HB2556 - Relating to certain health care transaction fees and payment claims; providing an administrative penalty.

  89R23495 MPF-F     By: Frank H.B. No. 2556     Substitute the following for H.B. No. 2556:     By:  VanDeaver C.S.H.B. No. 2556       A BILL TO BE ENTITLED   AN ACT   relating to certain health care transaction fees and payment   claims; providing an administrative penalty.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle G, Title 4, Health and Safety Code, is   amended by adding Chapter 328 to read as follows:   CHAPTER 328. FACILITY FEES           Sec. 328.001.  DEFINITIONS. In this chapter:                 (1)     "Commission" means the Health and Human Services   Commission.                 (2)     "Executive commissioner" means the executive   commissioner of the commission.                 (3)     "Facility fee" means a fee a health care provider   charges to compensate the health care provider for operational,   administrative, or management expenses that is separate from a fee   a health care provider charges in relation to professional medical   services provided by a physician, including a membership fee,   subscription fee, or other administrative fee.   The term does not   include a direct fee, as that term is defined by Section 162.251,   Occupations Code, charged by an independent physician or physician   group for providing direct primary care, as that term is defined by   that section.                 (4)     "Health care provider" means a hospital system,   hospital, provider-based outpatient facility, or other health care   facility, including:                       (A)     a designee or affiliate of a health care   facility;                       (B)     an entity that facilitates the provision of   or that provides health care services and that is owned or operated   by or affiliated with a health insurance company;                       (C)     a health care facility that is owned or   operated by or affiliated with a private equity fund; or                       (D)     a physician or physician group that is owned,   operated, or managed by or affiliated with a corporation.                 (5)  "Health care provider campus" means:                       (A)  the main buildings of a health care provider;                       (B)     the physical area immediately adjacent to the   main buildings and other areas or structures not contiguous to the   main buildings but located not more than 250 yards from the main   buildings; and                       (C)     any other area the Centers for Medicare and   Medicaid Services determine to be a health care provider campus.                 (6)     "Hospital" has the meaning assigned by Section   241.003.                 (7)     "Hospital-owned facility" means a clinic or other   facility that provides health care services and:                       (A)     is owned or operated by, in whole or in part,   a hospital; and                       (B)     is not located on the hospital's health care   provider campus.                 (8)     "Independent physician or physician group" means a   physician practice or physician group that is not employed, owned,   operated, or managed by or affiliated with a health care provider.                 (9)     "National provider identifier" means a national   provider identifier number, as that term is defined by Section   532.0152, Government Code.                 (10)     "Place of service code" means a two-digit code   maintained by the Centers for Medicare and Medicaid Services or an   alphanumeric indicator that is placed on a health care provider's   or independent physician or physician group's claim for   reimbursement or payment to indicate the setting in which a health   care service was provided.                 (11)     "Provider-based outpatient facility" means a   facility a health care provider owns or operates, wholly or partly,   where outpatient health care services and supplies are provided.                 (12)     "Telehealth service" and "telemedicine medical   service" have the meanings assigned by Section 111.001, Occupations   Code, except the terms do not include a telehealth service or   telemedicine medical service provided by a hospital or   provider-based outpatient facility to a patient physically located   at the hospital or provider-based outpatient facility at the time   the service is provided.                 (13)     "Third party payor" means an insurance company,   health benefit plan sponsor, health benefit plan issuer, or entity   other than a patient or health care provider that pays for health   care services and supplies provided to a patient.           Sec.   328.002.     PROHIBITED FACILITY FEES. A health care   provider may not charge a facility fee for telehealth services or   telemedicine medical services.           Sec.   328.003.     REQUIRED PLACE OF SERVICE CODE.   A health care   provider shall include a valid place of service code for the setting   where a health care service was provided on each claim for   reimbursement submitted for the health care service provided by the   provider.           Sec.   328.004.     REQUIRED NATIONAL PROVIDER IDENTIFIER. (a)     On or after January 1, 2031, a health care provider required or   eligible to obtain a national provider identifier under federal law   shall apply for and obtain a national provider identifier for:                 (1)  the provider;                 (2)     each provider-based outpatient facility the   health care provider owns or manages or with which the health care   provider is otherwise affiliated; and                 (3)     if the provider is a hospital, each hospital-owned   facility.           (b)  This section expires September 1, 2029.           Sec.   328.005.     NOTICE OF FACILITY FEE. (a) A health care   provider shall provide to a patient written notice of a facility fee   charged for a health care service or supply provided to the patient   at:                 (1)     if the provider is a hospital, a hospital-owned   facility; or                 (2)  a provider-based outpatient facility that:                       (A)     is at a location other than the health care   provider campus;                       (B)     provides services organizationally and   functionally integrated with the provider; and                       (C)     provides outpatient preventative health   services, diagnostic health services, treatment services, or   emergency care.           (b)     Except as provided by Subsection (c), the written notice   required under Subsection (a) must be provided to the patient not   later than the 10th day before the date scheduled for provision of   the health care service or supply or in accordance with Section   324.101 or 45 C.F.R. Section 149.610, as applicable.           (c)     A health care provider shall provide the written notice   required under Subsection (a) on the date the health care service or   supply is provided if the provision of the health care service or   supply is scheduled less than 10 days before that date or in   accordance with Section 324.101 or 45 C.F.R. Section 149.610, as   applicable.           (d)     The written notice required under Subsection (a) must   include:                 (1)     the amount of the facility fee or, if the exact   health care service or supply to be provided is not known, an   explanation that the patient may incur a cost-share or coinsurance   expense that would not occur if the service or supply is provided by   an independent physician or physician group;                 (2)  the purpose of the facility fee; and                 (3)     if the third party payor of a patient's health   benefit plan provides the information to a health care provider   before the date the notice is required, information on whether the   health benefit plan covers the facility fee.           (e)     Before a health care provider may begin charging a   facility fee for provision of a health care service or supply at a   newly built provider-based outpatient facility, at a   provider-based outpatient facility or hospital-owned facility that   did not previously charge a facility fee, or for a health care   service or supply that did not previously include a facility fee   charge, the provider must notify all contracted third party payors   of the provider's intent to begin charging facility fees not later   than the   90th day before the date the provider begins charging the   facility fee.           (f)     A health care provider may not charge a patient or third   party payor a facility fee at a provider-based outpatient facility   or hospital-owned facility unless the provider provides notice as   required by this section.           Sec.   328.006.     ENFORCEMENT. (a) The commission or   appropriate state regulatory authority with jurisdiction over a   health care provider shall assess an administrative penalty in an   amount not to exceed $1,000 for each violation against a health care   provider that violates this chapter or a rule adopted under this   chapter.           (b)     This section does not create a private cause of action   against a provider for legal or equitable relief.           Sec.   328.007.     RULES. (a)   The executive commissioner may   adopt rules to implement this chapter.           (b)     The executive head of a state regulatory authority with   jurisdiction over a health care provider may adopt rules regarding   the duties of a health care provider under this chapter and   disciplinary action to be taken against a health care provider that   violates this chapter.          SECTION 2.  (a)  In this section, "third party payor" and   "independent physician or physician group" have the meanings   assigned by Section 328.001, Health and Safety Code, as added by   this Act.          (b)  The University of Texas Health Science Center at   Houston, using the Texas All Payor Claims Database established   under Subchapter I, Chapter 38, Insurance Code, and in cooperation   with the Health and Human Services Commission and the Department of   State Health Services, shall conduct a study on health care   facility fees charged in this state.          (c)  The study must include:        [Text truncated for display. 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