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.
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