring in a 12-month | ||
period for a health care professional; or | ||
(3) $5,000 for all violations occurring in a 12-month | ||
period for a health care provider or facility. | ||
(g) All violations that are related to, arise from, or are | ||
discovered based on the same event or complaint shall be considered | ||
to be a single violation for purposes of this section. Each day a | ||
violation continues does not constitute a separate violation. | ||
(h) Notwithstanding any other law, this section provides | ||
the sole and exclusive remedy and enforcement mechanism for a | ||
violation of this chapter. | ||
Sec. 185.009. CONTINUING EDUCATION CREDIT. A health care | ||
professional is entitled to claim two hours of the continuing | ||
education credit, including half a credit hour of ethics, with the | ||
appropriate primary regulatory authority for each year of | ||
compliance with this chapter. | ||
Sec. 185.010. OUT-OF-NETWORK DISPUTE RESOLUTION. | ||
Notwithstanding any other law, a health care professional who is in | ||
compliance with this chapter at the time that a health care service, | ||
good, or procedure is provided is exempt from the mediation | ||
process, findings, penalties, and all related provisions, | ||
including the informal settlement teleconference under Chapter | ||
1467, Insurance Code, if: | ||
(1) the dispute concerns the provision of a health | ||
care service, good, or procedure listed in the health care | ||
professional's charge list; and | ||
(2) the amount billed for that service, good, or | ||
procedure is less than or equal to the amount stated in the charge | ||
list. | ||
Sec. 185.011. CHARGE LIST PROTECTIONS. (a) | ||
Notwithstanding any other law, this chapter does not create a cause | ||
of action or create a standard of care, obligation, or duty that | ||
provides a basis for a cause of action. | ||
(b) Except as otherwise provided by Section 185.008, a | ||
charge list under this chapter or evidence of a violation of this | ||
chapter is not admissible in any civil, judicial, or administrative | ||
proceeding unless the health care entity voluntarily consents in | ||
writing. | ||
(c) Notwithstanding any other law, a health care entity is | ||
not liable for damages related to charges on the health care | ||
entity's charge list in an action under Chapter 15 or 17, Business & | ||
Commerce Code. | ||
Sec. 185.012. FREE MARKET PROTECTIONS. This chapter does | ||
not authorize a governmental agency or other government-created | ||
entity to approve, disapprove, or limit a health care entity's: | ||
(1) charge for a health care service, good, or | ||
procedure; or | ||
(2) change to any charge. | ||
SECTION 2. Sections 185.008(a)-(g), Health and Safety Code, | ||
as added by this Act, apply only to conduct that occurs on or after | ||
January 1, 2018. | ||
SECTION 3. This Act takes effect September 1, 2017. |