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A BILL TO BE ENTITLED
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AN ACT
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relating to a health care entity's disclosure to patients and |
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prospective patients of charges for certain health care services, |
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goods, or procedures; authorizing administrative penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Title 2, Health and Safety Code, is amended by |
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adding Subtitle J to read as follows: |
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SUBTITLE J. MEDICAL BILLING AND CHARGES |
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CHAPTER 185. CHARGE TRANSPARENCY |
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Sec. 185.001. DEFINITIONS. In this chapter: |
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(1) "Bundled health care services, goods, or |
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procedures" means the grouping of multiple health care services, |
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goods, or procedures provided by a health care entity or multiple |
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health care entities represented as a single charge. |
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(2) "Charge" means the dollar amount set by the health |
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care entity as the cost for a health care service, good, or |
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procedure, before any applicable discount or negotiated rate is |
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applied. The term does not include any applicable discount, |
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including a discount: |
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(A) for prompt payment; |
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(B) under a written charity care policy; or |
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(C) under a health care entity's contract with a |
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health benefit plan issuer. |
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(3) "Charge list" means: |
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(A) for a health care professional or provider, a |
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list of charges for the health care professional's or provider's |
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health care services, goods, or procedures that the professional or |
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provider billed at least 50 times in the preceding calendar year; or |
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(B) for a health care facility, a list of charges |
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for the health care facility's: |
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(i) outpatient health care services, goods, |
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or procedures that the facility billed at least 50 times in the |
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preceding calendar year; and |
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(ii) inpatient health care services, goods, |
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or procedures that exceed $500 and the facility billed at least 50 |
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times in the preceding calendar year. |
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(4) "Health care entity" means: |
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(A) a health care professional; |
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(B) a health care provider; or |
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(C) a health care facility. |
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(5) "Health care facility" means a facility that |
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provides a health care service, good, or procedure in this state for |
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which a license, certificate, registration, or other authority |
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issued by this state is required. The term includes: |
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(A) an institutional health care provider; |
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(B) a hospital licensed under Chapter 241; |
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(C) an ambulatory surgical center licensed under |
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Chapter 243; |
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(D) a birthing center licensed under Chapter 244; |
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(E) a freestanding emergency medical care |
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facility licensed under Chapter 254; or |
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(F) a chemical dependency treatment facility |
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licensed under Chapter 464. |
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(6) "Health care professional" means an individual who |
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provides a health care service, good, or procedure in this state |
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under a license, certificate, registration, or other authority |
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issued by an agency of this state to diagnose, prevent, alleviate, |
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or cure a human illness or injury, including a physician, dentist, |
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or pharmacist. |
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(7) "Health care provider" means a person who provides |
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to patients in this state ancillary health care services, goods, or |
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procedures under a license, certificate, or registration issued by |
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this state or who is otherwise ordered or authorized by a health |
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care professional to diagnose, prevent, alleviate, or cure a human |
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illness or injury, including laboratory services, radiological |
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services, and durable medical equipment. The term does not include |
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a health care professional or a health care facility. |
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(8) "Patient" means an individual who is receiving or |
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has received a health care service, good, or procedure from a health |
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care entity. The term includes a personal representative of the |
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patient. |
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(9) "Personal representative" means: |
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(A) a parent, legal guardian, or relative; or |
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(B) an individual holding a medical power of |
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attorney for a patient or prospective patient. |
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(10) "Primary regulatory authority" means the state |
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agency that is primarily responsible for licensing, permitting, |
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registering, or otherwise regulating a health care entity. |
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(11) "Prospective patient" means an individual who is |
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considering obtaining a health care service, good, or procedure |
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from a health care entity. The term includes a personal |
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representative of a prospective patient. |
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Sec. 185.002. HEALTH CARE CHARGE LIST REQUIRED. (a) Each |
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health care entity shall compose and maintain a charge list under |
