Hughes Price Estimates Bill Also Wipes Out Subchapter B

The text as introduced · 712 words

89R2858 MCF-F

By: Hughes
S.B. No. 1219

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.