1-1 By: Hochberg (Senate Sponsor - Nelson) H.B. No. 213 1-2 (In the Senate - Received from the House April 22, 1999; 1-3 April 26, 1999, read first time and referred to Committee on 1-4 Economic Development; May 14, 1999, reported favorably by the 1-5 following vote: Yeas 5, Nays 0; May 14, 1999, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to certain claims for health care services. 1-9 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-10 SECTION 1. Title 6, Civil Practice and Remedies Code, is 1-11 amended by adding Chapter 146 to read as follows: 1-12 CHAPTER 146. CERTAIN CLAIMS BY HEALTH CARE SERVICE PROVIDERS BARRED 1-13 Sec. 146.001. DEFINITIONS. In this chapter: 1-14 (1) "Health benefit plan" means a plan or arrangement 1-15 under which medical or surgical expenses are paid for or reimbursed 1-16 or health care services are arranged for or provided. The term 1-17 includes: 1-18 (A) an individual, group, blanket, or franchise 1-19 insurance policy, insurance agreement, or group hospital service 1-20 contract; 1-21 (B) an evidence of coverage or group subscriber 1-22 contract issued by a health maintenance organization or an approved 1-23 nonprofit health corporation; 1-24 (C) a benefit plan provided by a multiple 1-25 employer welfare arrangement or another analogous benefit 1-26 arrangement; 1-27 (D) a workers' compensation insurance policy; or 1-28 (E) a motor vehicle insurance policy, to the 1-29 extent the policy provides personal injury protection or medical 1-30 payments coverage. 1-31 (2) "Health care service provider" means a person who, 1-32 under a license or other grant of authority issued by this state, 1-33 provides health care services the costs of which may be paid for or 1-34 reimbursed under a health benefit plan. 1-35 Sec. 146.002. TIMELY BILLING REQUIRED. (a) Except as 1-36 provided by Subsection (b) or (c), a health care service provider 1-37 shall bill a patient or other responsible person for services 1-38 provided to the patient not later than the first day of the 11th 1-39 month after the date the services are provided. 1-40 (b) If the health care service provider is required or 1-41 authorized to directly bill the issuer of a health benefit plan for 1-42 services provided to a patient, the health care service provider 1-43 shall bill the issuer of the plan not later than: 1-44 (1) the date required under any contract between the 1-45 health care service provider and the issuer of the health benefit 1-46 plan; or 1-47 (2) if there is no contract between the health care 1-48 service provider and the issuer of the health benefit plan, the 1-49 first day of the 11th month after the date the services are 1-50 provided. 1-51 (c) If the health care service provider is required or 1-52 authorized to directly bill a third party payor operating under 1-53 federal or state law, including Medicare and the state Medicaid 1-54 program, the health care service provider shall bill the third 1-55 party payor not later than: 1-56 (1) the date required under any contract between the 1-57 health care service provider and the third party payor or the date 1-58 required by federal regulation or state rule, as applicable; or 1-59 (2) if there is no contract between the health care 1-60 service provider and the third party payor and there is no 1-61 applicable federal regulation or state rule, the first day of the 1-62 11th month after the date the services are provided. 1-63 (d) For purposes of this section, the date of billing is the 1-64 date on which the health care service provider's bill is: 2-1 (1) mailed to the patient or responsible person, 2-2 postage prepaid, at the address of the patient or responsible 2-3 person as shown on the health care service provider's records; or 2-4 (2) mailed or otherwise submitted to the issuer of the 2-5 health benefit plan or third party payor as required by the health 2-6 benefit plan or third party payor. 2-7 Sec. 146.003. CERTAIN CLAIMS BARRED. (a) A health care 2-8 service provider who violates Section 146.002 may not recover from 2-9 the patient any amount that the patient would have been entitled to 2-10 receive as payment or reimbursement under a health benefit plan or 2-11 that the patient would not otherwise have been obligated to pay had 2-12 the provider complied with Section 146.002. 2-13 (b) If recovery from a patient is barred under this section, 2-14 the health care service provider may not recover from any other 2-15 individual who, because of a family or other personal relationship 2-16 with the patient, would otherwise be responsible for the debt. 2-17 Sec. 146.004. DISCIPLINARY ACTION NOT AUTHORIZED. A health 2-18 care service provider who violates this chapter is not subject to 2-19 disciplinary action for the violation under any other law, 2-20 including the law under which the health care service provider is 2-21 licensed or otherwise holds a grant of authority. 2-22 SECTION 2. This Act takes effect September 1, 1999. 2-23 SECTION 3. This Act applies only to health care services 2-24 provided on or after the effective date of this Act. Health care 2-25 services that are provided before the effective date of this Act 2-26 are governed by the law applicable to the services immediately 2-27 before the effective date of this Act, and that law is continued in 2-28 effect for that purpose. 2-29 SECTION 4. The importance of this legislation and the 2-30 crowded condition of the calendars in both houses create an 2-31 emergency and an imperative public necessity that the 2-32 constitutional rule requiring bills to be read on three several 2-33 days in each house be suspended, and this rule is hereby suspended. 2-34 * * * * *