Rehmet Bill Bars Hospital Facility Fees On Telehealth Visits

The text as introduced · 1,574 words

90R4420 AB-D

By: Rehmet
S.B. No. 259

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 330 to read as follows:

CHAPTER 330. FACILITY FEES

Sec. 330.001. 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. The term:

(A) includes a membership fee, subscription fee,

or other administrative fee; and

(B) does not include a direct fee, as that term is

defined by Section 117.001, Occupations Code, charged by an

independent physician or physician group for providing direct

patient 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 provides health care services and that is owned or operated by or

affiliated with a health insurance company;

(C) a health care facility owned or operated by

or affiliated with a private equity fund; or

(D) a physician or physician group 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 wholly or partly owned or operated by 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) "Place of service code" means a two-digit code

maintained by the Centers for Medicare and Medicaid Services or an

alphanumeric indicator 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.

(10) "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.

(11) "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 a hospital or provider-based

outpatient facility provided to a patient physically located at the

hospital or provider-based outpatient facility at the time the

service is provided.

(12) "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. 330.002. PROHIBITED FACILITY FEES. A health care

provider may not charge a facility fee for telehealth services or

telemedicine medical services.

Sec. 330.003. 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 the provider

provided.

Sec. 330.004. 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 unless 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. 330.005. 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. 330.006. 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, "independent physician or

physician group" and "third party payor" have the meanings assigned

by Section 330.001, 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:

(1) a description by third party payor type of a

patient's cost-sharing obligation for health care facility fees;

(2) a comparison, in the aggregate, of the cost of

health care services provided by health care professionals

affiliated with a health system and independent physicians or

physician groups, including a comparison of the charges for

professional fees when a health care facility fee is included in a

patient's statement of charges; and

(3) a comparison, in the aggregate, of any trends in

total spending and a patient's cost-sharing obligation for specific

health care services, including those services reported using a

Current Procedural Terminology code as performance of an evaluation

and management procedure, for claims for reimbursement submitted by

an individual health care provider or a health care facility.

(d) Not later than December 1, 2028, The University of Texas

Health Science Center at Houston shall submit to the legislature a

written report on the findings of the study conducted under this

section.

(e) This section expires September 1, 2029.

SECTION 3. The University of Texas Health Science Center at

Houston is required to conduct the study and make the report

required by Section 2 of this Act only if the legislature

appropriates money specifically for that purpose. If the

legislature does not appropriate money specifically for that

purpose, the center may, but is not required to, implement those

requirements using other money available to the center for that

purpose.

SECTION 4. (a) Except as provided by Subsection (b) of this

section, this Act takes effect September 1, 2027.

(b) Section 330.004, Health and Safety Code, as added by

this Act, takes effect January 1, 2028.