HBA-ATS, RBT H.B. 213 76(R)BILL ANALYSIS


Office of House Bill AnalysisH.B. 213
By: Hochberg
Civil Practices
6/3/1999
Enrolled

   
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.  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.  DEFINITIONS.  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.