|
|
|
|
AN ACT
|
|
relating to consumer information concerning facility-based |
|
physicians and 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, including the amount |
|
unpaid by the administrator or insurer, is greater than $500 |
|
[$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, including the amount unpaid by the administrator or |
|
insurer, is greater than $500 [$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. |
|
|
|
|
|
|
|
|
______________________________ |
______________________________ |
|
President of the Senate |
Speaker of the House |
|
|
I hereby certify that S.B. No. 481 passed the Senate on |
|
April 9, 2015, by the following vote: Yeas 28, Nays 3; and that |
|
the Senate concurred in House amendment on May 22, 2015, by the |
|
following vote: Yeas 29, Nays 2. |
|
|
|
|
______________________________ |
|
Secretary of the Senate |
|
|
I hereby certify that S.B. No. 481 passed the House, with |
|
amendment, on May 18, 2015, by the following vote: Yeas 137, |
|
Nays 1, one present not voting. |
|
|
|
|
______________________________ |
|
Chief Clerk of the House |
|
|
|
|
|
Approved: |
|
|
|
______________________________ |
|
Date |
|
|
|
|
|
______________________________ |
|
Governor |