By Madla S.B. No. 830
76R6633 MCK-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to billing policies of certain health care professionals
1-3 and facilities; providing administrative penalties.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 241.154(d), Health and Safety Code, is
1-6 amended to read as follows:
1-7 (d) A hospital may not charge a fee for:
1-8 (1) providing health care information under Subsection
1-9 (b) to the extent the fee is prohibited under Subchapter M, Chapter
1-10 161;
1-11 (2) a patient to examine the patient's own health care
1-12 information;
1-13 (3) providing an itemized statement of billed services
1-14 to a patient or third-party payor, except as provided under Section
1-15 311.002(f) [311.002(e)]; or
1-16 (4) health care information relating to treatment or
1-17 hospitalization for which workers' compensation benefits are being
1-18 sought, except to the extent permitted under Chapter 408, Labor
1-19 Code.
1-20 SECTION 2. Section 311.002, Health and Safety Code, is
1-21 amended to read as follows:
1-22 Sec. 311.002. ITEMIZED STATEMENT OF BILLED SERVICES. (a)
1-23 Each hospital shall develop, implement, and enforce a written
1-24 policy for the billing of hospital services and supplies. The
2-1 policy must include:
2-2 (1) a periodic review of the itemized statements
2-3 required by Subsection (b); and
2-4 (2) a procedure for handling complaints relating to
2-5 billed services.
2-6 (b) Not later than the 30th [10th] business day after the
2-7 date of the hospital discharge of a person who receives hospital
2-8 services, the hospital shall provide on request [have available] an
2-9 itemized statement of the billed services provided to the person.
2-10 The itemized statement must:
2-11 (1) be printed in a conspicuous manner;
2-12 (2) list the date services and supplies were provided;
2-13 (3) state whether:
2-14 (A) a claim has been submitted to a third party
2-15 payor; and
2-16 (B) a third party payor has paid the claim;
2-17 (4) if payment is not required, state that payment is
2-18 not required:
2-19 (A) in a typeface that is bold-faced,
2-20 capitalized, underlined, or otherwise set out from surrounding
2-21 written material; or
2-22 (B) by other reasonable means so as to be
2-23 conspicuous that payment is not required; and
2-24 (5) contain the telephone number of the facility to
2-25 call for an explanation of acronyms, abbreviations, and numbers
2-26 used to describe the services provided or supplies used or any
2-27 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
3-27 charge a reasonable fee for the third and subsequent copies
4-1 provided to that person. The fee may not exceed the hospital's
4-2 cost to copy, process, and deliver the copy to the person.
4-3 (g) [(f)] The Texas Department of Health or other
4-4 appropriate licensing agency may enforce this section by assessing
4-5 an administrative penalty, obtaining an injunction, or providing
4-6 [by] any other appropriate remedy, including suspending, revoking,
4-7 or refusing to renew a hospital's license.
4-8 (h) [(g)] In this section, "hospital" includes:
4-9 (1) a hospital licensed under Chapter 241;
4-10 (2) a treatment facility licensed under Chapter 464;
4-11 and
4-12 (3) [(2)] a mental health facility licensed under
4-13 Chapter 577.
4-14 (i) [(h)] This section does not apply to a hospital
4-15 maintained or operated by the federal government.
4-16 SECTION 3. Section 311.0025, Health and Safety Code, is
4-17 amended by adding Subsection (e) to read as follows:
4-18 (e) A licensing agency may not take disciplinary action
4-19 against a hospital, treatment facility, mental health facility, or
4-20 health care professional for unknowing and isolated billing errors.
4-21 SECTION 4. Section 5(b), Article 4512p, Revised Statutes, is
4-22 amended to read as follows:
4-23 (b) A health care professional may not violate Section
4-24 311.0025, Health and Safety Code [persistently or flagrantly
4-25 overcharge or overtreat a patient].
4-26 SECTION 5. Section 3.08, Medical Practice Act (Article
4-27 4495b, Vernon's Texas Civil Statutes), is amended to read as
5-1 follows:
5-2 Sec. 3.08. GROUNDS FOR REFUSAL TO ADMIT PERSONS TO
5-3 EXAMINATION AND TO ISSUE LICENSE AND RENEWAL LICENSE AND FOR
5-4 DISCIPLINARY ACTION. The board may refuse to admit persons to its
5-5 examinations and to issue a license to practice medicine to any
5-6 person and may take disciplinary action against any person for any
5-7 of the following reasons:
5-8 (1) submission of a false or misleading statement,
5-9 document, or certificate to the board in an application for
5-10 examination or licensure; the presentation to the board of any
5-11 license, certificate, or diploma that was illegally or fraudulently
5-12 obtained; the practice of fraud or deception in taking or passing
5-13 an examination;
5-14 (2) conviction of a crime of the grade of a felony or
5-15 a crime of a lesser degree that involves moral turpitude;
5-16 (3) intemperate use of alcohol or drugs that, in the
5-17 opinion of the board, could endanger the lives of patients;
5-18 (4) unprofessional or dishonorable conduct that is
5-19 likely to deceive or defraud the public or injure the public.
