By: Hancock	S.B. No. 481
	(In the Senate - Filed February 6, 2015; February 10, 2015,
	read first time and referred to Committee on Business and Commerce;
	March 31, 2015, reported favorably by the following vote:  Yeas 6,
	Nays 1; March 31, 2015, sent to printer.)
Click here to see the committee vote

	A BILL TO BE ENTITLED
	AN ACT
	relating to notice and availability of mediation for balance
	billing by a facility-based physician.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Section 324.001(8), Health and Safety Code, is
	amended to read as follows:
	(8)  "Facility-based physician" means a radiologist,
	an anesthesiologist, a pathologist, an emergency department
	physician, [or] a neonatologist, or an assistant surgeon.
	SECTION 2.  Section 1456.001(3), Insurance Code, is amended
	to read as follows:
	(3)  "Facility-based physician" means a radiologist,
	an anesthesiologist, a pathologist, an emergency department
	physician, [or] a neonatologist, or an assistant surgeon:
	(A)  to whom the facility has granted clinical
	privileges; and
	(B)  who provides services to patients of the
	facility under those clinical privileges.
	SECTION 3.  Section 1456.004(c), Insurance Code, is amended
	to read as follows:
	(c)  A facility-based physician who bills a patient covered
	by a preferred provider benefit plan or a health benefit plan under
	Chapter 1551 that does not have a contract with the facility-based
	physician shall send a billing statement to the patient that
	contains a conspicuous, plain-language explanation [with
	information sufficient to notify the patient] of the mandatory
	mediation process available under Chapter 1467 if [the amount for
	which] the enrollee is responsible to the physician, after
	copayments, deductibles, and coinsurance, for an [including the]
	amount unpaid by the administrator or insurer[, is greater than
	$1,000].
	SECTION 4.  Section 1467.001(4), Insurance Code, is amended
	to read as follows:
	(4)  "Facility-based physician" means a radiologist,
	an anesthesiologist, a pathologist, an emergency department
	physician, [or] a neonatologist, or an assistant surgeon:
	(A)  to whom the facility has granted clinical
	privileges; and
	(B)  who provides services to patients of the
	facility under those clinical privileges.
	SECTION 5.  Section 1467.051(a), Insurance Code, is amended
	to read as follows:
	(a)  An enrollee may request mediation of a settlement of an
	out-of-network health benefit claim if:
	(1)  [the amount for which] the enrollee is responsible
	to a facility-based physician, after copayments, deductibles, and
	coinsurance, for an [including the] amount unpaid by the
	administrator or insurer[, is greater than $1,000]; and
	(2)  the health benefit claim is for a medical service
	or supply provided by a facility-based physician in a hospital that
	is a preferred provider or that has a contract with the
	administrator.
	SECTION 6.  Sections 1456.004(c) and 1467.051(a), Insurance
	Code, as amended by this Act, apply only to charges for a medical
	service or supply provided on or after the effective date of this
	Act. Charges for a medical service or supply provided before the
	effective date of this Act are governed by the law as it existed
	immediately before the effective date of this Act, and that law is
	continued in effect for that purpose.
	SECTION 7.  This Act takes effect September 1, 2015.
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