By Hochberg H.B. No. 213 76R9138 DLF-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to certain claims for health care services. 1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-4 SECTION 1. Title 6, Civil Practice and Remedies Code, is 1-5 amended by adding Chapter 146 to read as follows: 1-6 CHAPTER 146. CERTAIN CLAIMS BY HEALTH CARE SERVICE PROVIDERS BARRED 1-7 Sec. 146.001. DEFINITIONS. In this chapter: 1-8 (1) "Health benefit plan" means a plan or arrangement 1-9 under which medical or surgical expenses are paid for or reimbursed 1-10 or health care services are arranged for or provided. The term 1-11 includes: 1-12 (A) an individual, group, blanket, or franchise 1-13 insurance policy, insurance agreement, or group hospital service 1-14 contract; 1-15 (B) an evidence of coverage or group subscriber 1-16 contract issued by a health maintenance organization or an approved 1-17 nonprofit health corporation; 1-18 (C) a benefit plan provided by a multiple 1-19 employer welfare arrangement or another analogous benefit 1-20 arrangement; 1-21 (D) a workers' compensation insurance policy; or 1-22 (E) a motor vehicle insurance policy, to the 1-23 extent the policy provides personal injury protection or medical 1-24 payments coverage. 2-1 (2) "Health care service provider" means a person who, 2-2 under a license or other grant of authority issued by this state, 2-3 provides health care services the costs of which may be paid for or 2-4 reimbursed under a health benefit plan. 2-5 Sec. 146.002. TIMELY BILLING REQUIRED. (a) Except as 2-6 provided by Subsection (b) or (c), a health care service provider 2-7 shall bill a patient or other responsible person for services 2-8 provided to the patient not later than the first day of the 11th 2-9 month after the date the services are provided. 2-10 (b) If the health care service provider is required or 2-11 authorized to directly bill the issuer of a health benefit plan for 2-12 services provided to a patient, the health care service provider 2-13 shall bill the issuer of the plan not later than: 2-14 (1) the date required under any contract between the 2-15 health care service provider and the issuer of the health benefit 2-16 plan; or 2-17 (2) if there is no contract between the health care 2-18 service provider and the issuer of the health benefit plan, the 2-19 first day of the 11th month after the date the services are 2-20 provided. 2-21 (c) If the health care service provider is required or 2-22 authorized to directly bill a third party payor operating under 2-23 federal or state law, including Medicare and the state Medicaid 2-24 program, the health care service provider shall bill the third 2-25 party payor not later than: 2-26 (1) the date required under any contract between the 2-27 health care service provider and the third party payor or the date 3-1 required by federal regulation or state rule, as applicable; or 3-2 (2) if there is no contract between the health care 3-3 service provider and the third party payor and there is no 3-4 applicable federal regulation or state rule, the first day of the 3-5 11th month after the date the services are provided. 3-6 (d) For purposes of this section, the date of billing is the 3-7 date on which the health care service provider's bill is: 3-8 (1) mailed to the patient or responsible person, 3-9 postage prepaid, at the address of the patient or responsible 3-10 person as shown on the health care service provider's records; or 3-11 (2) mailed or otherwise submitted to the issuer of the 3-12 health benefit plan or third party payor as required by the health 3-13 benefit plan or third party payor. 3-14 Sec. 146.003. CERTAIN CLAIMS BARRED. (a) A health care 3-15 service provider who violates Section 146.002 may not recover from 3-16 the patient any amount that the patient would have been entitled to 3-17 receive as payment or reimbursement under a health benefit plan or 3-18 that the patient would not otherwise have been obligated to pay had 3-19 the provider complied with Section 146.002. 3-20 (b) If recovery from a patient is barred under this section, 3-21 the health care service provider may not recover from any other 3-22 individual who, because of a family or other personal relationship 3-23 with the patient, would otherwise be responsible for the debt. 3-24 Sec. 146.004. DISCIPLINARY ACTION NOT AUTHORIZED. A health 3-25 care service provider who violates this chapter is not subject to 3-26 disciplinary action for the violation under any other law, 3-27 including the law under which the health care service provider is 4-1 licensed or otherwise holds a grant of authority. 4-2 SECTION 2. This Act takes effect September 1, 1999. 4-3 SECTION 3. This Act applies only to health care services 4-4 provided on or after the effective date of this Act. Health care 4-5 services that are provided before the effective date of this Act 4-6 are governed by the law applicable to the services immediately 4-7 before the effective date of this Act, and that law is continued in 4-8 effect for that purpose. 4-9 SECTION 4. The importance of this legislation and the 4-10 crowded condition of the calendars in both houses create an 4-11 emergency and an imperative public necessity that the 4-12 constitutional rule requiring bills to be read on three several 4-13 days in each house be suspended, and this rule is hereby suspended.