87R11251 SRA-D
 
  By: Martinez H.B. No. 4045
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the cost, payment, and collection of health care
  expenses.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle A, Title 4, Health and Safety Code, is
  amended by adding Chapter 226 to read as follows:
  CHAPTER 226. COST, PAYMENT, AND COLLECTION OF HEALTH CARE EXPENSES
  FOR SERVICES PROVIDED BY CERTAIN HEALTH CARE FACILITIES AND
  PROFESSIONALS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 226.001.  PURPOSE. The purpose of this chapter is to
  reduce burdensome medical debt and to protect patients in their
  dealings with medical creditors, medical debt collectors, and
  medical debt buyers in connection with medical debt.
         Sec. 226.002.  CONSTRUCTION OF CHAPTER. This chapter shall
  be liberally construed to effect its purposes.
         Sec. 226.003.  DEFINITIONS. In this chapter:
               (1)  "Commission" means the Health and Human Services
  Commission.
               (2)  "Consumer report" has the meaning assigned by
  Section 603(d) of the Fair Credit Reporting Act (15 U.S.C. Section
  1681a).
               (3)  "Consumer reporting agency" means a person who
  regularly engages wholly or partly in the practice of assembling or
  evaluating consumer credit information or other information on
  individuals to furnish consumer reports to third parties for
  monetary fees, for dues, or on a cooperative nonprofit basis.
               (4)  "Executive commissioner" means the executive
  commissioner of the Health and Human Services Commission.
               (5)  "Health care facility":
                     (A)  means:
                           (i)  a hospital licensed under Chapter 241;
                           (ii)  an outpatient clinic or facility
  affiliated with or operating under the license of a hospital
  described by Subparagraph (i);
                           (iii)  an ambulatory surgical center
  licensed under Chapter 243; or
                           (iv)  a facility licensed in this state that
  provides outpatient health care services and has revenues of at
  least $20 million annually; and
                     (B)  includes a health care professional licensed
  in this state who provides health care services in one or more of
  the facilities or other health care settings described by Paragraph
  (A) and who bills patients independently.
               (6)  "Health care services" means services for the
  diagnosis, prevention, treatment, cure, or relief of a physical,
  dental, behavioral, substance use disorder or mental health
  condition, illness, injury, or disease.  The term includes any
  procedures, products, devices, or medications.
               (7)  "Medical creditor" means a health care facility or
  other entity that provides health care services and to whom an
  individual:
                     (A)  owes money for those services; or
                     (B)  previously owed money for those services if
  the medical debt has been purchased by a medical debt buyer.
               (8)  "Medical debt" means a debt arising from the
  receipt of health care services.
               (9)  "Medical debt buyer" means a person who purchases
  a medical debt for collection purposes from a medical creditor or
  other subsequent owner of the medical debt, regardless of whether
  the person collects the medical debt, hires a third party to collect
  the medical debt, or hires an attorney to pursue collection
  litigation in connection with the medical debt.
               (10)  "Medical debt collector" means a person who
  regularly collects or attempts to collect, directly or indirectly,
  a medical debt originally owed or due another or asserted to be owed
  or due another. The term includes a medical debt buyer.
         Sec. 226.004.  RULES. (a)  The executive commissioner shall
  adopt rules to administer this chapter.
         (b)  In adopting rules under this section, the executive
  commissioner shall consult with the Texas Medical Board, the State
  Board of Dental Examiners, and the commissioner of insurance as
  appropriate and necessary.
  SUBCHAPTER B. PRICE INFORMATION AND PAYMENTS
         Sec. 226.051.  PRICE INFORMATION ONLINE. (a)  In this
  section, "gross charges" means a health care facility's full
  established price for a health care service that the facility
  charges patients who do not have health benefit plan coverage
  before applying any contractual allowances, discounts, or
  deductions.
         (b)  A health care facility shall post price information of
  the facility's health care services on its Internet website.  The
  information must be accessible from a link on the website's home
  page, and at a minimum must:
               (1)  list the gross charges for each health care
  service provided by the facility;
               (2)  list the Medicare reimbursement amount for the
  health care service, next to the relevant gross charges; and
               (3)  use plain language titles or descriptions of
  health care services that can be understood by the average
  individual.
         Sec. 226.052.  ITEMIZED BILL. On a patient's written or oral
  request and without charge, a medical creditor or medical debt
  collector shall provide an itemized bill to the patient not later
  than the 60th day after the date of the request.  The bill must
  contain:
               (1)  the name and address of the medical creditor;
               (2)  the date a health care service was provided;
               (3)  the date the medical debt was incurred, if
  different from the date of service;
               (4)  a detailed list of the specific health care
  services provided to the patient;
               (5)  a list of all health care professionals who
  treated the patient;
               (6)  the amount of principal for any medical debt
  incurred;
               (7)  any adjustment to the bill, such as negotiated
  insurance rates or other discounts;
               (8)  the amount of any payments received from the
  patient or any other person on the patient's behalf; and
               (9)  any interest or fees.
