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By: Isett H.B. No. 3276
A BILL TO BE ENTITLED
AN ACT
relating to the reporting of data from health care facilities and
the disclosure of estimated charges and the billing policies of
certain health care facilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 108.009 (a), Health and Safety Code, is
amended to read as follows:
(a) The council shall [may] collect, and, except as provided
by Subsections (c) and (d), providers shall submit to the council or
another entity as determined by the council, all inpatient and
outpatient data required by this section. The data shall be
collected according to uniform submission formats, coding systems,
and other technical specifications necessary to make the incoming
data substantially valid, consistent, compatible, and manageable
using electronic data processing, if available.
SECTION 2. Section 311.002, Health and Safety Code, is
amended to read as follows:
Sec. 311.002. ESTIMATED CHARGES, BILLING POLICIES, AND
ITEMIZED STATEMENT OF BILLED SERVICES. (a) Prior to any
nonemergency treatment or services being rendered, each hospital
shall disclose to any person his or her right to receive a written
estimate of charges for any procedure, service, or supply.
(b) [(a)] Each hospital shall develop, implement, disclose,
and enforce a written policy for the billing of hospital services
and supplies. The policy must include:
(1) a periodic review of the itemized statements
required by Subsection (d); and
(2) whether interest will be applied to any billed
service not covered by a third party payor and the rate of any
interest charged; and
(3) (2) a procedure for handling complaints relating to
billed services.
(c) Each hospital shall post, in a prominent location within
its reception areas, patient waiting rooms, admissions offices, and
billing offices, a clear and conspicuous notice of the availability
of the information required by Subsections (a), (b), and (d) and a
person's right to request this information.
(d) [(c)] Not later than the 30th business day after the
date of the hospital discharge of a person who receives hospital
services, the hospital shall provide on request an itemized
statement of the billed services provided to the person. The
itemized statement must:
(1) be printed in a conspicuous manner;
(2) list the date services and supplies were provided;
(3) state whether:
(A) a claim has been submitted to a third party
payor; and
(B) a third party payor has paid the claim;
(4) if payment is not required, state that payment is
not required:
(A) in a typeface that is bold-faced,
capitalized, underlined,or otherwise set out from surrounding
written material; or
(B) by other reasonable means so as to be
conspicuousthat payment is not required; and
(5) contain the telephone number of the facility to
call for anexplanation of acronyms, abbreviations, and numbers
used to describe the services provided or supplies used or any other
questions regarding the bill.
[(d) Before a person is discharged from a hospital, the
hospital shall inform the person of the availability of the
statement.]
(e) To be entitled to receive a statement, a person must
request the statement not later than one year after the date on
which the person isdischarged from the hospital. The hospital
shall provide the statement to theperson not later than the 30th
day after the date on which the person requeststhe statement.
(f) A hospital shall provide an itemized statement of billed
services to a third party payor who is actually or potentially
responsible for paying all or part of the billed services provided
to a patient and who has received a claim for payment of those
services. To be entitled to receive a statement, the third party
payor must request the statement from the hospital and must have
received a claim for payment. The request must be made not later
than one year after the date on which the payor received the claim
for payment. The hospital shall provide the statement to the payor
not later than the 30th day after the date on which the payor
requests the statement. If a third party payor receives a claim for
payment of part but not all of the billed services, the third party
payor may request an itemized statement of only the billed services
for which payment is claimed or to which any deduction or copayment
applies.
(g) If a person, including a third party payor, requests
more than two copies of the statement, the hospital may charge a
reasonable fee for the third and subsequent copies provided to that
person. The fee may not exceed the hospital's cost to copy,
process, and deliver the copy to the person.
(h) The Texas Department of Health or other appropriate
licensing agency may enforce this section by assessing an
administrative penalty, obtaining an injunction, or providing any
other appropriate remedy, including suspending, revoking, or
refusing to renew a hospital's license.
(i) In this section, "hospital" includes:
(1) a hospital licensed under Chapter 241;
(2) a treatment facility licensed under Chapter 464;
[and]
(3) a mental health facility licensed under Chapter
577.;
(4) an ambulatory surgical center licensed under
Chapter 243; and
(5) a birthing center licensed under Chapter 244.
(j) This section does not apply to a hospital maintained or
operated by the federal government.
SECTION 3. This Act takes effect September 1, 2005.