81R7500 YDB-D

By: Duncan S.B. No. 1747

A BILL TO BE ENTITLED

AN ACT

relating to billing practices for certain health care facilities and providers.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 324.001, Health and Safety Code, is amended by adding Subdivision (8) to read as follows:

(8) "Preferred provider" means a facility that contracts to provide medical care or health care to participants or beneficiaries of a health plan in accordance with agreed reimbursement rates.

SECTION 2. Section 324.101, Health and Safety Code, is amended by amending Subsections (e) and (f) and adding Subsections (f-1), (f-2), (f-3), (f-4), (f-5), and (f-6) to read as follows:

(e) A facility shall provide to the consumer at the consumer's request an itemized statement of the billed charges [services] if the consumer requests the statement not later than the first anniversary of the date the person is discharged from the facility. The facility shall provide the statement to the consumer not later than the 10th business day after the date on which the statement is requested. The facility may provide the consumer with an electronic copy of the itemized statement.

(f) If the billed charges exceed $20,000, the [A] facility shall provide an itemized statement of the billed charges [services] to a third-party payor who is actually or potentially responsible for paying all or part of the billed charges for providing 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 facility 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 facility shall provide the statement to the payor with the facility's claim for payment.

(f-1) A third-party payor may request an itemized statement for billed charges of $20,000 or less.

(f-2) After receiving an itemized statement under Subsection (f) or (f-1), a third-party payor may request additional information, including medical records and operative reports.

(f-3) The facility shall provide the statement requested under Subsection (f-1) or information requested under Subsection (f-2) as soon as practicable. The third-party payor and the facility may agree to allow the itemized statement and the additional information to be requested simultaneously to facilitate investigation and payment of billed charges. The days between the date a third-party payor requests an itemized statement or additional information from the facility and the date the payor receives the statement or information may not be counted in a payment period established by statute or under contract.

(f-4) The facility may provide the third-party payor with an electronic copy of an itemized statement under this section [not later than the 30th day after the date on which the payor requests the statement].

(f-5) If a third-party payor receives a claim for payment of part [but not all] of the billed services, the third-party payor is entitled to [may request] an itemized statement of only the billed charges [services] for which payment is claimed or to which any deduction or copayment applies.

(f-6) A third-party payor that requests an itemized statement or additional information under Subsection (f-1) or (f-2) must have evidence sufficient to prove the date the payor made the request, which may include a certified mail receipt or an electronic date stamp. Unless rebutted by sufficient evidence provided by a facility, the date the payor receives the statement or additional information, as shown in the payor's records, is presumed to be the date of receipt for purposes of Subsection (f-3).

SECTION 3. Section 324.103, Health and Safety Code, is amended to read as follows:

Sec. 324.103. [CONSUMER] WAIVER PROHIBITED. The provisions of this chapter may not be waived, voided, or nullified by a contract or an agreement between a facility and a consumer or third-party payor.

SECTION 4. Subchapter C, Chapter 324, Health and Safety Code, is amended by adding Sections 324.104, 324.105, and 324.106 to read as follows:

Sec. 324.104. CLAIM FOR PAYMENT FROM PREFERRED PROVIDER. (a) A preferred provider that directly or through its agent or assignee asserts that a claim for payment of a medical or health care service or supply provided to a consumer, including a claim for payment of the amount due for a disallowed discount on the service or supply provided, has not been timely or accurately paid shall provide written notification of the nonpayment or inaccuracy to the third-party payor not later than the 180th day after the earlier of the date the preferred provider received payment from the payor or the date that payment was due. A preferred provider or agent that fails to provide the notification before the 180th day is barred from asserting the claim of nonpayment or inaccuracy.

(b) If a patient is admitted to a preferred provider for more than 15 days, the preferred provider on request of a third-party payor shall provide an interim statement of the facility's billed charges to the third-party payor not later than the 10th day after the date the third-party payor submits the request.

Sec. 324.105. OVERPAYMENT AND REIMBURSEMENT. (a) Not later than the 45th day after the date a preferred provider receives a written notice of overpayment and request for reimbursement from a third-party payor or the preferred provider makes a determination that it has received an overpayment, the preferred provider shall reimburse the third-party payor for any payment amount that exceeds the amount owed to the preferred provider for an eligible charge.

(b) A preferred provider that fails to make a reimbursement required by this section shall pay, in addition to the reimbursement, a late payment penalty in an amount equal to 10 percent of the amount of the required reimbursement.

Sec. 324.106. COLLECTION OF BILLED CHARGES BY OTHERS. A person collecting a billed charge of a facility subject to this chapter shall comply with the requirements of this chapter before submitting a demand for payment. This section applies without regard to whether the person collecting the billed charge is acting on behalf of the facility or otherwise.

SECTION 5. The changes in law made by this Act to Chapter 324, Health and Safety Code, apply only to services or supplies provided by a health care facility to a consumer on or after the effective date of this Act. Services or supplies provided before the effective date of this Act are governed by the law in effect immediately before the effective date of this Act, and that law is continued in effect for that purpose.

SECTION 6. This Act takes effect September 1, 2009.