By: Hancock, Hinojosa, West S.B. No. 481
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to notice and availability of mediation for balance
  billing by a facility-based physician.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 324.001(8), Health and Safety Code, is
  amended to read as follows:
               (8)  "Facility-based physician" means a radiologist,
  an anesthesiologist, a pathologist, an emergency department
  physician, [or] a neonatologist, or an assistant surgeon.
         SECTION 2.  Section 1456.001(3), Insurance Code, is amended
  to read as follows:
               (3)  "Facility-based physician" means a radiologist,
  an anesthesiologist, a pathologist, an emergency department
  physician, [or] a neonatologist, or an assistant surgeon:
                     (A)  to whom the facility has granted clinical
  privileges; and
                     (B)  who provides services to patients of the
  facility under those clinical privileges.
         SECTION 3.  Section 1456.004(c), Insurance Code, is amended
  to read as follows:
         (c)  A facility-based physician who bills a patient covered
  by a preferred provider benefit plan or a health benefit plan under
  Chapter 1551 that does not have a contract with the facility-based
  physician shall send a billing statement to the patient that
  contains a conspicuous, plain-language explanation [with
  information sufficient to notify the patient] of the mandatory
  mediation process available under Chapter 1467 if [the amount for
  which] the enrollee is responsible to the physician, after
  copayments, deductibles, and coinsurance, for an [including the]
  amount unpaid by the administrator or insurer[, is greater than
  $1,000].
         SECTION 4.  Section 1467.001(4), Insurance Code, is amended
  to read as follows:
               (4)  "Facility-based physician" means a radiologist,
  an anesthesiologist, a pathologist, an emergency department
  physician, [or] a neonatologist, or an assistant surgeon:
                     (A)  to whom the facility has granted clinical
  privileges; and
                     (B)  who provides services to patients of the
  facility under those clinical privileges.
         SECTION 5.  Section 1467.051(a), Insurance Code, is amended
  to read as follows:
         (a)  An enrollee may request mediation of a settlement of an
  out-of-network health benefit claim if:
               (1)  [the amount for which] the enrollee is responsible
  to a facility-based physician, after copayments, deductibles, and
  coinsurance, for an [including the] amount unpaid by the
  administrator or insurer[, is greater than $1,000]; and
               (2)  the health benefit claim is for a medical service
  or supply provided by a facility-based physician in a hospital that
  is a preferred provider or that has a contract with the
  administrator.
         SECTION 6.  Sections 1456.004(c) and 1467.051(a), Insurance
  Code, as amended by this Act, apply only to charges for a medical
  service or supply provided on or after the effective date of this
  Act. Charges for a medical service or supply provided before the
  effective date of this Act are governed by the law as it existed
  immediately before the effective date of this Act, and that law is
  continued in effect for that purpose.
         SECTION 7.  This Act takes effect September 1, 2015.