         Sec. 226.053.  INTEREST ON MEDICAL DEBT. (a)  
  Notwithstanding any agreement to the contrary or other law,
  interest on medical debt is limited to the rate of interest equal to
  the weekly average one-year constant maturity treasury yield, but
  not less than two percent per year and not more than five percent
  per year, as published by the Board of Governors of the Federal
  Reserve System, for the calendar week preceding the date when the
  patient was first provided with a bill for payment of the health
  care services.  If the Board of Governors of the Federal Reserve
  System ceases to publish this interest rate, the executive
  commissioner by rule shall substitute another measure for
  determining a reasonable interest rate of not more than five
  percent per year.
         (b)  Notwithstanding any agreement to the contrary or other
  law, the rate of interest specified by Subsection (a) applies to a
  judgment on medical debt.
         Sec. 226.054.  RECEIPT FOR PAYMENTS. Not later than the 10th
  business day after the date payment of a medical debt is received,
  the medical creditor or medical debt collector shall provide to the
  person making the payment a receipt showing:
               (1)  the amount paid;
               (2)  the date payment is received;
               (3)  the outstanding balance of the patient's account
  before the most recent payment;
               (4)  the new balance after application of the payment;
               (5)  the interest rate and interest accrued since the
  last payment;
               (6)  the patient's account number;
               (7)  the name of the current owner of the debt and, if
  different, the name of the medical creditor; and
               (8)  whether the payment is accepted as payment in full
  of the debt.
         Sec. 226.055.  LIABILITY FOR MEDICAL DEBT. (a)  Parents and
  legal guardians are jointly liable for any medical debt incurred by
  a child under 18 years of age.
         (b)  A spouse or other person is not liable for the medical
  debt of a person 18 years of age or older.  A person may consent to
  assume liability, if the consent is:
               (1)  on a separate document signed by the person;
               (2)  not solicited in an emergency room or during an
  emergency situation; and
               (3)  not required as a condition of providing emergency
  or nonemergency health care services.
  SUBCHAPTER C. MEDICAL DEBT COLLECTIONS
         Sec. 226.101.  PROHIBITED COLLECTION ACTIONS. To collect a
  medical debt, a medical creditor or medical debt collector may not:
               (1)  cause an individual's arrest;
               (2)  cause an individual to be the subject of a capias
  as defined by Article 23.01, Code of Criminal Procedure; or
               (3)  foreclose on an individual's real property.
         Sec. 226.102.  EXTRAORDINARY COLLECTION ACTIONS. (a)  In
  this section, "extraordinary collection action," with respect to a
  patient, means:
               (1)  selling the patient's medical debt to another
  party, unless, before the sale, the medical creditor enters into a
  written agreement with the medical debt buyer providing that:
                     (A)  the medical debt buyer may not engage in an
  extraordinary collection action as provided by this section to
  obtain payment of the debt; and
                     (B)  the medical debt collector may not charge
  interest on the debt at a rate in excess of the limit prescribed by
  Section 226.053;
               (2)  reporting adverse information about the patient to
  a consumer reporting agency; or
               (3)  initiating an action that requires a legal or
  judicial process, including:
                     (A)  placing a lien on the patient's property;
                     (B)  seizing the patient's bank account or any
  other personal property; or
                     (C)  bringing a civil action against the patient.
         (b)  Except as provided by Section 226.103, a medical
  creditor or medical debt collector may not engage in an
  extraordinary collection action against a patient until the 180th
  day after the date the first bill for an amount owed for receipt of
  health care services has been sent to the patient.
         (c)  At least 30 days before taking an extraordinary
  collection action, a medical creditor or medical debt collector
  shall provide to the patient a notice containing:
               (1)  the extraordinary collection actions that will be
  initiated to obtain payment; and
               (2)  a deadline after which extraordinary collection
  actions will be initiated, which may not be earlier than the 30th
  day after the date notice is provided.
         (d)  A health care facility or medical debt collector
  collecting medical debt for services provided at a health care
  facility may not use any extraordinary collection action not
  described in the facility's billing and collections policy.
         Sec. 226.103.  REPORTING TO CONSUMER REPORTING AGENCY. (a)  
  A medical creditor or medical debt collector may not communicate
  with or report information to a consumer reporting agency regarding
  a patient's medical debt during the one-year period beginning on
  the date when the patient was first given a bill for the health care
  service to which the debt pertains.
         (b)  After expiration of the one-year period prescribed by
  Subsection (a), a medical creditor or medical debt collector shall
  give the patient at least one additional bill before reporting the
  medical debt to a consumer reporting agency.  The amount reported
  must be the same as the amount stated in the additional bill, and
  the bill must state that the debt is being reported to a consumer
  reporting agency.
