AN ACT
1-1 relating to billing policies of certain health care professionals
1-2 and facilities; providing administrative penalties.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subsection (d), Section 241.154, Health and
1-5 Safety Code, is amended to read as follows:
1-6 (d) A hospital may not charge a fee for:
1-7 (1) providing health care information under Subsection
1-8 (b) to the extent the fee is prohibited under Subchapter M, Chapter
1-9 161;
1-10 (2) a patient to examine the patient's own health care
1-11 information;
1-12 (3) providing an itemized statement of billed services
1-13 to a patient or third-party payor, except as provided under Section
1-14 311.002(f) [311.002(e)]; or
1-15 (4) health care information relating to treatment or
1-16 hospitalization for which workers' compensation benefits are being
1-17 sought, except to the extent permitted under Chapter 408, Labor
1-18 Code.
1-19 SECTION 2. Section 311.002, Health and Safety Code, is
1-20 amended to read as follows:
1-21 Sec. 311.002. ITEMIZED STATEMENT OF BILLED SERVICES.
1-22 (a) Each hospital shall develop, implement, and enforce a written
1-23 policy for the billing of hospital services and supplies. The
1-24 policy must include:
2-1 (1) a periodic review of the itemized statements
2-2 required by Subsection (b); and
2-3 (2) a procedure for handling complaints relating to
2-4 billed services.
2-5 (b) Not later than the 30th [10th] business day after the
2-6 date of the hospital discharge of a person who receives hospital
2-7 services, the hospital shall provide on request [have available] an
2-8 itemized statement of the billed services provided to the person.
2-9 The itemized statement must:
2-10 (1) be printed in a conspicuous manner;
2-11 (2) list the date services and supplies were provided;
2-12 (3) state whether:
2-13 (A) a claim has been submitted to a third party
2-14 payor; and
2-15 (B) a third party payor has paid the claim;
2-16 (4) if payment is not required, state that payment is
2-17 not required:
2-18 (A) in a typeface that is bold-faced,
2-19 capitalized, underlined, or otherwise set out from surrounding
2-20 written material; or
2-21 (B) by other reasonable means so as to be
2-22 conspicuous that payment is not required; and
2-23 (5) contain the telephone number of the facility to
2-24 call for an explanation of acronyms, abbreviations, and numbers
2-25 used to describe the services provided or supplies used or any
2-26 other questions regarding the bill.
3-1 (c) [(b)] Before a person is discharged from a hospital, the
3-2 hospital shall inform the person of the availability of the
3-3 statement.
3-4 (d) [(c)] To be entitled to receive a statement, a person
3-5 must request the statement not later than one year after the date
3-6 on which the person is discharged from the hospital. The hospital
3-7 shall provide the statement to the person not later than the 30th
3-8 [10th] day after the date on which the person requests the
3-9 statement.
3-10 (e) [(d)] A hospital shall provide an itemized statement of
3-11 billed services to a third party payor who is actually or
3-12 potentially responsible for paying all or part of the billed
3-13 services provided to a patient and who has received a claim for
3-14 payment of those services. To be entitled to receive a statement,
3-15 the third party payor must request the statement from the hospital
3-16 and must have received a claim for payment. The request must be
3-17 made not later than one year after the date on which the payor
3-18 received the claim for payment. The hospital shall provide the
3-19 statement to the payor not later than the 30th [10th] day after the
3-20 date on which the payor requests the statement. If a third party
3-21 payor receives a claim for payment of part but not all of the
3-22 billed services, the third party payor may request an itemized
3-23 statement of only the billed services for which payment is claimed
3-24 or to which any deduction or copayment applies.
3-25 (f) [(e)] If a person, including a third party payor,
3-26 requests more than two copies of the statement, the hospital may
4-1 charge a reasonable fee for the third and subsequent copies
4-2 provided to that person. The fee may not exceed the hospital's
4-3 cost to copy, process, and deliver the copy to the person.
4-4 (g) [(f)] The Texas Department of Health or other
4-5 appropriate licensing agency may enforce this section by assessing
4-6 an administrative penalty, obtaining an injunction, or providing
4-7 [by] any other appropriate remedy, including suspending, revoking,
4-8 or refusing to renew a hospital's license.
4-9 (h) [(g)] In this section, "hospital" includes:
4-10 (1) a hospital licensed under Chapter 241;
4-11 (2) a treatment facility licensed under Chapter 464;
4-12 and
4-13 (3) [(2)] a mental health facility licensed under
4-14 Chapter 577.
4-15 (i) [(h)] This section does not apply to a hospital
4-16 maintained or operated by the federal government.
4-17 SECTION 3. This Act takes effect September 1, 1999, and
4-18 applies only to acts or omissions occurring on or after that date.
4-19 SECTION 4. The importance of this legislation and the
4-20 crowded condition of the calendars in both houses create an
4-21 emergency and an imperative public necessity that the
4-22 constitutional rule requiring bills to be read on three several
4-23 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 830 passed the Senate on
April 8, 1999, by the following vote: Yeas 30, Nays 0.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 830 passed the House on
May 26, 1999, by a non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor