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A BILL TO BE ENTITLED
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AN ACT
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relating to the reporting and disclosure of financial arrangements |
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between referring health care providers and diagnostic imaging |
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providers; providing penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle A, Title 3, Occupations Code, is |
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amended by adding Chapter 113 to read as follows: |
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CHAPTER 113. REPORTING AND DISCLOSURE OF |
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HEALTH CARE PROVIDER REFERRALS |
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Sec. 113.001. DEFINITIONS. In this chapter: |
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(1) "Center" means the Center for Health Statistics of |
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the Department of State Health Services. |
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(2) "Diagnostic imaging provider" means any person or |
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entity that has an investment interest in any facility, office, |
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clinic, imaging center, hospital, or other location in which a |
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diagnostic imaging service is provided or in any machine or |
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equipment that is used to provide a diagnostic imaging service. |
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(3) "Diagnostic imaging service" means magnetic |
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resonance imaging, computed tomography, positron emission |
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tomography, and any hybrid technology that combines any of those |
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imaging modalities. |
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(4) "Health care provider" means a person licensed as |
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a health care professional or authorized to practice in health care |
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under Subtitle B or C. |
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(5) "Immediate family member" means a person's spouse, |
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child, child's spouse, grandchild, grandchild's spouse, parent, |
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parent–in–law, or sibling. |
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(6) "Investment interest" means an equity or debt |
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security issued by a person, including shares of stock in a |
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corporation, membership or other interest in a company, including a |
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limited liability company, units or other interests in a |
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partnership, including a limited liability partnership, bonds, |
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debentures, notes, or other equity interests or debt instruments. |
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The term includes the rental or time sharing of imaging equipment in |
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which a referring physician receives a portion of the billing |
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revenue. |
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(7) "Investor" means a person who directly or |
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indirectly holds a legal, beneficial ownership, or investment |
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interest, including an interest held through an immediate family |
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member, trust, or another person related to the investor within the |
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meaning of 42 C.F.R. Section 413.17. |
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(8) "Licensing authority" means a department, board, |
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office, or other agency of this state that regulates a health care |
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provider subject to this chapter. |
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(9) "Patient" means a person who receives a physical |
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examination, evaluation, diagnosis, or treatment by a health care |
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provider. |
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(10) "Referral" means a health care provider's request |
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for or ordering of a diagnostic imaging service for a patient. |
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Sec. 113.002. RULES. The executive commissioner of the |
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Health and Human Services Commission, on behalf of the center, |
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shall adopt rules specifying the procedures and forms health care |
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providers must use to comply with this chapter. |
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[Sections 113.003-113.050 reserved for expansion] |
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SUBCHAPTER B. REFERRALS |
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Sec. 113.051. REPORTING AND DISCLOSURE OF REFERRALS. (a) A |
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health care provider who refers a patient for a diagnostic imaging |
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service provided by a diagnostic imaging provider in which the |
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health care provider is an investor or has an investment interest |
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shall provide the licensing authority with a quarterly report |
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containing: |
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(1) the total number of referrals to any diagnostic |
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imaging provider; and |
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(2) all claims data related to those referrals that |
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are required by the center. |
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(b) A diagnostic imaging provider that performs services |
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for a referring health care provider shall report to the center: |
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(1) the identity of the referring health care |
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provider; |
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(2) the exact nature of any investment interest the |
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health care provider has in the diagnostic imaging provider; |
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(3) the total number of patients receiving diagnostic |
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imaging services who were referred by the health care provider; and |
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(4) the additional claims data required by the center. |
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(c) The report required under Subsection (b) may be in the |
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form of a bill for services provided by the diagnostic imaging |
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provider in accordance with rules for filing a clean claim adopted |
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by the Texas Department of Insurance (28 TAC 21.2803), as those |
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rules existed on September 1, 2007. |
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(d) A health care provider making a referral for diagnostic |
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imaging services as described by this section must: |
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(1) disclose in writing to the provider's patients the |
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provider's investment interest in the diagnostic imaging provider; |
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(2) advise the provider's patients that the patient |
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may choose to have another diagnostic imaging provider provide the |
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diagnostic imaging services; and |
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(3) obtain and record the patient's written consent |
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after the disclosure and before the diagnostic imaging services are |
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provided. |
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(e) A report required by this section must be made to the |
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appropriate licensing agency and the center on a form provided to |
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each health care provider by the center. |
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Sec. 113.052. PUBLIC INFORMATION. Information collected |
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under Section 113.051 shall be made available to the public. |
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Sec. 113.053. FEES FOR DISCLOSURE. (a) A health care |
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provider or diagnostic imaging provider shall pay to the center a |
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fee in the amount of $500: |
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(1) at the time of submitting an initial disclosure to |
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the center under Section 113.051; and |
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(2) once each calendar year in which the health care |
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provider or diagnostic imaging provider provides a report to the |
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center. |
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(b) Fees collected under this section shall be maintained in |
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a separate account outside the state treasury by the center to be |
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used in the collection and analysis of data collected under this |
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chapter. |
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[Sections 113.054-113.100 reserved for expansion] |
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SUBCHAPTER C. DISCIPLINARY ACTION; PENALTIES |
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Sec. 113.101. DISCIPLINARY ACTION. A health care |
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provider's or a diagnostic imaging provider's failure to report or |
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disclose information required by this chapter is grounds for |
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disciplinary action, including the imposition of an administrative |
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penalty, by the licensing authority that regulates the health care |
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provider or diagnostic imaging provider. |
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Sec. 113.102. CIVIL PENALTY. (a) A health care provider or |
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diagnostic imaging provider that violates rules adopted under this |
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chapter is subject to a civil penalty of not more than $1,000 for |
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each violation. |
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(b) The attorney general at the request of the center shall |
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bring an action to collect penalties under this section. In the |
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suit, the center and the attorney general each may recover |
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reasonable expenses incurred in obtaining the penalty, including |
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investigation and court costs and reasonable attorney's fees. |
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(c) Expenses recovered by the center under this section |
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shall be deposited in a separate account outside the state treasury |
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to be used by the center in the enforcement of this chapter. |
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SECTION 2. (a) The Department of State Health Services |
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shall conduct a study of the financial impact of the use of |
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diagnostic imaging services required to be reported under Section |
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113.051, Occupations Code, as added by this Act. |
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(b) In conducting the study, the department shall compare |
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the rates at which diagnostic imaging services were used by |
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physicians of the same specialty who have a financial interest in |
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the diagnostic imaging services prescribed for the patient's care |
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and those who do not have a financial interest in the prescribed |
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diagnostic imaging services. |
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(c) Not later than December 1, 2008, the department shall |
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submit a report regarding the study to the lieutenant governor and |
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the speaker of the house of representatives. |
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SECTION 3. Section 113.051, Occupations Code, as added by |
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this Act, applies only to a referral or service that occurs on or |
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after the effective date of this Act. A referral or service that |
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occurs before the effective date of this Act is governed by the law |
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as it existed immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2007. |