5-20 Unprofessional or dishonorable conduct likely to deceive or defraud
5-21 the public includes but is not limited to the following acts:
5-22 (A) committing any act that is in violation of
5-23 the laws of the State of Texas if the act is connected with the
5-24 physician's practice of medicine. A complaint, indictment, or
5-25 conviction of a law violation is not necessary for the enforcement
5-26 of this provision. Proof of the commission of the act while in the
5-27 practice of medicine or under the guise of the practice of medicine
6-1 is sufficient for action by the board under this section;
6-2 (B) failing to keep complete and accurate
6-3 records of purchases and disposals of drugs listed in Chapter 481,
6-4 Health and Safety Code, or of controlled substances scheduled in
6-5 the Federal Comprehensive Drug Abuse Prevention and Control Act of
6-6 1970, 21 U.S.C.A. Section 801 et seq. (Public Law 91-513). A
6-7 physician shall keep records of his purchases and disposals of
6-8 these drugs to include without limitation the date of purchase, the
6-9 sale or disposal of the drugs by the physician, the name and
6-10 address of the person receiving the drugs, and the reason for the
6-11 disposing or dispensing of the drugs to the person. A failure to
6-12 keep the records for a reasonable time is grounds for revoking,
6-13 canceling, suspending, or probating the license of any practitioner
6-14 of medicine. The board or its representative may enter and inspect
6-15 a physician's place(s) of practice during reasonable business hours
6-16 for the purpose of verifying the correctness of these records and
6-17 of taking inventory of the prescription drugs on hand;
6-18 (C) writing prescriptions for or dispensing to a
6-19 person known to be an abuser of narcotic drugs, controlled
6-20 substances, or dangerous drugs or to a person who the physician
6-21 should have known was an abuser of the narcotic drugs, controlled
6-22 substances, or dangerous drugs. This provision does not apply to
6-23 those persons:
6-24 (i) being treated by the physician for
6-25 their narcotic use after the physician notifies the board in
6-26 writing of the name and address of the person being so treated; or
6-27 (ii) who the physician is treating for
7-1 intractable pain under the Intractable Pain Treatment Act (Article
7-2 4495c, Revised Statutes) and its subsequent amendments;
7-3 (D) writing false or fictitious prescriptions
7-4 for dangerous drugs as defined by Chapter 483, Health and Safety
7-5 Code, of controlled substances scheduled in the Texas Controlled
7-6 Substances Act (Chapter 481, Health and Safety Code), or of
7-7 controlled substances scheduled in the Federal Comprehensive Drug
7-8 Abuse Prevention and Control Act of 1970, 21 U.S.C.A. Section 801
7-9 et seq. (Public Law 91-513);
7-10 (E) prescribing or administering a drug or
7-11 treatment that is nontherapeutic in nature or nontherapeutic in the
7-12 manner the drug or treatment is administered or prescribed;
7-13 (F) prescribing, administering, or dispensing in
7-14 a manner not consistent with public health and welfare dangerous
7-15 drugs as defined by Chapter 483, Health and Safety Code, controlled
7-16 substances scheduled in the Texas Controlled Substances Act
7-17 (Chapter 481, Health and Safety Code), or controlled substances
7-18 scheduled in the Federal Comprehensive Drug Abuse Prevention and
7-19 Control Act of 1970, 21 U.S.C.A. Section 801 et seq. (Public Law
7-20 91-513);
7-21 (G) violating Section 311.0025, Health and
7-22 Safety Code, or any other state or federal law or rule related to
7-23 billing [persistently or flagrantly overcharging or overtreating
7-24 patients];
7-25 (H) failing to supervise adequately the
7-26 activities of those acting under the supervision of the physician;
7-27 or
8-1 (I) delegating professional medical
8-2 responsibility or acts to a person if the delegating physician
8-3 knows or has reason to know that the person is not qualified by
8-4 training, experience, or licensure to perform the responsibility or
8-5 acts;
8-6 (5) violation or attempted violation, direct or
8-7 indirect, of any valid rules issued under this Act, either as a
8-8 principal, accessory, or accomplice;
8-9 (6) use of any advertising statement that is false,
8-10 misleading, or deceptive;
8-11 (7) advertising professional superiority or the
8-12 performance of professional service in a superior manner if the
8-13 advertising is not readily subject to verification;
8-14 (8) purchase, sale, barter, or use or any offer to
8-15 purchase, sell, barter, or use any medical degree, license,
8-16 certificate, diploma, or transcript of license, certificate, or
8-17 diploma in or incident to an application to the board for a license
8-18 to practice medicine;
8-19 (9) altering, with fraudulent intent, any medical
8-20 license, certificate, diploma, or transcript of a medical license,
8-21 certificate, or diploma;
8-22 (10) using any medical license, certificate, diploma,
8-23 or transcript of a medical license, certificate, or diploma that
8-24 has been fraudulently purchased, issued, or counterfeited or that
8-25 has been materially altered;
8-26 (11) impersonating or acting as proxy for another in
8-27 any examination required by this Act for a medical license; or
9-1 engaging in conduct which subverts or attempts to subvert any
9-2 examination process required by this Act for a medical license.