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this chapter. |
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(b) A health care entity is not required to include in the |
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entity's charge list the charges of health care services, goods, or |
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procedures provided by any other health care entity. |
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(c) A health care entity that bills bundled health care |
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services, goods, or procedures may, at the entity's discretion, |
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list the charges of the bundled health care services, goods, or |
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procedures in the entity's charge list. |
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Sec. 185.003. EXPRESSION OF CHARGES. Each charge listed on |
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a charge list required under this chapter must be accompanied by one |
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of the following at the discretion of the health care entity: |
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(1) a description in plain English of the associated |
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health care service, good, or procedure; or |
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(2) the applicable standard billing code along with a |
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description of the associated health care service, good, or |
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procedure. |
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Sec. 185.004. CHARGE LIST AVAILABILITY. (a) A health care |
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entity shall make its charge list available to patients and |
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prospective patients by: |
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(1) posting the charge list on the entity's Internet |
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website; or |
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(2) providing access to the charge list on request at |
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the entity's office, facility, or other practice site. |
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(b) A health care entity that maintains a waiting area shall |
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post a clear and conspicuous notice of the availability of its |
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charge list in the waiting area and in any registration, admission, |
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or business office in which patients or prospective patients are |
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reasonably expected to seek service. The notice must include a |
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statement describing the method used to make the charge list |
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available under Subsection (a). |
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(c) When a health care entity makes the charge list |
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available to patients and prospective patients, the list must be |
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accompanied by a notice that substantially states the following: |
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"NOTICE: THE CHARGES CONTAINED WITHIN THIS CHARGE LIST ARE |
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SUBJECT TO CHANGE. |
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"YOUR BILL, INCLUDING ACTUAL OR TOTAL CHARGES, WILL VARY |
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BASED ON MANY FACTORS, INCLUDING YOUR MEDICAL CONDITION, ANY |
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UNKNOWN MEDICAL CONDITIONS YOU MAY HAVE, YOUR DIAGNOSIS AND |
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RECOMMENDED TREATMENT PROTOCOLS, AND OTHER FACTORS ASSOCIATED WITH |
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PERFORMANCE OF THE HEALTH CARE SERVICE OR PROCEDURE OR THE |
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PROVISION OF THE HEALTH CARE GOOD. |
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"THE CHARGES CONTAINED IN THIS CHARGE LIST MAY DIFFER FROM |
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THE AMOUNT TO BE PAID BY YOU OR YOUR THIRD-PARTY PAYOR, IF |
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APPLICABLE. YOU MAY BE ELIGIBLE FOR A DISCOUNT FROM THE AMOUNTS |
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STATED ON THE CHARGE LIST. REGARDLESS OF YOUR HEALTH BENEFIT PLAN |
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COVERAGE, YOU MAY INQUIRE ABOUT THE AVAILABILITY OF DISCOUNTS. |
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"YOU MAY BE PERSONALLY LIABLE FOR PAYMENT FOR THE HEALTH CARE |
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SERVICE, GOOD, OR PROCEDURE, DEPENDING ON YOUR HEALTH BENEFIT PLAN |
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COVERAGE. YOU SHOULD CONTACT YOUR HEALTH BENEFIT PLAN ISSUER, IF |
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YOU HAVE COVERAGE, FOR ACCURATE INFORMATION REGARDING THE PLAN |
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STRUCTURE, BENEFIT COVERAGE, DEDUCTIBLES, COPAYMENTS, COINSURANCE, |
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AND OTHER PLAN PROVISIONS, SUCH AS NETWORK AVAILABILITY, THAT MAY |
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IMPACT YOUR OUT-OF-POCKET RESPONSIBILITY FOR PAYMENT FOR HEALTH |
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CARE SERVICES, GOODS, OR PROCEDURES, INCLUDING THOSE CONTAINED IN |
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THIS CHARGE LIST." |
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Sec. 185.005. EXEMPTION. A health care entity that owns or |
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is an employee of an entity that has fewer than three full-time |
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equivalent employees is exempt from the requirements of this |
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chapter. |
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Sec. 185.006. DISCOUNTS AND ADDITIONS. This chapter does |
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not prohibit a health care entity from: |
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(1) offering or providing discounts from the amounts |
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stated on the charge list or accepting less than the amount of a |
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charge on the charge list as payment in full; |
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(2) offering or providing additional, different, or a |
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higher complexity level of health care services, goods, or |
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procedures for an additional or different amount; |
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(3) departing from the amounts on the charge list for a |
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reason specified in the notice required by Section 185.004; or |
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(4) changing a charge on the charge list at any time, |
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provided that the charge list is updated with the effective date to |
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reflect the change. |
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Sec. 185.007. DELEGATION. A health care entity's |
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responsibilities under this chapter may be performed by the |
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entity's employer, employee, or other authorized delegate. |
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Sec. 185.008. ENFORCEMENT. (a) Each primary regulatory |
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authority of a health care entity shall enforce this chapter in |
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accordance with this section. If the applicable primary regulatory |
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authority's enforcement process is complaint-based, a complaint |