         (c)  A medical debt collector shall also provide the notice
  required by 15 U.S.C. Section 1692g before reporting a medical debt
  to a consumer reporting agency.
         Sec. 226.104.  COLLECTION OF MEDICAL DEBT DURING HEALTH
  BENEFIT PLAN REVIEW PROHIBITED. (a)  In this section:
               (1)  "External review" means a review of an adverse
  benefit determination conducted under Chapter 4201, Insurance
  Code, a federal external review process as described by 42 U.S.C.
  Section 300gg-19, a review conducted under 29 U.S.C. Section 1133,
  a Medicare appeals process, a Medicaid appeals process, or another
  applicable external appeals process.
               (2)  "Internal review" means a review of an adverse
  benefit determination conducted by a health benefit plan issuer or
  other insurer.
         (b)  A medical creditor or medical debt collector that knows
  or should have known about an internal review, external review, or
  other appeal of a health benefit plan decision that concerns a
  medical debt and is pending or was pending during the 60 days
  preceding the date of the review or appeal may not:
               (1)  provide information regarding unpaid charges for
  health care services to a consumer reporting agency;
               (2)  communicate with the patient regarding the medical
  debt for the purpose of seeking to collect the debt; or
               (3)  initiate a lawsuit or arbitration proceeding
  against the patient regarding the medical debt.
         (c)  If a medical debt has already been reported to a
  consumer reporting agency and the medical creditor or medical debt
  collector who reported the information learns of an internal
  review, external review, or other appeal of a health benefit plan
  decision that concerns the debt and is pending or was pending during
  the 60 days preceding the date of the review or appeal, the creditor
  or collector shall instruct the consumer reporting agency to delete
  information about the debt.
         (d)  A medical creditor described by Subsection (b) may not
  refer, sell, or send the medical debt to a medical debt collector,
  including selling the debt to a medical debt buyer.
         Sec. 226.105.  FORGIVEN COST-SHARING AMOUNTS RELATED TO
  HEALTH BENEFIT PLAN COVERAGE NOT BREACH OF CONTRACT.  Forgiveness
  of a patient's copayment, coinsurance, deductible, facility fee,
  out-of-network charge, or other cost-sharing amounts related to a
  patient's health benefit plan coverage is not a breach of contract
  or other violation of an agreement between the medical creditor and
  the health benefit plan issuer or payor.
  SUBCHAPTER D.  ENFORCEMENT AND REMEDIES
         Sec. 226.151.  DECEPTIVE TRADE PRACTICE. A violation of
  this chapter constitutes a deceptive trade practice in addition to
  the practices described by Subchapter E, Chapter 17, Business &
  Commerce Code, and is actionable under that subchapter.
         Sec. 226.152.  INJUNCTIVE RELIEF. An individual may bring
  an action for injunctive relief or other appropriate equitable
  relief to enforce compliance with this chapter.
         Sec. 226.153.  WAIVER OF RIGHTS OR REMEDIES PROHIBITED. (a)  
  An agreement between a patient and a health care facility or medical
  debt collector may not contain a provision that, before a dispute
  arises, waives or has the effect of waiving the rights of a patient
  to resolve the dispute by:
               (1)  obtaining:
                     (A)  injunctive, declaratory, or other equitable
  relief;
                     (B)  monetary damages; or
                     (C)  attorney's fees and costs; or
               (2)  requesting a hearing at which the patient can
  present evidence in person.
         (b)  A provision that violates Subsection (a) is void and
  unenforceable.
         (c)  A waiver by a patient or other individual of any
  protection provided by or any right of the patient or other
  individual granted under this chapter is void and unenforceable.
         (d)  The remedies provided by this section are not exclusive
  remedies, and a patient is not required to exhaust any
  administrative remedies provided by this chapter or any other
  applicable law.
         Sec. 226.154.  COMPLAINT PROCESS. (a)  The commission shall
  establish a complaint process by which a patient or other member of
  the public may file a complaint against a medical creditor or
  medical debt collector who violates this chapter.
         (b)  A complaint filed under this section is public
  information, except for the name or address of a complainant or
  other personal identifying information.
         SECTION 2.  As soon as practicable after the effective date
  of this Act, the executive commissioner of the Health and Human
  Services Commission shall adopt rules as required to administer,
  implement, and enforce Chapter 226, Health and Safety Code, as
  added by this Act, including rules relating to establishing a
  complaint process as required by Section 226.154, Health and Safety
  Code, as added by this Act.
         SECTION 3.  The changes in law made by this Act apply only to
  a health care service provided on or after the effective date of
  this Act.  A health care service provided before the effective date
  of this Act is governed by the law in effect on the date the service
  was provided, and the former law is continued in effect for that
  purpose.
         SECTION 4.  This Act takes effect September 1, 2021.