The following is an analysis of health care bills signed into law by Governor Rick Perry. Specifically, these bills are of interest to hospitals and medical practices. In addition, bills that failed to pass have been included as well. They will probably make an appearance in the 2011 Texas Legislature.
Insurance Issues -Signed Into Law:
HB 2256 (Hancock) - Relating to requirements between physicians, hospitals, and health benefit plans. The bill became the "negotiated" balance billing bill. A health plan enrollee may request mediation of a settlement of an out-of-network health benefit claim if the enrollee is responsible to the facility-based physician for more than $1,000 and if 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 contractor with the plan administrator.
Except in the case of an emergency, a facility-based physician shall, prior to a service, provide a complete disclosure that explains that the facility-based physician does not have a contract with the health plan, disclose projected amounts for which the enrollee might be responsible and discloses the circumstances under which the enrollee would be responsible. As a result of disclosing this, the facility-based physician will not be required to mediate a billed charge if the amount billed is less than or equal to the maximum amount projected in this disclosure.
"Facility-based physician" refers to a radiologist, an anesthesiologist, a pathologist, an emergency department physician or a neonatologist. Each facility must develop, implement and enforce written policies for the billing of facility health care services and supplies. The policy must address: any discounting of facility charges to an uninsured patient, any discounting of facility charges provided to a financial or medically indigent patient, the providing of an itemized statement (whether interest will be applied to any billed service not covered by a third-party payor), the procedure for handling complaints and the providing of a conspicuous written disclosure to a consumer at the time they are first admitted to a facility.
HB 1342 (Menendez) - It requires a health insurance company to have information concerning co-payment, deductibles and covered plans and services available in a real-time manner. In addition, a provider that receives an overpayment from an enrollee must refund it within 30 days of when that overpayment was officially identified.
HB 389 (John Zerwas) - Clarifies the definition of a "medical group."
HB 1888 (John Davis) - Relating to standards required for certain rankings of physicians by health benefit plans. The bill would prohibit health plans from ranking physicians unless the plan uses standards prescribed by the TDI Commissioner in conformance with nationally recognized standards.
Nursing Issues - Signed Into Law
SB 476 (Jane Nelson) - SB 476, which will prohibit mandatory overtime for hospital nurses, will go into law on September 1, 2009. This does not prevent nurses from working voluntary overtime. In addition, there are exceptions for emergencies. Texas will now join Pennsylvania in banning mandatory overtime.
As you may remember, this bill competed against a bill that was endorsed by a California nursing union. The union bill did not make it out of a committee hearing.
Scope of Practice/Facility Issues - Signed Into Law
HB 643 (John Zerwas) - Regarding surgical technologists. All surgical technologists hired after September 1, 2009 must complete an accredited educational program for surgical technologists and hold and maintain certification as a surgical technologist by: the National Board of Surgical Technology and Surgical Assisting, the National Center for Competency Testing or another surgical technologist certification program approved by the program. Or the person can complete an appropriate training program for surgical technology in the U.S. Military or U.S. Public Health Service. All of those who were employed prior to September 1, 2009 or are in the service of the federal government will be grandfathered.
SB 911 (Tommy Williams) - Relating to the certification and regulation of pain management clinics. Hospitals and clinics owned and operated by a physician who treats patients within the physician's area of specialty and who uses other forms of treatment, including surgery, with the issuance of a prescription for the majority of the patients are exempted. This act will require pain management clinics that don't meet the exemptions to obtain a certificate from the state. The owner/operator must be on-site at the clinic at least 33 percent of the clinic's total number of operating hours and review at least 33 percent of the total number of patient files of the clinic.
SB 532 (Dan Patrick) - Amends a physician's delegation of prescriptive authority to physician assistants or advanced practice nurses.
HB 1357 - (Carl Isett) - Regulation of freestanding emergency departments.
Health IT (Medicaid) - Signed Into Law
HB 1218 (Donna Howard) - Relating to programs to exchange certain health information between the Health and Human Services Commission and certain health care entities and facilities.
HB 1996 (John Davis) - Relating to an e-prescribing implementation plan under the Medicaid and child health plan programs.
Reporting Requirements/Data Collection - Signed Into Law
HB 1362 (Gutierrez) - Amends the 2007 MRSA registry pilot program that tracks MRSA infections in Bexar, Brazos, Potter, and Randall counties. The extension will allow the San Antonio Metropolitan Health District to continue tracking these infections.
SB 203 (Shapleigh) - Relating to the reporting of MRSA infection rates in general hospitals (pediatric hospitals have different requirements). Requires a general hospital to report to DSHS the incidence of surgical site infections, including the causative pathogen if the infection is laboratory-confirmed, occurring in certain procedures. It amends SB 288 (from the 2007 Legislature) that handled HAI. SB 203 will require hospitals to report each HAI adverse condition for which the Medicare program will not provide additional payment and also includes adverse events identified by the National Quality Forum. In addition, it changes the HAI advisory panel.
Other Hospital Issues - Signed Into Law
HB 2585 (Will Hartnett) - Updates the state's advance medical directives laws by stating that electronic and digital signatures are acceptable (this was not completely clear in the past).
