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