82R7931 YDB-F

By: Kolkhorst H.B. No. 2430

A BILL TO BE ENTITLED

AN ACT

relating to the price charged by a health care provider for a health care service or supply; providing penalties.

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

SECTION 1. This Act may be cited as the Texas Health Care Pricing Disclosure Act.

SECTION 2. The heading to Subchapter H, Chapter 101, Occupations Code, is amended to read as follows:

SUBCHAPTER H. BILLING AND PRICING INFORMATION

SECTION 3. Subchapter H, Chapter 101, Occupations Code, is amended by adding Section 101.3515 to read as follows:

Sec. 101.3515. PRICING INFORMATION. (a) In this section:

(1) "Bundled health care services and supplies" means for pricing purposes the grouping of multiple health care services and supplies provided by a health care provider to a patient during one visit to or treatment by the provider.

(2) "Health care price" means the total amount of compensation a health care provider accepts as payment in full for a health care service or supply or bundled health care services and supplies provided to a patient.

(3) "Health care provider" means:

(A) a health care professional who performs a health care service or provides a health care supply in this state under a license, certificate, registration, or other authority issued by this state to diagnose, prevent, alleviate, or cure a human illness or injury, including a physician and dentist;

(B) a health care facility that provides a health care service or supply in this state under a license, certificate, registration, or other authority issued by this state to diagnose, prevent, alleviate, or cure a human illness or injury, including an institutional health care provider; or

(C) a person that provides to patients in this state ancillary health care-related services and supplies under a license, certificate, or registration issued by this state, or that is otherwise authorized to provide to patients in this state ancillary health care-related services and supplies ordered or authorized by a licensed health care professional, to diagnose, prevent, alleviate, or cure a human illness or injury, including laboratory services, radiological services, and durable medical equipment.

(4) "Pricing information list" means a list of:

(A) the health care price of each health care service and each health care supply that may be provided by a health care provider to a patient; and

(B) the health care price of each set of bundled health care services and supplies that may be provided by the health care provider to a patient.

(b) This section does not apply to a health care price of a health care service or supply or bundled health care services and supplies provided to:

(1) a patient for whom a health care provider has accepted assignment for the health care service or supply from Medicaid or Medicare or any other federal, state, or local government-sponsored medical assistance program; or

(2) a financially or medically indigent person who qualifies for indigent health care services based on:

(A) a sliding fee scale; or

(B) a health care provider's written charity care policy.

(c) Each health care provider shall:

(1) compile a pricing information list;

(2) post on the provider's Internet website the pricing information list and the effective date of the list before providing a health care service or supply or bundled health care services and supplies to a patient; and

(3) not less than 30 days before changing the health care price of a health care service or supply or bundled health care services and supplies provided by the provider to the patient, provide notice of the price change by posting the notice on the provider's Internet website.

(d) A health care provider may not:

(1) charge an amount that is different from the amount listed as the health care price in the pricing information list for a health care service or supply or bundled health care services and supplies provided to a patient; or

(2) include a discount, bonus, fee, or other charge that changes the health care price listed in the pricing information list.

(e) A health care provider may accept from a patient a payment that is less than the health care price listed in the pricing information list if the health care provider determines, in the provider's sole discretion, that payment of the listed price would present a hardship to the patient.

(f) Except for a health care service or supply or bundled health care services and supplies provided to a patient in an emergency department of a hospital or as a result of an emergent direct admission, a patient who receives a health care service or supply or bundled health care services and supplies from a health care provider whose health care price listed is greater than the payment provided under the patient's health plan is personally responsible for the amount that exceeds the listed price.

(g) A health care provider that violates this section is subject to an administrative penalty, a civil penalty, or other disciplinary action, as applicable, in the same manner as if the provider violated the law under which the provider is licensed, certified, registered, or authorized.

SECTION 4. Section 101.352(a), Occupations Code, is amended to read as follows:

(a) A physician shall develop, implement, and enforce written policies for the billing of health care services and supplies. The policies must address:

(1) [any discounting of charges for health care services or supplies provided to an uninsured patient that is not covered by a patient's third-party payor, subject to Chapter 552, Insurance Code;

[(2)] any discounting of charges for health care services or supplies provided to an indigent patient who qualifies for services or supplies based on a sliding fee scale or a written charity care policy established by the physician;

(2) [(3)] whether interest will be applied to any billed health care service or supply not covered by a third-party payor and the rate of any interest charged; and

(3) [(4)] the procedure for handling complaints relating to billed charges for health care services or supplies.

SECTION 5. Section 324.101(a), Health and Safety Code, is amended to read as follows:

(a) Each facility shall develop, implement, and enforce written policies for the billing of facility health care services and supplies. The policies must address:

(1) [any discounting of facility charges to an uninsured consumer, subject to Chapter 552, Insurance Code;

[(2)] any discounting of facility charges provided to a financially or medically indigent consumer who qualifies for indigent services based on a sliding fee scale or a written charity care policy established by the facility and the documented income and other resources of the consumer;

(2) [(3) the providing of an itemized statement required by Subsection (e);

[(4)] 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) [(5)] the procedure for handling complaints[;

[(6) the providing of a conspicuous written disclosure to a consumer at the time the consumer is first admitted to the facility or first receives services at the facility that:

[(A) provides confirmation whether the facility is a participating provider under the consumer's third-party payor coverage on the date services are to be rendered based on the information received from the consumer at the time the confirmation is provided;

[(B) informs consumers that a facility-based physician who may provide services to the consumer while the consumer is in the facility may not be a participating provider with the same third-party payors as the facility;

[(C) informs consumers that the consumer may receive a bill for medical services from a facility-based physician for the amount unpaid by the consumer's health benefit plan;

[(D) informs consumers that the consumer may request a listing of facility-based physicians who have been granted medical staff privileges to provide medical services at the facility; and

[(E) informs consumers that the consumer may request information from a facility-based physician on whether the physician has a contract with the consumer's health benefit plan and under what circumstances the consumer may be responsible for payment of any amounts not paid by the consumer's health benefit plan;

[(7) the requirement that a facility provide a list, on request, to a consumer to be admitted to, or who is expected to receive services from, the facility, that contains the name and contact information for each facility-based physician or facility-based physician group that has been granted medical staff privileges to provide medical services at the facility; and

[(8) if the facility operates a website that includes a listing of physicians who have been granted medical staff privileges to provide medical services at the facility, the posting on the facility's website of a list that contains the name and contact information for each facility-based physician or facility-based physician group that has been granted medical staff privileges to provide medical services at the facility and the updating of the list in any calendar quarter in which there are any changes to the list].

SECTION 6. Sections 324.101(b) and (d), Health and Safety Code, are repealed.

SECTION 7. Notwithstanding Section 101.3515, Occupations Code, as added by this Act, Section 101.352, Occupations Code, as amended by this Act, or Section 324.101, Health and Safety Code, as amended by this Act, a health care provider is not required to comply with the changes in law made by those sections until September 1, 2012.

SECTION 8. This Act takes effect September 1, 2011.