HBA-RBT, RBT C.S.H.B. 213 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 213 By: Hochberg Civil Practices 3/22/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Some insurance companies will only pay medical bills within predetermined time limits. However, medical providers do not always bill the insurance company within the insurance company's time limits. Consequently, patients receive bills that the insurance company refuses to pay because the insurance company maintains the provider did not submit the claim within the specified amount of time. C.S.H.B. 213 limits the amount that a health care provider may recover from a patient to what the patient would have paid if the bill had been sent on time. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Title 6, Civil Practice and Remedies Code, by adding Chapter 146, as follows: CHAPTER 146. CERTAIN CLAIMS BY HEALTH CARE SERVICE PROVIDERS BARRED Sec. 146.001. DEFINITION. Defines "health benefit plan" and "health care service provider." Sec. 146.002. TIMELY BILLING REQUIRED. (a) Requires a health care service provider to bill a responsible party on or before the first day of the 11th month after the date services are rendered. (b) Sets forth the time deadlines for the health care service provider to bill the issuer of the health benefit plan (plan), if required or authorized to directly bill the issuer of a plan for services provided to a patient. (c) Sets forth the time deadlines for the health care service provider to bill a third party payor operating under federal or state law, including Medicare and the state Medicaid program. (d) Establishes the date of billing under this section. Sec. 146.003. CERTAIN CLAIMS BARRED. Prohibits a health care service provider who violates Section 146.002 from recovering from a patient, or any other individual who because of a family or other personal relationship with the patient would otherwise be responsible for the bill, any amount that the patient would have been entitled to receive under a plan or that the patient would not otherwise have been obligated to pay had the provider complied with Section 146.002. Sec. 146.004. DISCIPLINARY ACTION NOT AUTHORIZED. Provides that a health care service provider who violates this chapter is not subject to disciplinary action for the violation under any other law, including the law under which the health care service provider is licensed or otherwise holds a grant of authority. SECTION 2. Effective date: September 1, 1999. SECTION 3. Makes application of this Act prospective. SECTION 4. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE In SECTION 1, the substitute differs from the original by adding to Section 146.002, new Subsections (b) and (c) to provide exceptions to the timely billing requirements set out in Subsection (a), and by adding new Subsection (d) establishing the date of billing. The substitute also modifies the original by changing proposed Section 146.003 to specify that a health care provider who violates Section 146.002 is prohibited from recovering any amount that a patient would not have been obligated to pay if the provider had complied with Section 146.002, and also to specify that in such an instance the provider is also barred from recovering from a person who might be responsible for a patient's debt due to a familial or other personal relationship. The substitute adds Section 146.004, which establishes that a health care service provider who violates Chapter 146 is not subject to disciplinary action for the violation under any other law.