HB3321 - Relating to certain health care entity or system transaction fees and payment claims; providing administrative and civil penalties.

  89R6051 MPF-D     By: Oliverson H.B. No. 3321       A BILL TO BE ENTITLED   AN ACT   relating to certain health care entity or system transaction fees   and payment claims; providing administrative and civil penalties.          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. HEALTH CARE ENTITY AND HEALTH CARE SYSTEM TRANSACTION   FEES AND PAYMENT CLAIMS   SUBCHAPTER A. GENERAL PROVISIONS           Sec. 328.001.  DEFINITIONS. In this chapter:                 (1)  "Affiliate" means a person who is:                       (A)     employed by a hospital or health care system;   or                       (B)     under a professional services agreement,   faculty agreement, or management agreement with a hospital or   health care system that authorizes the hospital or health care   system to bill on behalf of the person.                 (2)     "Campus" means, with respect to a health care   entity:                       (A)     the entity's main buildings for providing   health care services;                       (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)     another area the Centers for Medicare and   Medicaid Services determines is a campus of a health care entity.                 (3)     "Commission" means the Health and Human Services   Commission.                 (4)     "Enrollee" means an individual who is covered   under a health benefit plan, including a multiple employer welfare   arrangement. The term does not include an individual who is covered   under a limited benefit plan, accident plan, indemnity plan,   limited scope dental or vision plan, or short-term limited-duration   insurance policy governed by Chapter 1509, Insurance Code.                 (5)     "Executive commissioner" means the executive   commissioner of the commission.                 (6)     "Facility fee" means a fee a health care entity or   health care system charges for outpatient health care services that   is:                       (A)     intended to compensate the entity or system   for operational expenses; and                       (B)     separate from a fee the entity or system   charges for professional health care services.                 (7)     "Freestanding emergency medical care facility"   has the meaning assigned by Section 254.001.                 (8)     "Health benefit plan issuer" means an insurer,   health maintenance organization, or other entity authorized to   provide health benefits coverage under the laws of this state.                 (9)     "Health care entity" means a group, professional   corporation, or other entity that provides health care services.   The term includes a hospital, medical clinic, medical group, home   health care agency, health infusion clinic, urgent care clinic, and   freestanding emergency medical care facility.                 (10)     "Health care system" means a system of health   care entities in this state that are under the common governance or   control of a corporate parent.                 (11)     "Hospital" means a health care facility licensed   under Chapter 241. The term includes a general hospital and special   hospital.                 (12)     "National provider identifier" means the   national provider identifier described by 45 C.F.R. Section   162.406.           Sec.   328.002.     RULES. The executive commissioner shall   adopt rules to implement this chapter.   SUBCHAPTER B. FACILITY FEES FOR CERTAIN HEALTH CARE SERVICES           Sec.   328.051.     PROHIBITED FACILITY FEES. A health care   entity or health care system may not charge a facility fee for:                 (1)     health care services provided at a location   outside of a campus associated with the entity or system; and                 (2)     outpatient health care services classified by a   Current Procedural Terminology code as performance of an evaluation   and management procedure, regardless of whether the services are   provided at a campus.           Sec.   328.052.     FACILITY FEE NOTICE FOR EXISTING AFFILIATES.   (a) This section applies only to a health care entity that is an   affiliate of or owned by a hospital or health care system and that   charges a facility fee.           (b)  A health care entity subject to this section shall:                 (1)  provide to a patient written notice:                       (A)     at the time a health care service appointment   is scheduled and before delivering the service:                             (i)     that the entity may charge a facility   fee; and                             (ii)     of the cost range of a potential   facility fee; and                       (B)     at the time a health care service appointment   is scheduled regarding:                             (i)     available complaint procedures for   improper billing;                             (ii)     available programs for eligible   patients to receive free or reduced cost health care services; and                             (iii)     the facility fee waiver process   authorized by Section 328.054; and                 (2)  post a sign that states:                       (A)     the entity may charge a facility fee in   addition to the cost for the health care service;                       (B)     the location within the entity's facility at   which the health care services are provided where a patient may   inquire about the entity's facility fees;                       (C)     the address of the entity's Internet webpage   that provides information about the entity's facility fees; and                       (D)     a toll-free telephone number available to the   patient that provides information about the entity's facility fees.           (c)  The sign required by Subsection (b)(2) must be:                 (1)     posted prominently and conspicuously at each   location in the health care entity's facility where health care   services are provided and for which a facility fee is charged and at   the location where an individual registers or checks in for the   services;                 (2)     posted in English and the 15 other foreign   languages most commonly spoken in this state; and                 (3)     available in an alternative format for individuals   with a disability who require an auxiliary aid for communication.           (d)     A health care entity that requests payment from a   patient after providing a health care service for which a facility   fee is charged shall submit with the payment request the written,   itemized bill required by Section 185.002 that also includes:                 (1)     a specific notation of the facility fee charge;   and                 (2)     contact information for the entity representative   through which the patient may appeal the facility fee charge.           (e)     A health care entity shall, to the extent practicable,   provide the notice required by Subsection (b)(1) and the itemized   billing information required by Subsection (d) to the patient in   the patient's preferred language and in plain language.           Sec.   328.053.     FACILITY FEE NOTICE FOR AFFILIATES. (a) A   health care entity shall, on becoming an affiliate of a hospital or   health care system, provide written notice to any patient who   received health care services from the entity in the 12 months   preceding the date the facility became an affiliate of:                 (1)     the name, address, and telephone number of the   affiliated hospital or system;                 (2)     the date on which the entity may begin charging a   facility fee for the affiliated hospital or system;                 (3)     the prohibition on the entity charging a patient a   facility fee for the affiliated hospital or system before the date   described by Subdivision (2); and                 (4)     the patient's opportunity to contact the patient's   health benefit plan issuer for additional information regarding a   facility fee, including the patient's financial responsibility for   the facility fee.           (b)     A health care entity and the affiliated hospital or   health care system may not charge a patient a facility fee for a   health care service provided before the 30th day after the date the   entity provides the notice required by Subsection (a).           Sec.   328.054.     FACILITY FEE WAIVER PROCESS. (a) Each health   care entity and health care system that charges a facility fee shall   develop a process by which a patient may apply for a waiver to   wholly or partly reduce the costs of the facility fee. The process   must provide a patient:                 (1)     a period of not less than 30 days for the patient   to apply for the waiver that begins the day after the date the   patient receives the notice described by Section 328.052(b)(1); and                 (2)     information on the waiver process in the patient's   preferred language and with any auxiliary aid necessary for the   patient to complete the process.           (b)     Each health care entity and health care system that   charges facility fees shall provide waivers described by Subsect [Text truncated for display. Full text available on Congress.gov.]