Bill Text: TX HB2556 | 2025-2026 | 89th Legislature | Introduced
Bill Title: Relating to certain health care transaction fees and payment claims and inclusion of a national provider identifier on a payment claim; providing an administrative penalty.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced) 2025-02-06 - Filed [HB2556 Detail]
Download: Texas-2025-HB2556-Introduced.html
| 89R5574 MPF-F | ||
| By: Frank | H.B. No. 2556 | |
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| relating to certain health care transaction fees and payment claims | ||
| and inclusion of a national provider identifier on a payment claim; | ||
| 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 that is: | ||
| (A) intended to compensate the health care | ||
| provider for operational expenses; and | ||
| (B) separate from a fee a health care provider | ||
| charges for professional medical services provided in a | ||
| provider-based facility. | ||
| (4) "Health care provider" means a hospital system, | ||
| hospital, provider-based facility, or other health care facility, | ||
| including a designee or affiliate of the facility. | ||
| (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) "National provider identifier" means the national | ||
| provider identifier described by 45 C.F.R. Part 162. | ||
| (8) "Preventative health services" means the | ||
| preventive health services described by 42 U.S.C. Section 300gg-13. | ||
| (9) "Provider-based facility" means a facility a | ||
| health care provider owns or operates, wholly or partly, where | ||
| health care services and supplies are provided. | ||
| (10) "Telehealth service" and "telemedicine medical | ||
| service" have the meanings assigned by Section 111.001, Occupations | ||
| Code. | ||
| (11) "Third party payor" means an insurance company, | ||
| health benefit plan sponsor, 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: | ||
| (1) telehealth services or telemedicine medical | ||
| services; or | ||
| (2) preventative health services. | ||
| Sec. 328.003. REQUIRED NATIONAL PROVIDER IDENTIFIER. 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; and | ||
| (2) each provider-based facility the health care | ||
| provider owns or manages or with which the health care provider is | ||
| otherwise affiliated. | ||
| Sec. 328.004. INCLUSION OF NATIONAL PROVIDER IDENTIFIER ON | ||
| HEALTH CARE PROVIDER CLAIM. (a) A health care provider or | ||
| provider-based facility required to obtain a unique national | ||
| provider identifier under Section 328.003 shall include the | ||
| national provider identifier of the facility where the health care | ||
| services and supplies were provided on each claim for reimbursement | ||
| or payment, including any facility fee charged, for the provided | ||
| health care services or supplies. | ||
| (b) A health care provider or provider-based facility | ||
| required to obtain a unique national provider identifier may charge | ||
| a facility fee for providing health care services or supplies only | ||
| if the claim for reimbursement or payment for the services or | ||
| supplies includes the national provider identifier of the facility | ||
| where the services or supplies were provided. | ||
| Sec. 328.005. PROHIBITED REIMBURSEMENT. A health benefit | ||
| plan issuer or third party payor may not pay a facility fee charge | ||
| on a health care provider's claim for reimbursement for provided | ||
| health care services or supplies unless the claim includes the | ||
| unique national provider identifier for the facility where the | ||
| health care services or supplies were provided. | ||
| Sec. 328.006. 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 a provider-based facility that: | ||
| (1) is at a location other than the health care | ||
| provider campus; | ||
| (2) provides services organizationally and | ||
| functionally integrated with the provider; and | ||
| (3) 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. | ||
| (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. | ||
| (d) The written notice required under Subsection (a) must | ||
| include: | ||
| (1) the amount of the facility fee; | ||
| (2) the purpose of the facility fee; and | ||
| (3) information on whether a patient's 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 facility, at a provider-based 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 health benefit plan | ||
| issuers and third party payors of the provider's intent to begin | ||
| charging facility fees at the facility or for the service or supply. | ||
| (f) A health care provider may not charge a patient a | ||
| facility fee at a provider-based facility or for a health care | ||
| service or supply unless the provider provides notice as required | ||
| by this section. | ||
| Sec. 328.007. ENFORCEMENT. (a) The commission shall | ||
| assess an administrative penalty in an amount not to exceed $1,000 | ||
| 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. 328.008. RULES. The executive commissioner may adopt | ||
| rules to implement this chapter. | ||
| SECTION 2. (a) Except as provided by Subsection (b) of this | ||
| section, this Act takes effect September 1, 2025. | ||
| (b) Section 328.005, Health and Safety Code, as added by | ||
| this Act, takes effect January 1, 2026. | ||
