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.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 213 was passed by the House on April
21, 1999, by a non-record vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 213 was passed by the Senate on May
26, 1999, by the following vote: Yeas 30, Nays 0.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor