HB 321 — A health care provider's offer

90R1413 KRM/SCL-D By: Oliverson H.B. No. 321 relating to a health care provider's offer and disclosure to patients of a discounted cash price.

SECTION 1. Chapter 185, Health and Safety Code, is amended by adding Subchapter A, and a heading is added to that subchapter to read as follows: SUBCHAPTER A. ITEMIZED BILLING

SECTION 2. Section 185.001, Health and Safety Code, is transferred to Subchapter A, Chapter 185, Health and Safety Code, as added by this Act, and amended to read as follows: Sec. 185.001. DEFINITIONS. In this subchapter [ chapter ]: (1) "Debt collection" has the meaning assigned by Section 392.001, Finance Code. (2) "Health care provider" means a facility licensed, certified, or otherwise authorized to provide health care services or supplies in this state in the ordinary course of business, including a hospital, except the term does not include a federally-qualified health center, as defined by 42 U.S.C. Section 1396d(l)(2)(B). (3) "Health care service" means a service a health care provider provides to an individual to diagnose, prevent, treat, alleviate, cure, or heal a human health condition, illness, injury, or disease.

SECTION 3. Section 185.002, Health and Safety Code, is transferred to Subchapter A, Chapter 185, Health and Safety Code, as added by this Act.

SECTION 4. Section 185.003, Health and Safety Code, is transferred to Subchapter A, Chapter 185, Health and Safety Code, as added by this Act, and amended to read as follows: Sec. 185.003. DISCIPLINARY ACTION BY LICENSING AUTHORITY. (a) The appropriate licensing authority shall take disciplinary action against a health care provider that violates this subchapter [ chapter ] as if the provider violated an applicable licensing law. (b) Subsection (a) does not apply to a health care provider that in good faith mails a hard copy of an itemized bill to a patient if: (1) the mailed copy is returned as undeliverable or lost; or (2) the address on file for the patient was not current at the time the itemized bill was mailed.

SECTION 5. Chapter 185, Health and Safety Code, is amended by adding Subchapter B to read as follows: SUBCHAPTER B. DISCOUNTED CASH PRICE Sec. 185.051. DEFINITIONS. In this subchapter: (1) "Discounted cash price" means the price charged to an individual who pays cash or a cash equivalent for a health care service or supply. (2) "Health care provider" means a health care practitioner or health care facility that provides health care services or supplies under a license, certificate, registration, or similar authorization issued by this state. (3) "Health care service" has the meaning assigned by Section 185.001. Sec. 185.052. REQUIRED OFFER AND DISCLOSURE. A health care provider that provides at a discounted cash price a health care service or supply to a patient who is without health benefit plan coverage shall for each other patient to whom the provider provides the service or supply: (1) offer the same discounted cash price for the service or supply, regardless of the other patient's health benefit plan coverage; and (2) disclose in writing the discounted cash price for the service or supply. Sec. 185.053. ENFORCEMENT. The appropriate state regulatory authority shall suspend or revoke the license, certificate, registration, or other authorization of a health care provider that violates this subchapter as if the provider violated an applicable regulatory law.

SECTION 6. Subtitle F, Title 8, Insurance Code, is amended by adding Chapter 1459 to read as follows: CHAPTER 1459. LIMITATIONS ON PROVIDER CONTRACTS Sec. 1459.001. DEFINITIONS. In this chapter: (1) "Discounted cash price" means the price charged to an individual who pays cash or a cash equivalent for a health care service or supply. (2) "Health care provider" means a health care practitioner or health care facility that provides health care services or supplies under a license, certificate, registration, or similar authorization issued by this state. Sec. 1459.002. APPLICABILITY OF CHAPTER. (a) This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is issued by: (1) an insurance company; (2) a group hospital service corporation operating under Chapter 842; (3) a health maintenance organization operating under Chapter 843; (4) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; (5) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; (6) a stipulated premium company operating under Chapter 884; (7) a fraternal benefit society operating under Chapter 885; (8) a Lloyd's plan operating under Chapter 941; or (9) an exchange operating under Chapter 942. (b) Notwithstanding any other law, this chapter applies to: (1) a basic coverage plan under Chapter 1551; (2) a basic plan under Chapter 1575; (3) a primary care coverage plan under Chapter 1579; (4) a plan providing basic coverage under Chapter 1601; (5) the state Medicaid program, including the Medicaid managed care program operated under Chapter 540, Government Code; (6) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code; (7) county employee group health benefits provided under Chapter 157, Local Government Code; and (8) health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code. Sec. 1459.003. PROHIBITED CONTRACT PROVISION ON DISCOUNTED CASH PRICE. A contract between a health benefit plan issuer and a health care provider may not contain a provision that prohibits the provider from offering and disclosing to a patient a discounted cash price in accordance with Section 185.052, Health and Safety Code.

SECTION 7. If before implementing any provision of this Act a state agency determines that a waiver or authorization from a federal agency is necessary for implementation of that provision, the agency affected by the provision shall request the waiver or authorization and may delay implementing that provision until the waiver or authorization is granted.

SECTION 8. As soon as practicable after the effective date of this Act, the executive commissioner of the Health and Human Services Commission shall adopt the rules necessary to implement Subchapter B, Chapter 185, Health and Safety Code, as added by this Act.

SECTION 9. Chapter 1459, Insurance Code, as added by this Act, applies only to a contract between a health benefit plan issuer and health care provider entered into or renewed on or after the effective date of this Act.

SECTION 10. This Act takes effect September 1, 2027.