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A BILL TO BE ENTITLED
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AN ACT
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relating to disclosure of certain health care costs. |
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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. HEALTH CARE PRICE DISCLOSURES |
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CHAPTER 185. HEALTH CARE PRICE DISCLOSURES |
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Sec. 185.001. DEFINITIONS. In this chapter: |
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(1) "Facility" means a hospital, outpatient clinic, |
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birthing center, ambulatory surgical center, or other licensed |
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facility providing health care services. The term does not include |
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an emergency clinic, a freestanding emergency medical care |
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facility, or other facility providing only emergency care. |
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(2) "Patient" includes a prospective patient and a |
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personal representative of the patient. |
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(3) "Practitioner" means an individual who is licensed |
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to provide and provides medical or other health care services in |
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this state. |
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Sec. 185.002. PRICE DISCLOSURE OR ESTIMATE. (a) Before |
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providing a nonemergency health care service offered to the patient |
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by the facility or practitioner, a facility or practitioner shall |
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provide a price disclosure described by Subsection (b) or an |
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estimate described by Subsection (c) unless declined by the |
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patient. |
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(b) Except as provided by Subsection (c), a facility or |
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practitioner required to provide a price disclosure under |
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Subsection (a) shall disclose to the patient the amount, including |
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facility fees, that: |
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(1) the patient's health benefit plan will reimburse |
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the facility or practitioner for the service, if the facility or |
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practitioner is a participating provider under the patient's health |
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benefit plan; or |
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(2) the facility or practitioner will charge for the |
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service, if the facility or practitioner is not a participating |
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provider under the patient's health benefit plan. |
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(c) If a facility or practitioner is unable to quote a |
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specific amount under Subsection (b) because of the facility's or |
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practitioner's inability to predict the specific service the |
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patient will need, the facility or practitioner shall provide an |
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estimate of the amount, including facility fees, that: |
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(1) the patient's health benefit plan will reimburse |
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the facility or practitioner for the predicted service, if the |
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facility or practitioner is a participating provider under the |
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patient's health benefit plan; or |
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(2) the facility or practitioner will charge for the |
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predicted service, if the facility or practitioner is not a |
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participating provider under the patient's health benefit plan. |
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(d) A facility or practitioner that provides an estimate |
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described by Subsection (c) shall: |
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(1) disclose the incomplete nature of the estimate; |
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and |
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(2) inform the patient that the facility or |
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practitioner may be able to provide an updated estimate after the |
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facility or practitioner obtains additional information. |
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(e) Notwithstanding any other law, a facility or |
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practitioner that does not provide the price disclosure or estimate |
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required by this section before providing a health care service for |
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which the price disclosure or estimate is required may not bill the |
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patient or the patient's health benefit plan for the service. |
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Sec. 185.003. EFFECT OF OTHER LAW. A facility that provides |
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an estimate under Section 324.101(d) is not relieved of the |
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obligation to provide a price disclosure or estimate under Section |
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185.002. |
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Sec. 185.004. PATIENT INFORMATION. On request, a facility |
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or practitioner shall provide a patient with sufficient information |
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about a proposed nonemergency health care service to enable the |
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patient to determine the amount of the patient's personal liability |
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by using the patient's health benefit plan's toll-free telephone |
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number or Internet website. The facility or practitioner shall |
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provide the information to the patient based on the information |
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available to the facility or practitioner at the time of the |
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request. The facility or practitioner may assist the patient in |
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using the telephone number or website. |
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SECTION 2. Section 324.101, Health and Safety Code, is |
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amended by adding Subsection (d-1) and amending Subsection (e) to |
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read as follows: |
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(d-1) A facility that provides a price disclosure or |
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estimate under Section 185.002 is not relieved of the obligation to |
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provide an estimate under Subsection (d). |
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(e) A facility shall provide to the consumer at the |
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consumer's request an itemized statement in plain language of the |
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billed services if the consumer requests the statement not later |
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than the first anniversary of the date the person is discharged from |
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the facility. The facility shall provide the statement to the |
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consumer not later than the 10th business day after the date on |
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which the statement is requested. |
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SECTION 3. Chapter 185, Health and Safety Code, as added by |
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this Act, and Section 324.101(e), Health and Safety Code, as |
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amended by this Act, apply only to a service provided by a facility |
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or practitioner on or after January 1, 2024. A service provided |
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before January 1, 2024, is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2023. |