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A BILL TO BE ENTITLED
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AN ACT
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relating to disclosure of the price charged by a health care |
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provider for a health care service or supply; providing penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. This Act may be cited as the Texas Health Care |
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Pricing Disclosure Act. |
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SECTION 2. The heading to Subchapter H, Chapter 101, |
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Occupations Code, is amended to read as follows: |
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SUBCHAPTER H. BILLING AND PRICING INFORMATION |
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SECTION 3. Subchapter H, Chapter 101, Occupations Code, is |
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amended by adding Section 101.3515 to read as follows: |
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Sec. 101.3515. PRICING INFORMATION. (a) In this section: |
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(1) "Bundled health care services and supplies" means |
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for pricing purposes the grouping of multiple health care services |
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and supplies provided by a health care provider to a patient during |
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one visit to or treatment by the provider. |
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(2) "Health care price" means the total amount of |
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compensation a health care provider accepts as payment in full for a |
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health care service or supply or bundled health care services and |
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supplies provided to a patient. |
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(3) "Health care provider" means: |
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(A) a health care professional who performs a |
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health care service or provides a health care supply in this state |
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under a license, certificate, registration, or other authority |
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issued by this state to diagnose, prevent, alleviate, or cure a |
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human illness or injury, including a physician and dentist; |
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(B) a health care facility that provides a health |
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care service or supply in this state under a license, certificate, |
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registration, or other authority issued by this state to diagnose, |
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prevent, alleviate, or cure a human illness or injury, including an |
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institutional health care provider; or |
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(C) a person that provides to patients in this |
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state ancillary health care-related services and supplies under a |
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license, certificate, or registration issued by this state, or that |
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is otherwise authorized to provide to patients in this state |
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ancillary health care-related services and supplies ordered or |
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authorized by a licensed health care professional, to diagnose, |
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prevent, alleviate, or cure a human illness or injury, including |
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laboratory services, radiological services, and durable medical |
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equipment. |
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(b) Each health care provider shall compile a pricing |
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information list that lists the prices of certain frequently |
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performed services. A health care facility that provides inpatient |
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care shall list the prices for the 25 most frequently performed |
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procedures of each department in the facility based on the 25 most |
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frequently coded Diagnosis-Related Groups codes for that |
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department. A health care facility that provides outpatient care |
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shall list the prices for the 25 most frequently performed |
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procedures of each department in the facility based on the 25 most |
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frequently coded Ambulatory Payment Classification codes for that |
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department. A physician or other practitioner shall list the |
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prices for the 10 most frequently performed procedures of the |
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physician or other practitioner based on the 10 most frequently |
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coded Current Procedural Terminology codes. |
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(c) The health care provider may choose to disclose its |
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prices under Subsection (b) in either of the following formats: |
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(1) the prices of each health care service and each |
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health care supply; or |
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(2) the prices of each set of bundled health care |
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services and supplies. |
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(d) For each service in the pricing information list under |
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Subsection (b), a health care provider shall disclose: |
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(1) the highest charge the patient can expect to pay; |
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and |
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(2) the lowest discounted charge accepted for that |
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service from a payor. |
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(e) A health care provider shall make the provider's pricing |
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information list under Subsection (b) available to the public in |
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the form and manner determined by the provider. |
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(f) This section does not apply to a health care price of a |
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health care service or supply or bundled health care services and |
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supplies provided to: |
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(1) a patient for whom a health care provider has |
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accepted assignment for the health care service or supply from |
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Medicaid or Medicare or any other federal, state, or local |
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government-sponsored medical assistance program; or |
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(2) a financially or medically indigent person who |
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qualifies for indigent health care services based on: |
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(A) a sliding fee scale; or |
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(B) a health care provider's written charity care |
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policy. |
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(g) Each health care provider shall: |
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(1) compile a pricing information list under |
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Subsection (b); |
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(2) post on the provider's Internet website or |
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otherwise make public the pricing information list and the |
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effective date of the list before providing a health care service or |
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supply or bundled health care services and supplies to a patient; |
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and |
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(3) not less than 30 days before changing the health |
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care price of a health care service or supply or bundled health care |
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services and supplies provided by the provider to the patient, |
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provide notice of the price change by posting the notice on the |
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provider's Internet website or by another method of publication or |
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dissemination that the provider uses for the list. |
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(h) A health care provider may not: |
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(1) charge an amount that is different from the amount |
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listed as the health care price in the pricing information list |
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under Subsection (b) for a health care service or supply or bundled |
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health care services and supplies provided to a patient; or |
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(2) include a discount, bonus, fee, or other charge |
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that changes the health care price listed in the pricing |
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information list under Subsection (b). |
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(i) Notwithstanding Subsection (h), a health care provider |
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may accept or negotiate a payment that is less than the health care |
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price listed in the pricing information list under Subsection (b) |
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from an individual patient. A health care provider may not accept |
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or negotiate a payment that is less than the health care price |
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listed in the pricing information list under Subsection (b) from a |
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third party payor. |
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(j) A health care provider that violates this section is |
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subject to an administrative penalty, a civil penalty, or other |
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disciplinary action, as applicable, in the same manner as if the |
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provider violated the law under which the provider is licensed, |
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certified, registered, or authorized. |
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SECTION 4. Notwithstanding Section 101.3515, Occupations |
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Code, as added by this Act, a health care provider is not required |
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to comply with the change in law made by that section until |
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September 1, 2014. |
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SECTION 5. This Act takes effect September 1, 2013. |