Bill Text: TX HB705 | 2011-2012 | 82nd Legislature | Introduced
Bill Title: Relating to certain prohibited practices concerning the payment of copayments and deductibles under health benefit plans; providing a civil penalty and for injunctive relief.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2011-04-26 - Left pending in committee [HB705 Detail]
Download: Texas-2011-HB705-Introduced.html
82R901 TRH-F | ||
By: J. Davis of Harris | H.B. No. 705 |
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relating to certain prohibited practices concerning the payment of | ||
copayments and deductibles under health benefit plans; providing a | ||
civil penalty and for injunctive relief. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. The heading to Chapter 552, Insurance Code, is | ||
amended to read as follows: | ||
CHAPTER 552. ILLEGAL PRICING AND PAYMENT PRACTICES | ||
SECTION 2. Sections 552.001, 552.002, and 552.003, | ||
Insurance Code, are designated as Subchapter A, Chapter 552, | ||
Insurance Code, and a heading is added to Subchapter A to read as | ||
follows: | ||
SUBCHAPTER A. ILLEGAL PRICING PRACTICES | ||
SECTION 3. Section 552.001, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 552.001. APPLICABILITY OF SUBCHAPTER [ |
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This subchapter [ |
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health care service to a: | ||
(1) Medicaid or Medicare patient or a patient who is | ||
covered by a federal, state, or local government-sponsored indigent | ||
health care program; | ||
(2) financially or medically indigent person who | ||
qualifies for indigent health care services based on: | ||
(A) a sliding fee scale; or | ||
(B) a written charity care policy established by | ||
a health care provider; or | ||
(3) person who is not covered by a health insurance | ||
policy or other health benefit plan that provides benefits for the | ||
services and qualifies for services for the uninsured based on a | ||
written policy established by a health care provider. | ||
(b) This subchapter [ |
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establishment of health care provider policies or contracts that | ||
violate any other state or federal law. | ||
(c) This subchapter [ |
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care provider from entering into a contract to provide services | ||
covered by a health insurance policy or other health benefit plan | ||
with: | ||
(1) the issuer of the health insurance policy or other | ||
health benefit plan; or | ||
(2) a preferred provider organization that contracts | ||
with the issuer of the health insurance policy or other health | ||
benefit plan. | ||
SECTION 4. Chapter 552, Insurance Code, is amended by | ||
adding Subchapter B to read as follows: | ||
SUBCHAPTER B. ILLEGAL PAYMENT PRACTICES | ||
Sec. 552.051. DEFINITIONS. In this subchapter: | ||
(1) "Enrollee" means an individual entitled to | ||
coverage under a health benefit plan. | ||
(2) "Health benefit plan" means a plan that provides | ||
benefits for hospital, medical, surgical, or other treatment | ||
expenses incurred as a result of a health condition, an accident, or | ||
sickness, including an individual, group, blanket, or franchise | ||
health insurance policy or insurance agreement, a group hospital | ||
service contract, an individual or group evidence of coverage, or | ||
any other similar coverage document. The term includes a | ||
self-funded plan that is otherwise described by this subdivision. | ||
(3) "Health care provider" means an individual or | ||
entity that is licensed or otherwise authorized to provide health | ||
care services or supplies in this state. The term includes: | ||
(A) an individual licensed under or otherwise | ||
subject to Title 3, Occupations Code; and | ||
(B) a public or private entity licensed under | ||
Subtitle B, Title 4, or Subtitle C, Title 7, Health and Safety Code. | ||
Sec. 552.052. DUTY TO COLLECT COPAYMENT OR DEDUCTIBLE; | ||
CERTAIN WAIVERS PROHIBITED. (a) Except as provided by Subsection | ||
(b), a health care provider: | ||
(1) shall make a good faith effort to collect any | ||
applicable copayment or deductible from each enrollee in a health | ||
benefit plan; and | ||
(2) based on an enrollee's coverage under a health | ||
benefit plan, may not waive, in cash or in kind, all or part of any | ||
applicable copayment or deductible under the health benefit plan to | ||
induce or encourage the enrollee to purchase, order, use, or lease | ||
any facility, service, or supply. | ||
(b) A health care provider may waive any applicable | ||
copayment or deductible for an enrollee if the enrollee | ||
demonstrates special financial need or hardship. | ||
Sec. 552.053. CIVIL PENALTY; INJUNCTION. (a) If it | ||
appears that an individual or entity has violated or is violating | ||
this subchapter, a district or county attorney in the jurisdiction | ||
where the violation is alleged to have occurred or may occur may | ||
institute a civil suit for: | ||
(1) an order enjoining the violation; | ||
(2) a permanent or temporary injunction, a temporary | ||
restraining order, or other appropriate remedy if the district or | ||
county attorney shows that the individual or entity has engaged in | ||
or is engaging in a violation; | ||
(3) the assessment and recovery of a civil penalty; or | ||
(4) both injunctive relief and a civil penalty. | ||
(b) A civil penalty may not exceed $25,000 a day for each | ||
violation. Each day the violation occurs constitutes a separate | ||
violation for the purposes of the assessment of a civil penalty. | ||
(c) In determining the amount of the civil penalty, the | ||
court hearing the matter shall consider: | ||
(1) the individual's or entity's history of previous | ||
violations; | ||
(2) the seriousness of the violation; | ||
(3) the hazard to the health and safety of the public; | ||
(4) the demonstrated good faith of the individual or | ||
entity charged; and | ||
(5) any other matter that justice may require. | ||
(d) A civil penalty recovered in a suit instituted by a | ||
local government under this subchapter shall be paid to the local | ||
government. | ||
(e) The district or county attorney, as appropriate, may | ||
recover, on behalf of the local government, reasonable expenses | ||
incurred in obtaining injunctive relief or a civil penalty under | ||
this section, including investigation and court costs, reasonable | ||
attorney's fees, witness fees, and other expenses. | ||
SECTION 5. The change in law made by this Act applies only | ||
to a health benefit plan copayment or deductible relating to a | ||
facility, service, or supply provided by a health care provider on | ||
or after the effective date of this Act. A health benefit plan | ||
copayment or deductible relating to a facility, service, or supply | ||
provided before the effective date of this Act is covered by the law | ||
in effect on the date the facility, service, or supply is provided, | ||
and that law is continued in effect for that purpose. | ||
SECTION 6. This Act takes effect September 1, 2011. |