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must be filed in order for the primary regulatory authority to |
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enforce this chapter. |
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(b) A health care entity that violates any applicable |
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requirement of this chapter must be provided with an opportunity to |
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correct the violation under Subsection (d). |
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(c) A primary regulatory authority that determines a health |
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care entity has violated this chapter shall notify the entity of the |
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violation. |
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(d) If the health care entity corrects the violation not |
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later than the 30th business day after the date the health care |
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entity receives notice under Subsection (c): |
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(1) the primary regulatory authority may not impose a |
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fine, reprimand, administrative penalty, or other discipline on the |
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health care entity; and |
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(2) the violation is confidential and not subject to |
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Chapter 552, Government Code. |
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(e) The primary regulatory authority may assess an |
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administrative penalty for a health care entity's violation of this |
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chapter in the same manner as if the entity had violated the law |
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under which the entity holds a license, certificate, registration, |
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or other authority only if the entity: |
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(1) was provided notice of one or more violations |
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under this chapter in the 12-month period preceding the notice of |
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the most recent violation; or |
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(2) failed to correct the violation before the 31st |
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business day after the date the entity received notice of the |
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violation. |
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(f) The amount of penalties assessed against a health care |
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entity under this section may not exceed: |
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(1) $250 for a single violation; |
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(2) $500 for all violations occurring in a 12-month |
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period for a health care professional; or |
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(3) $5,000 for all violations occurring in a 12-month |
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period for a health care provider or health care facility. |
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(g) All violations that are related to, arise from, or are |
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discovered based on the same event or complaint shall be considered |
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to be a single violation for purposes of this section. Each day a |
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violation continues does not constitute a separate violation. |
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(h) Notwithstanding any other law, this section and the law |
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referenced by this section provide the sole and exclusive remedy |
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and enforcement mechanism for a violation of this chapter. |
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Sec. 185.009. CONTINUING EDUCATION CREDIT. A health care |
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professional is entitled to claim two hours of the continuing |
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education credit, including half a credit hour of ethics, with the |
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appropriate primary regulatory authority for each year of |
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compliance with this chapter. |
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Sec. 185.010. OUT-OF-NETWORK DISPUTE RESOLUTION. |
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Notwithstanding any other law, a health care professional who is in |
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compliance with this chapter at the time that a health care service, |
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good, or procedure is provided is exempt from the mediation |
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process, findings, penalties, and all related provisions, |
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including the informal settlement teleconference under Chapter |
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1467, Insurance Code, if: |
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(1) the dispute concerns the provision of a health |
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care service, good, or procedure listed in the health care |
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professional's charge list; and |
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(2) the amount billed for that service, good, or |
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procedure is less than or equal to the amount stated in the charge |
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list. |
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Sec. 185.011. CHARGE LIST PROTECTIONS. (a) |
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Notwithstanding any other law, this chapter does not create a cause |
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of action or create a standard of care, obligation, or duty that |
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provides a basis for a cause of action. |
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(b) Except as otherwise provided by Section 185.008, a |
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charge list under this chapter or evidence of a violation of this |
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chapter is not admissible in any civil, judicial, or administrative |
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proceeding unless the health care entity voluntarily consents in |
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writing. |
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(c) Notwithstanding any other law, a health care entity is |
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not liable for damages related to charges on the entity's charge |
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list in an action under Chapter 15 or 17, Business & Commerce Code. |
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Sec. 185.012. FREE MARKET PROTECTIONS. This chapter does |
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not authorize a governmental agency or other government-created |
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entity to approve, disapprove, or limit a health care entity's: |
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(1) charge for a health care service, good, or |
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procedure; or |
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(2) change to any charge. |
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SECTION 2. Sections 185.008(a)-(g), Health and Safety Code, |
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as added by this Act, apply only to conduct that occurs on or after |
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January 1, 2022. |
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SECTION 3. This Act takes effect September 1, 2021. |