88R12345 LRM-F

By: Klick H.B. No. 3218

A BILL TO BE ENTITLED

AN ACT

relating to price estimates and billing requirements for certain health care facilities.

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

SECTION 1. Section 324.001, Health and Safety Code, is amended by adding Subdivision (5-a) to read as follows:

(5-a) "Estimate" means a written statement outlining a consumer's total expected billed charges for a nonemergency elective medical service or procedure.

SECTION 2. Section 324.101, Health and Safety Code, is amended by amending Subsections (d) and (g) and adding Subsection (d-1) to read as follows:

(d) A consumer who presents to a [The] facility a valid medical order [shall provide an estimate of the facility's charges] for any elective inpatient admission or nonemergency outpatient surgical procedure or other service is entitled to receive on request and before the scheduling of the admission, [or] procedure, or service an estimate of the facility's charges for the admission, procedure, or service. Not later than 24 hours after receiving a request for an estimate under this subsection, the facility shall provide the [The] estimate to the requesting consumer by e-mail [must be provided not later than the 10th business day after the date on which the estimate is requested]. The facility must advise the consumer that:

(1) the request for an estimate of billed charges may result in a delay in the scheduling and provision of the inpatient admission, outpatient surgical procedure, or other service;

(2) the actual charges for an inpatient admission, outpatient surgical procedure, or other service will vary based on the person's medical condition and other factors associated with performance of the procedure or service;

(3) the actual charges for an inpatient admission, outpatient surgical procedure, or other service may differ from the amount to be paid by the consumer or the consumer's third-party payor;

(4) the consumer may be personally liable for payment for the inpatient admission, outpatient surgical procedure, or other service depending on the consumer's health benefit plan coverage; and

(5) the consumer should contact the consumer's health benefit plan for accurate information regarding the plan structure, benefit coverage, deductibles, copayments, coinsurance, and other plan provisions that may impact the consumer's liability for payment for the inpatient admission, outpatient surgical procedure, or other service.

(d-1) A facility's final billed charges may not exceed the amount specified in an estimate by more than five percent unless the additional charges are related to complications that arose during the procedure or service or as a result of a change of diagnosis that is documented in the patient's chart. If the final billed charges exceed the amount specified in an estimate by more than five percent, the facility shall provide to the patient a written statement describing:

(1) the difference in the billed charge amount and the estimate amount; and

(2) the complications or change of diagnosis that resulted in the difference.

(g) A facility that violates [in violation of] this section:

(1) may not:

(A) collect or take any collection action against a consumer;

(B) report the consumer to a credit bureau; or

(C) pursue an action against the consumer; and

(2) is subject to an enforcement action by the appropriate licensing agency.

SECTION 3. Subchapter B, Chapter 324, Health and Safety Code, is repealed.

SECTION 4. The changes in law made to Chapter 324, Health and Safety Code, apply only to a request for an estimate made on or after the effective date of this Act. A request for an estimate made before the effective date of this Act is governed by the law in effect at the time the request was made, and the former law is continued in effect for that purpose.

SECTION 5. This Act takes effect September 1, 2023.