By Madla                                               S.B. No. 512
         76R1126 MCK-D                           
                                A BILL TO BE ENTITLED
 1-1                                   AN ACT
 1-2     relating to billing medical patients and the penalty for certain
 1-3     pricing practices.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1.  Section 18A(g), Texas Health Maintenance
 1-6     Organization Act (Article 20A.18A, Vernon's Texas Insurance Code),
 1-7     as added by Chapter 1026, Acts of the 75th Legislature, Regular
 1-8     Session, 1997, is amended to read as follows:
 1-9           (g)  All contracts or other agreements between a health
1-10     maintenance organization and a physician or provider shall specify
1-11     that the physician or provider will hold an enrollee harmless for
1-12     payment of the cost of covered health care services in the event
1-13     the health maintenance organization fails to pay the provider for
1-14     the full amount charged by the provider for the covered health care
1-15     services.
1-16           SECTION 2.  Article 21.79F(b), Insurance Code, is amended to
1-17     read as follows:
1-18           (b)  An offense under this article is a felony of the third
1-19     degree [Class B misdemeanor].
1-20           SECTION 3.  Chapter 6, Title 71, Revised Statutes, is amended
1-21     by adding Article 4496 to read as follows:
1-22           Art. 4496.  BALANCE BILLING PROHIBITED.  (a)  In this
1-23     section, "health care provider" means a person who is licensed,
1-24     certified, or otherwise authorized by the laws of this state to
 2-1     provide health care in the ordinary course of business or practice
 2-2     of a profession.
 2-3           (b)  A health care provider, except a hospital governed by
 2-4     Section 241.0261, Health and Safety Code, may not bill a patient
 2-5     for health care services in violation of Section 18A(g), Texas
 2-6     Health Maintenance Organization Act (Article 20A.18A, Vernon's
 2-7     Texas Insurance Code), as added by Chapter 1026, Acts of the 75th
 2-8     Legislature, Regular Session, 1997.
 2-9           (c)  A health care provider who violates this article may be
2-10     disciplined by the appropriate licensing agency.
2-11           SECTION 4.  Subchapter B, Chapter 241, Health and Safety
2-12     Code, is amended by adding Section 241.0261 to read as follows:
2-13           Sec. 241.0261.  BALANCE BILLING PROHIBITED.  A hospital may
2-14     not bill a patient for health care services in violation of Section
2-15     18A(g), Texas Health Maintenance Organization Act (Article 20A.18A,
2-16     Vernon's Texas Insurance Code), as added by Chapter 1026, Acts of
2-17     the 75th Legislature, Regular Session, 1997.
2-18           SECTION 5.  (a)  This Act takes effect September 1, 1999.
2-19           (b)  Sections 1, 3, and 4 of this Act apply only to acts or
2-20     omissions occurring on or after the effective date of this Act.
2-21           (c)  The change in law made by Section 2 of this Act applies
2-22     only to an offense committed on or after the effective date of this
2-23     Act.  For the purposes of this section, an offense is committed
2-24     before the effective date of this Act if any element of the offense
2-25     occurs before that date.
2-26           (d)  An offense committed before the effective date of this
2-27     Act is covered by the law in effect when the offense was committed,
 3-1     and the former law is continued in effect for that purpose.
 3-2           SECTION 6.  The importance of this legislation and the
 3-3     crowded condition of the calendars in both houses create an
 3-4     emergency and an imperative public necessity that the
 3-5     constitutional rule requiring bills to be read on three several
 3-6     days in each house be suspended, and this rule is hereby suspended.