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A BILL TO BE ENTITLED
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AN ACT
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relating to restrictions on the use of credit card payments to |
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settle claims for health care services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. (a) The legislature finds and declares that |
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this Act is necessary to: |
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(1) remove barriers that hinder physicians and other |
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health care providers from exercising their right to receive |
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payments, upon request, from health plans through Health Insurance |
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Portability and Accountability Act-standard automated |
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clearinghouse electronic fund transfers; |
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(2) eliminate unnecessary and excessive fees imposed |
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on physicians and other health care providers by certain licensees |
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and their contracted vendors who use credit card payments, rather |
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than automated clearinghouse electronic fund transfer payments, to |
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settle claims for health care services; and |
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(3) eliminate the unnecessary administrative hassle |
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that licensee use of credit card payments in the settlement of |
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claims for health care services imposes on physicians and other |
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health care providers. |
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(b) The legislature finds and declares that: |
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(1) despite the potential benefits associated with |
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electronic funds transfer payments, many physicians and other |
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health care providers are being subjected to fees associated with |
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credit card payments that essentially: |
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(A) reduce the contracted fee amounts of |
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physicians and other health care providers; and |
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(B) shift the costs of transferring money |
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electronically from the licensee to the physician or other health |
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care provider; |
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(2) physicians and other health care providers are |
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often unaware of these high fees when accepting credit card |
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payments from licensees and their contracted vendors; |
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(3) physicians and other health care providers also |
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are often unaware: |
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(A) of their right to receive, upon request, |
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Health Insurance Portability and Accountability Act-standard |
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automated clearinghouse electronic fund transfer payments from |
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health plans; and |
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(B) that the only fee that should be assessed in |
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association with an automated clearinghouse electronic fund |
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transfer payment is a nominal banking fee; |
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(4) licensees often receive cash-back incentives from |
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credit card companies for credit card payment transactions; |
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(5) the use of virtual credit cards for payment is an |
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administrative hassle in that it requires the staff of physicians |
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and other health care providers to manually enter payments into |
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their own credit card processing system or devote staff time to |
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write or call the licensee to assert the right to be paid by |
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automated clearinghouse electronic fund transfer; and |
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(6) unlike payments made by patients using credit |
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cards, credit card payments made by licensees or their contracted |
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vendors do not offer significant risk reduction for physicians and |
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other health care providers, but nonetheless carry increased |
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processing charges. |
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SECTION 2. Subtitle C, Title 5, Insurance Code, is amended |
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by adding Chapter 564 to read as follows: |
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CHAPTER 564. PROHIBITED PRACTICES RELATED TO PAYMENT FOR |
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HEALTH CARE SERVICES |
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Sec. 564.001. CERTAIN CREDIT CARD PAYMENTS PROHIBITED. |
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(a) In this section: |
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(1) "Administrator" has the meaning assigned by |
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Section 4151.001. Notwithstanding that section or any other law, |
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the term includes: |
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(A) a joint fund, risk management pool, or |
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self-insurance pool composed of political subdivisions of this |
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state that participate in a fund or pool through interlocal |
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agreements, any nonprofit administrative agency or governing body |
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or other nonprofit entity that acts solely on behalf of a fund, |
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pool, agency, or body, or any other fund, pool, agency, or body |
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established under or for the purpose of implementing an interlocal |
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governmental agreement; and |
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(B) a self-insured political subdivision. |
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(2) "Credit card payment" means a type of electronic |
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funds transfer by which a licensee or a contracted vendor of a |
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licensee sends credit card payment information and instructions |
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through or on any medium to the health care provider, who then |
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processes the payments using standard credit card technology. The |
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term includes a virtual credit card payment. |
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(3) "Health care provider" means any person, |
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partnership, professional association, corporation, facility, or |
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institution duly licensed, certified, registered, or chartered by |
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this state to provide health care services, including: |
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(A) a physician; |
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(B) an officer, director, shareholder, member, |
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partner, manager, owner, or affiliate of a physician or other |
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health care provider; and |
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(C) an employee, independent contractor, or |
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agent of a physician or other health care provider acting in the |
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course and scope of the employment or contractual relationship. |
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(4) "Health care services" means services provided to |
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an individual to prevent, alleviate, cure, or heal human illness or |
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injury, including: |
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(A) pharmaceutical services; |
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(B) medical, chiropractic, or dental care |
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services; |
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(C) hospitalization; and |
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(D) care or services incidental to the health |
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care services described by Paragraphs (A)-(C). |
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(5) "Licensee" means: |
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(A) an insurer as defined by Section 1301.001; |
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(B) a health maintenance organization as defined |
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by Section 843.002; |
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(C) a person required to register under Section |
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1458.051; |
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(D) an administrator; |
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(E) an officer, director, shareholder, member, |
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partner, manager, owner, or affiliate of a licensee described by |
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Paragraphs (A)-(D); and |
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(F) an employee, independent contractor, or |
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agent of a licensee described by Paragraphs (A)-(D) acting in the |
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course and scope of the employment or contractual relationship. |
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(6) "Physician" means: |
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(A) an individual licensed to practice medicine |
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in this state; |
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(B) a professional association organized by an |
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individual physician or group of physicians; |
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(C) a partnership or limited liability |
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partnership formed by a group of physicians; |
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(D) a nonprofit health corporation certified by |
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the Texas Medical Board under Chapter 162, Occupations Code; |
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(E) a limited liability company formed by a group |
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of physicians; or |
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(F) a single legal entity authorized to practice |
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medicine owned by a group of physicians. |
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(7) "Virtual credit card payment" means a credit card |
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payment for which no physical credit card is presented to the health |
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care provider and the single-use credit card expires upon payment |
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processing. |
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(b) A licensee or contracted vendor of a licensee may not |
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use a credit card payment to settle a claim for health care services |
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with a health care provider. |
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(c) The provisions in this section may not be waived, |
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voided, nullified, or modified by contract. |
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(d) Nothing in this section may be construed to prohibit: |
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(1) the use of an automated clearinghouse electronic |
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funds transfer to settle a claim for health care services with a |
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health care provider; |
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(2) the use of a credit card to settle a claim for |
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health care services with a health care provider, if the payment |
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using a credit card is made: |
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(A) directly by the patient; or |
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(B) by an individual on behalf of the patient for |
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the purpose of paying the patient's out-of-pocket |
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responsibilities; or |
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(3) the use of a flexible spending account or health |
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savings account, without regard to whether a credit card is issued |
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to the patient under the account. |
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SECTION 3. The change in law made by this Act applies only |
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to charges for health care services provided on or after the |
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effective date of this Act. Charges for health care services |
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provided before the effective date of this Act are governed by the |
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law in effect immediately before that date, and that law is |
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continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2015. |