84R12079 PMO-F
 
  By: Estes S.B. No. 1445
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to regulation of certain segments of the health care
  system.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1451, Insurance Code, is amended by
  adding Subchapter K to read as follows:
  SUBCHAPTER K. HOSPITALS, HOSPITAL SYSTEMS, HEALTH CARE FACILITIES,
  AND PHYSICIAN GROUP PRACTICES
         Sec. 1451.501.  DEFINITIONS. In this chapter:
               (1)  "Affiliate" means an affiliate as described by
  Section 823.003.
               (2)  "Health care facility" has the meaning assigned by
  Section 1456.001.
               (3)  "Health care provider" has the meaning assigned by
  Section 1301.001.
               (4)  "Hospital" and "hospital system" have the meanings
  assigned by Section 74.001, Civil Practice and Remedies Code.
               (5)  "Physician group practice" has the meaning
  assigned by Section 157.051, Occupations Code.
         Sec. 1451.502.  APPLICABILITY OF SUBCHAPTER. This
  subchapter applies only to a hospital, hospital system, health care
  facility, or physician group practice that contracts with an
  insurer for payment of claims or reimbursement under a health
  benefit plan issued by the insurer.
         Sec. 1451.503.  CONFLICT WITH OTHER LAWS. To the extent this
  subchapter conflicts with other law, the other law controls.
         Sec. 1451.504.  CERTAIN CONTRACTING PROVISIONS PROHIBITED.
  A contract between an insurer and a hospital, hospital system,
  health care facility, or physician group practice may not restrict
  the ability of an insurer to furnish information to an insured
  concerning the cost of a procedure or quality of care at the
  hospital, hospital system, health care facility, or physician group
  practice.
         Sec. 1451.505.  CONTRACT NEGOTIATIONS. To promote
  competition between hospitals, hospital systems, health care
  facilities, and physician group practices the commissioner shall
  adopt reasonable rules establishing minimum standards, including
  standards relating to information sharing, negotiating teams, and
  firewalls for negotiating teams, for contract negotiations between
  an insurer and a hospital, hospital system, health care facility,
  or physician group practice that is owned by or affiliated with an
  entity that owns other hospitals, hospital systems, health care
  facilities, or physician group practices.
         Sec. 1451.506.  TRANSPARENCY. The commissioner shall adopt
  reasonable rules establishing minimum standards related to
  disclosures a hospital, hospital system, health care facility, or
  physician group practice must make to an insured relating to the
  amount or charge or estimate of the amount or charge, including any
  facility fees, for an admission to or procedure or service
  performed at the hospital, hospital system, health care facility,
  or physician group practice for which the insured may be
  financially responsible.
         Sec. 1451.507.  DISCLOSURE OF REFERRALS. The commissioner
  shall adopt reasonable rules establishing minimum standards,
  including the existence and nature of the affiliation, for
  disclosures a health care provider must make on referral of an
  insured to an affiliated provider. 
         Sec. 1451.508.  NOTICE OF FACILITY FEE CHARGES. (a)  The
  commissioner shall adopt reasonable rules requiring a hospital or
  hospital system to provide to an insured written notice of the
  amount or estimate of the amount of a professional fee, if any,
  including a facility fee, that the hospital or hospital system may
  charge, in addition to and separate from the professional fee
  charged by the physician or health care provider who treats the
  insured, for a service provided at the hospital or hospital
  system's hospital-based facility.
         (b)  The commissioner shall adopt reasonable rules requiring
  certain information be included in the notice described by
  Subsection (a), including an explanation that the insured may incur
  financial liability that is greater than the insured might incur if
  the service provided at the hospital or hospital system's
  hospital-based facility was not provided at the hospital or
  facility.
         (c)  The commissioner shall adopt reasonable rules
  prescribing the manner and time of delivery of the notice described
  by Subsection (a) and requiring the notice be provided to the
  insured in plain language and in a form that may be reasonably
  understood by an insured who does not possess special knowledge
  regarding hospital or health system facility fee charges.
         (d)  Subsections (a), (b), and (c) do not apply to the child
  health plan program operated under Chapter 62, Health and Safety
  Code, the health benefits plan for children operated under Chapter
  63, Health and Safety Code, the state Medicaid program, or a managed
  care organization that contracts with the Health and Human Services
  Commission to provide health care services to recipients through a
  managed care plan.
         (e)  The commissioner shall adopt reasonable rules requiring
  an insurer to contract only with hospital-based facilities that
  prominently and publicly display written notice that the facility
  is a hospital-based facility and clearly holds itself out to the
  public and insureds as being a hospital-based facility.
         Sec. 1451.509.  MARKET CONCENTRATION. (a) The commissioner
  shall adopt rules requiring hospitals, hospital systems, health
  care facilities, and physician group practices and physicians and
  health care providers practicing at the hospitals, hospital
  systems, health care facilities, and physician group practices to
  report information concerning:
               (1)  any merger or acquisition in which the hospital,
  hospital system, health care facility, physician group practice,
  physician, or health care provider is involved; or
               (2)  any material change to the business or corporate
  structure of the hospital, hospital system, health care facility,
  physician group practice, physician, or health care provider.
         (b)  The information required under Subsection (a) must
  include information identifying the parties to and nature of the
  merger or acquisition or describing the material change to the
  business or corporate structure of the hospital, hospital system,
  health care facility, physician group practice, physician, or
  health care provider.
         (c)  The commissioner shall compile and provide to the
  attorney general the information required under this section for
  review and analysis. The attorney general shall review and analyze
  the information provided by the commissioner and make
  recommendations, as necessary, to the legislature for legislative
  action related to the review and analysis conducted under this
  subsection.
         Sec. 1451.510.  ANNUAL HEARING AND REPORT. (a) The attorney
  general shall hold an annual public hearing concerning the impact
  of the rules adopted under this subchapter on health care provider
  costs and cost trends, including health care costs paid by the
  state.
         (b)  On request of the attorney general, the commissioner
  shall provide to the attorney general information related to the
  subject matter of the hearing.
         (c)  The attorney general shall prepare an annual report
  based on the findings from the hearing conducted under Subsection
  (a) and submit the report to the legislature not later than December
  31 of the year in which the hearing is held.
         SECTION 2.  (a) The changes in law made by this Act apply
  only to a contract executed or renewed on or after January 1, 2016.
  A contract entered into or renewed before January 1, 2016, is
  governed by the law as it existed immediately before that date, and
  that law is continued in effect for that purpose.
         (b)  The commissioner of insurance shall provide to the
  attorney general the information reported and compiled under
  Section 1451.509, Insurance Code, as added by this Act, not later
  than September 1, 2017. The attorney general shall submit
  recommendations under that section not later than December 31,
  2017.
         (c)  The attorney general shall hold the initial annual
  public hearing required under Section 1451.510, Insurance Code, as
  added by this Act, not later than December 31, 2017.
         SECTION 3.  This Act takes effect September 1, 2015.