HB251 - Relating to price estimates and billing requirements for certain health care facilities.

  89R2858 MCF-F     By: Harris Davila H.B. No. 251       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   the total amount a facility will accept as payment in full,   inclusive of all payment sources, 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 Subsections   (d-1) and (d-2) 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 from the facility .   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 in person, by e-mail, or through an online patient portal,   as chosen by the consumer [ 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 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 the estimate provided under Subsection (d) by   more than five percent unless the additional charges are:                 (1)     related to complications arising during the   procedure or service and not reasonably avoidable in provision of   the procedure or service by the medical provider while exercising   reasonable medical judgment; or                 (2)     as a result of a change of diagnosis not   discoverable before the procedure or service and documented in the   patient's chart.           (d-2)     If the final billed charges exceed the amount   specified in an estimate provided under Subsection (d) by more than   five percent, the facility must provide to the patient a written   statement describing:                 (1)     the difference in the final billed amount and the   estimate amount; and                 (2)     a plain-language explanation describing 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 or other financially responsible party;                       (B)  report the consumer to a credit bureau; or                       (C)  pursue an action against the consumer; and                 (2)   is subject to 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, 2025.