SRC-JBJ S.B. 512 76(R)   BILL ANALYSIS


Senate Research Center   S.B. 512
76R1126 MCK-DBy: Madla
Economic Development
3/2/1999
As Filed


DIGEST 

Currently, a health maintenance organization (HMO) may not bill a patient
for health care services not paid by the patient's HMO plan, a process
known as balance billing; a violation is a Class B misdemeanor.  However,
some health care providers that participate in an HMO plan do charge a
patient the balance of the bill.  S.B. 512 would prohibit hospitals and
physicians from billing a patient charges not paid by the patient's HMO
plan, and reclassify the prohibition as a third degree felony. 

PURPOSE

As proposed, S.B. 512 prohibits balance billing by physicians and hospitals
and subjects the providers to actions against their license for the
offense. 

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 Section 18A(g), Article 20A.18A, V.T.C.S., to require
all contracts and other agreements between a health maintenance
organization (HMO) and a physician or provider to specify that a physician
or provider will hold an enrollee harmless for payment of the cost of
covered health care services in the event the HMO fails to pay the provider
for the full amount charged by the provider for the covered health care
services. 

SECTION 2.  Amends Article 21.79F(b), Insurance Code, to make an offense
under this article a felony of the third degree, rather than a Class B
misdemeanor. 

SECTION 3.  Amends Chapter 6, Title 71, V.T.C.S., by adding Article 4496,
as follows: 

Art. 4496.  BALANCE BILLING PROHIBITED.  Defines "health care provider."
Prohibits a health care provider, except a hospital governed by Section
241.0261, Health and Safety Code, from billing a patient for health care
services in violation of Section 18A(g), Article 20A.18A, V.T.C.S.
Authorizes a health care provider who violates this article to be
disciplined by the appropriate licensing agency. 

SECTION 4.  Amends Chapter 241B, Health and Safety Code, by adding Section
241.0261, as follows: 

Sec. 241.0261.  BALANCE BILLING PROHIBITED.  Prohibits a hospital from
billing a patient for health care services in violation of Section 18A(g),
Article 20A.18A, V.T.C.S.   

SECTION 5.  (a)  Effective date: September 1, 1999.

 (b)-(d)  Makes application of this Act prospective.

SECTION 6.Emergency clause.