SRC-DBM H.B. 213 76(R)   BILL ANALYSIS


Senate Research Center   H.B. 213
76R9138  DLF-DBy: Hochberg (Nelson)
Economic Development
5/13/1999
Engrossed


DIGEST 

Currently, some insurance companies will only pay medical bills within
predetermined limits. However, medical providers do not always bill the
insurance company within the insurance company's time limits.  As a result,
patients receive bills that the insurance company refuses to pay because
the insurance company maintains the provider did not submit the claim
within the specified amount of time.  H.B. 213 would regulate certain
claims for health care services. 

PURPOSE

As proposed, H.B. 213 regulates certain claims for health care services.

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Title 6, Civil Practice and Remedies Code, by adding
Chapter 146, as follows: 

CHAPTER 146.  CERTAIN CLAIMS BY HEALTH CARE SERVICE PROVIDERS BARRED

Sec. 146.001.  DEFINITIONS.  Defines "health benefit plan" and "health care
service provider." 

Sec. 146.002.  TIMELY BILLING REQUIRED.  Requires a health care service
provider, except as provided by Subsection (b) or (c), to bill a patient or
other responsible person for services provided to the patient, not later
than a certain time.  Sets forth the dates at which time a health care
service provider is required to bill the issuer of the plan, if the health
care service provider is required or authorized to directly bill the issuer
of a health benefit plan for services provided to the patient.  Sets forth
the latest dates at which time a health service provider is required to
bill the third party payor, if the health care service provider is required
or authorized to directly bill a third party payor operating under federal
or state law, including Medicare and the state Medicaid program.  Provides
that the date of billing is the date on which the health care service
provider's bill is mailed or otherwise submitted in a certain manner. 

Sec. 146.003.  CERTAIN CLAIMS BARRED.  Prohibits a health care provider who
violates Section 146.002 from recovering from a patient any amount that the
patient would have been entitled to receive as payment or reimbursement
under a health benefit plan or that the patient would not otherwise have
been obligated to pay had the provider complied with Section 146.002.
Prohibits the health care service provider from recovering from any other
individual who, because of a family or other personal relationship with the
patient, would otherwise be responsible for the debt, if recovery from a
patient is barred under this section. 

Sec. 146.004.  DISCIPLINARY ACTION NOT AUTHORIZED.  Provides that a health
care provider who violates this chapter is not subject to disciplinary
action for the violation under any other law, including the law under which
the health care provider is licensed or otherwise  holds a grant authority. 

SECTION 2.Effective date: September 1, 1999.

 SECTION 3.Makes application of this Act prospective.

SECTION 4.Emergency clause.