Oliverson Bill Gives Insured Patients The Same Discounted Cash Price

The text as introduced · 1,110 words

90R1413 KRM/SCL-D

By: Oliverson
H.B. No. 321

A BILL TO BE ENTITLED

AN ACT

relating to a health care provider's offer and disclosure to

patients of a discounted cash price.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 185, Health and Safety Code, is amended

by adding Subchapter A, and a heading is added to that subchapter to

read as follows:

SUBCHAPTER A. ITEMIZED BILLING

SECTION 2. Section 185.001, Health and Safety Code, is

transferred to Subchapter A, Chapter 185, Health and Safety Code,

as added by this Act, and amended to read as follows:

Sec. 185.001. DEFINITIONS. In this subchapter [ chapter ]:

(1) "Debt collection" has the meaning assigned by

Section 392.001, Finance Code.

(2) "Health care provider" means a facility licensed,

certified, or otherwise authorized to provide health care services

or supplies in this state in the ordinary course of business,

including a hospital, except the term does not include a

federally-qualified health center, as defined by 42 U.S.C. Section

1396d(l)(2)(B).

(3) "Health care service" means a service a health

care provider provides to an individual to diagnose, prevent,

treat, alleviate, cure, or heal a human health condition, illness,

injury, or disease.

SECTION 3. Section 185.002, Health and Safety Code, is

transferred to Subchapter A, Chapter 185, Health and Safety Code,

as added by this Act.

SECTION 4. Section 185.003, Health and Safety Code, is

transferred to Subchapter A, Chapter 185, Health and Safety Code,

as added by this Act, and amended to read as follows:

Sec. 185.003. DISCIPLINARY ACTION BY LICENSING AUTHORITY.

(a) The appropriate licensing authority shall take disciplinary

action against a health care provider that violates this subchapter

[ chapter ] as if the provider violated an applicable licensing law.

(b) Subsection (a) does not apply to a health care provider

that in good faith mails a hard copy of an itemized bill to a patient

if:

(1) the mailed copy is returned as undeliverable or

lost; or

(2) the address on file for the patient was not current

at the time the itemized bill was mailed.

SECTION 5. Chapter 185, Health and Safety Code, is amended

by adding Subchapter B to read as follows:

SUBCHAPTER B. DISCOUNTED CASH PRICE

Sec. 185.051. DEFINITIONS. In this subchapter:

(1) "Discounted cash price" means the price charged to

an individual who pays cash or a cash equivalent for a health care

service or supply.

(2) "Health care provider" means a health care

practitioner or health care facility that provides health care

services or supplies under a license, certificate, registration, or

similar authorization issued by this state.

(3) "Health care service" has the meaning assigned by

Section 185.001.

Sec. 185.052. REQUIRED OFFER AND DISCLOSURE. A health care

provider that provides at a discounted cash price a health care

service or supply to a patient who is without health benefit plan

coverage shall for each other patient to whom the provider provides

the service or supply:

(1) offer the same discounted cash price for the

service or supply, regardless of the other patient's health benefit

plan coverage; and

(2) disclose in writing the discounted cash price for

the service or supply.

Sec. 185.053. ENFORCEMENT. The appropriate state

regulatory authority shall suspend or revoke the license,

certificate, registration, or other authorization of a health care

provider that violates this subchapter as if the provider violated

an applicable regulatory law.

SECTION 6. Subtitle F, Title 8, Insurance Code, is amended

by adding Chapter 1459 to read as follows:

CHAPTER 1459. LIMITATIONS ON PROVIDER CONTRACTS

Sec. 1459.001. DEFINITIONS. In this chapter:

(1) "Discounted cash price" means the price charged to

an individual who pays cash or a cash equivalent for a health care

service or supply.

(2) "Health care provider" means a health care

practitioner or health care facility that provides health care

services or supplies under a license, certificate, registration, or

similar authorization issued by this state.

Sec. 1459.002. APPLICABILITY OF CHAPTER. (a) This chapter

applies only to a health benefit plan that provides benefits for

medical or surgical expenses incurred as a result of a health

condition, accident, or sickness, including an individual, group,

blanket, or franchise insurance policy or insurance agreement, a

group hospital service contract, or an individual or group evidence

of coverage or similar coverage document that is issued by:

(1) an insurance company;

(2) a group hospital service corporation operating

under Chapter 842;

(3) a health maintenance organization operating under

Chapter 843;

(4) an approved nonprofit health corporation that

holds a certificate of authority under Chapter 844;

(5) a multiple employer welfare arrangement that holds

a certificate of authority under Chapter 846;

(6) a stipulated premium company operating under

Chapter 884;

(7) a fraternal benefit society operating under

Chapter 885;

(8) a Lloyd's plan operating under Chapter 941; or

(9) an exchange operating under Chapter 942.

(b) Notwithstanding any other law, this chapter applies to:

(1) a basic coverage plan under Chapter 1551;

(2) a basic plan under Chapter 1575;

(3) a primary care coverage plan under Chapter 1579;

(4) a plan providing basic coverage under Chapter

1601;

(5) the state Medicaid program, including the Medicaid

managed care program operated under Chapter 540, Government Code;

(6) a self-funded health benefit plan sponsored by a

professional employer organization under Chapter 91, Labor Code;

(7) county employee group health benefits provided

under Chapter 157, Local Government Code; and

(8) health and accident coverage provided by a risk

pool created under Chapter 172, Local Government Code.

Sec. 1459.003. PROHIBITED CONTRACT PROVISION ON DISCOUNTED

CASH PRICE. A contract between a health benefit plan issuer and a

health care provider may not contain a provision that prohibits the

provider from offering and disclosing to a patient a discounted

cash price in accordance with Section 185.052, Health and Safety

Code.

SECTION 7. If before implementing any provision of this Act

a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 8. As soon as practicable after the effective date

of this Act, the executive commissioner of the Health and Human

Services Commission shall adopt the rules necessary to implement

Subchapter B, Chapter 185, Health and Safety Code, as added by this

Act.

SECTION 9. Chapter 1459, Insurance Code, as added by this

Act, applies only to a contract between a health benefit plan issuer

and health care provider entered into or renewed on or after the

effective date of this Act.

SECTION 10. This Act takes effect September 1, 2027.