9-3 Conduct which subverts or attempts to subvert the medical licensing
9-4 examination process includes, but is not limited to:
9-5 (A) conduct which violates the security of the
9-6 examination materials, as prescribed by board rules;
9-7 (B) conduct which violates the standard of test
9-8 administration, as prescribed by board rules; or
9-9 (C) conduct which violates the accreditation
9-10 process, as prescribed by board rules;
9-11 (12) impersonating a licensed practitioner or
9-12 permitting or allowing another to use his license or certificate to
9-13 practice medicine in this state for the purpose of diagnosing,
9-14 treating, or offering to treat sick, injured, or afflicted human
9-15 beings;
9-16 (13) employing, directly or indirectly, any person
9-17 whose license to practice medicine has been suspended, canceled, or
9-18 revoked or association in the practice of medicine with any person
9-19 or persons whose license to practice medicine has been suspended,
9-20 canceled, or revoked or any person who has been convicted of the
9-21 unlawful practice of medicine in Texas or elsewhere;
9-22 (14) performing or procuring a criminal abortion or
9-23 aiding or abetting in the procuring of a criminal abortion or
9-24 attempting to perform or procure a criminal abortion or attempting
9-25 to aid or abet the performance or procurement of a criminal
9-26 abortion;
9-27 (15) aiding or abetting, directly or indirectly, the
10-1 practice of medicine by any person, partnership, association, or
10-2 corporation not duly licensed to practice medicine by the board;
10-3 (16) inability to practice medicine with reasonable
10-4 skill and safety to patients by reason of illness, drunkenness,
10-5 excessive use of drugs, narcotics, chemicals, or any other type of
10-6 material or as a result of any mental or physical condition. In
10-7 enforcing this subdivision the board shall, upon probable cause,
10-8 request a physician to submit to a mental or physical examination
10-9 by physicians designated by the board. If the physician refuses to
10-10 submit to the examination, the board shall issue an order requiring
10-11 the physician to show cause why he should not be required to submit
10-12 to the examination and shall schedule a hearing on the order within
10-13 30 days after notice is served on the physician. The physician
10-14 shall be notified by either personal service or certified mail with
10-15 return receipt requested. At the hearing, the physician and his
10-16 attorney are entitled to present any testimony and other evidence
10-17 to show why the physician should not be required to submit to the
10-18 examination. After a complete hearing, the board shall issue an
10-19 order either requiring the physician to submit to the examination
10-20 or withdrawing the request for examination. An appeal from the
10-21 decision of the board shall be taken under the Administrative
10-22 Procedure Act;
10-23 (17) judgment by a court of competent jurisdiction
10-24 that a person licensed to practice medicine is of unsound mind;
10-25 (18) professional failure to practice medicine in an
10-26 acceptable manner consistent with public health and welfare;
10-27 (19) being removed, suspended, or having disciplinary
11-1 action taken by his peers in any professional medical association
11-2 or society, whether the association or society is local, regional,
11-3 state, or national in scope, or being disciplined by a licensed
11-4 hospital or medical staff of a hospital, including removal,
11-5 suspension, limitation of hospital privileges, or other
11-6 disciplinary action, if that action in the opinion of the board was
11-7 based on unprofessional conduct or professional incompetence that
11-8 was likely to harm the public, provided that the board finds that
11-9 the actions were appropriate and reasonably supported by evidence
11-10 submitted to it. The action does not constitute state action on
11-11 the part of the association, society, or hospital medical staff;
11-12 (20) repeated or recurring meritorious health-care
11-13 liability claims that in the opinion of the board evidence
11-14 professional incompetence likely to injure the public; or
11-15 (21) suspension, revocation, restriction, or other
11-16 disciplinary action by another state of a license to practice
11-17 medicine, or disciplinary action by the uniformed services of the
11-18 United States, based upon acts by the licensee similar to acts
11-19 described in this section. A certified copy of the record of the
11-20 state taking the action is conclusive evidence of it.
11-21 SECTION 6. This Act takes effect September 1, 1999, and
11-22 applies only to acts or omissions occurring on or after that date.
11-23 SECTION 7. The importance of this legislation and the
11-24 crowded condition of the calendars in both houses create an
11-25 emergency and an imperative public necessity that the
11-26 constitutional rule requiring bills to be read on three several
11-27 days in each house be suspended, and this rule is hereby suspended.