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A BILL TO BE ENTITLED
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AN ACT
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relating to price estimates and billing requirements for certain |
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health care facilities. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 324.001, Health and Safety Code, is |
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amended by adding Subdivision (5-a) to read as follows: |
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(5-a) "Estimate" means a written statement outlining |
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the total amount a facility will accept as payment in full, |
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inclusive of all payment sources, for a nonemergency elective |
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medical service or procedure. |
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SECTION 2. Section 324.101, Health and Safety Code, is |
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amended by amending Subsections (d) and (g) and adding Subsections |
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(d-1) and (d-2) to read as follows: |
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(d) A consumer who presents to a [The] facility a valid |
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medical order [shall provide an estimate of the facility's charges] |
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for any elective inpatient admission or nonemergency outpatient |
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surgical procedure or other service is entitled to receive on |
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request and before the scheduling of the admission, [or] procedure, |
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or service an estimate from the facility. Not later than 24 hours |
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after receiving a request for an estimate under this subsection, |
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the facility shall provide the [The] estimate to the requesting |
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consumer in person, by e-mail, or through an online patient portal, |
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as chosen by the consumer [must be provided not later than the 10th |
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business day after the date on which the estimate is requested]. |
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[The facility must advise the consumer that: |
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[(1) the request for an estimate of charges may result |
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in a delay in the scheduling and provision of the inpatient |
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admission, outpatient surgical procedure, or other service; |
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[(2) the actual charges for an inpatient admission, |
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outpatient surgical procedure, or other service will vary based on |
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the person's medical condition and other factors associated with |
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performance of the procedure or service; |
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[(3) the actual charges for an inpatient admission, |
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outpatient surgical procedure, or other service may differ from the |
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amount to be paid by the consumer or the consumer's third-party |
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payor; |
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[(4) the consumer may be personally liable for payment |
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for the inpatient admission, outpatient surgical procedure, or |
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other service depending on the consumer's health benefit plan |
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coverage; and |
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[(5) the consumer should contact the consumer's health |
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benefit plan for accurate information regarding the plan structure, |
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benefit coverage, deductibles, copayments, coinsurance, and other |
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plan provisions that may impact the consumer's liability for |
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payment for the inpatient admission, outpatient surgical |
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procedure, or other service.] |
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(d-1) A facility's final billed charges may not exceed the |
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amount specified in the estimate provided under Subsection (d) by |
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more than five percent unless the additional charges are: |
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(1) related to complications arising during the |
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procedure or service and not reasonably avoidable in provision of |
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the procedure or service by the medical provider while exercising |
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reasonable medical judgment; or |
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(2) as a result of a change of diagnosis not |
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discoverable before the procedure or service and documented in the |
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patient's chart. |
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(d-2) If the final billed charges exceed the amount |
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specified in an estimate provided under Subsection (d) by more than |
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five percent, the facility must provide to the patient a written |
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statement describing: |
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(1) the difference in the final billed amount and the |
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estimate amount; and |
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(2) a plain-language explanation describing the |
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complications or change of diagnosis that resulted in the |
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difference. |
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(g) A facility that violates [in violation of] this section: |
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(1) may not: |
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(A) collect or take any collection action against |
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a consumer or other financially responsible party; |
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(B) report the consumer to a credit bureau; or |
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(C) pursue an action against the consumer; and |
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(2) is subject to enforcement action by the |
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appropriate licensing agency. |
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SECTION 3. Subchapter B, Chapter 324, Health and Safety |
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Code, is repealed. |
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SECTION 4. The changes in law made to Chapter 324, Health |
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and Safety Code, apply only to a request for an estimate made on or |
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after the effective date of this Act. A request for an estimate |
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made before the effective date of this Act is governed by the law in |
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effect at the time the request was made, and the former law is |
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continued in effect for that purpose. |
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SECTION 5. This Act takes effect September 1, 2025. |