SB 2577 (Mike Jackson) - Requires the board of trustees of the Employee Retirement System of Texas to develop a cost-neutral or cost-positive plan for providing bariatric surgery coverage to eligible employees. Stakeholders and the Employees Retirement System of Texas have been meeting about this issue for the past two years.
Insurance Issues - Did Not Pass:
HB 223 (Eiland)/SB 714 (Van de Putte) - Relating to regulation of the secondary market in certain physician and health care provider discounts.
HB 531 (Anchia) - Relating to medical loss ratios of certain health benefit plan issuers. The bill would require health plans to report their medical loss ratios and set minimums requiring rebates to the insureds.
SB 863 (Harris) - Relating to adoption of certain information technology. The bill would take a step toward real-time claims adjudication by the health plans.
HB 1369 (Rodriguez) - Relating to unfair claim settlement practices by an insurer that issues a preferred provider benefit plan. The bill would set the out-of-network provider's billed charges as the amount the PPO must use to computer out-of-network co-insurance.
HB 1370 (Rodriguez) - Relating to the use of certain insurance policy forms in connection with a PPO plan. The bill would create a DTPA cause of action against the health plan that does not use the out-of-network billed charge to calculate the co-insurance amounts.
HB 1442 (Hancock)/SB 586 (Carona) - Relating to the operation of certain managed care plans regarding out-of-network health care providers. The bill would prohibit health plans from removing or otherwise punishing in-network physicians for referring their patients to out-of-network providers.
HB 2431 (Todd Smith) - Relating to mediation of out-of-network health benefit claim disputes between enrollees and health benefit plan issuers. This is the "model bill" for dispute resolutions regarding balance billing.
SB 1007 (Hegar) - The Texas Department of Insurance (TDI) sunset bill failed to pass. Instead, a temporary extension was passed during a special session. The sunset bill will be taken up again in a few years.
HB 1929 (Jim Jackson) - Relating to payment of claims of certain out-of-network physicians and health care providers. The bill punishes the out-of-network provider by limiting their out-of-network payment to the health plan's in-network rates if the enrollee has made a "reasonable" effort to find an in-network provider.
HB 1930 (Jim Jackson) - Relating to health services provided to health benefit plan enrollees by certain out-of-network health care providers. The bill punishes the out-of-network by banning balance billing if the referring provider does not give the patient notice of the out-of-network provider's out-of-network status and have the patient sign a document in which the patient states that they know the out-of-network provider is out-of-network and agrees to pay the out-of-network provider the balance bill. This measure was opposed by most medical groups.
SB 351 (Shapleigh) - Relating to payment of certain emergency room physicians for services provided to enrollees of managed care health benefit plans. The bill would ban balance billing in ER situations. This measure was opposed by most medical groups.
Integrated Care Models/"Evidence-Based Medicine" - Did Not Pass:
SB 10 (Robert Duncan) - This bill would authorize the board of trustees of the Employees Retirement System of Texas to establish one or more pilot programs that would resemble a physician-hospital organization (PHO). The pilot program would be established in at least one region and reimburse the state health insurance plan with an alternative model that focuses on "quality-based" reimbursement. The pilot program would have been located in Lubbock.
SB 7 - Nelson - Senator Jane Nelson's bill includes 10 elements that she believes would improve Texas health care. Although the bill failed, several items, such as the HAI reporting, were amended to other bills that were signed into law. Among the sections that would be of interest to hospitals:
· Uncompensated hospital care data - Increased hospital and state reporting requirements regarding uncompensated care.
· A quality-based reimbursement program for Medicaid.
· "Preventable events" reporting - Additional measures would be added to the current Health-Care Associated Infection Reporting System (which should receive funding for enforcement this Legislature). "Never events" would not be reimbursed under the state's Medicaid program.
Uncompensated Care/Charity Care - Did Not Pass:
HB 3473 (Garnet Coleman) - Relating to charity care requirements by for-profit hospitals. The bill would require for-profit hospitals that receive tax abatements to provide charity care or government-sponsored indigent health care. A hospital that qualifies would be required to provide charity care in an amount equal to at least five percent of the hospital's gross patient revenue, and government-sponsored indigent health care in an amount equal to at least four percent of the hospital's gross patient revenue.
SB 2278 (Rodney Ellis) -Relating to charity care. The bill would require a hospital to report total gross revenue, including: Medicare gross revenue, Medicaid gross revenue, other revenue from state programs, revenue from local governments, local tax support, charitable contributions, other third party payments, gross inpatient revenue, and gross outpatient revenue. Hospitals would also have to report DSH payment revenue, UPL payment revenue, tobacco settlement proceeds, federal grant funding, charity care, bad debt expenses. In addition, they would have to report total admissions, including: Medicare admissions, Medicaid admissions, admissions under a local government program, charity care admissions, any other type of admission, total discharges, total patient days, average length of stay, total outpatient visits, total assets, total liabilities, estimates of unreimbursed costs of unreimbursed costs of services reported separately (emergency and trauma care, neonatal intensive care, free-standing community clinics, collaborative efforts with local government or private agencies in preventive medicine), donations, total costs of reimbursed and unreimbursed research, education of faculty, and community health education through informational programs and publications. Also, the hospital would have to submit its charge description master or charge master.
The bill would require hospitals electing to provide charity or government-sponsored indigent health care make sure that the charity care and community benefits are provided in a combined amount equal to or at least 10 percent of the hospital's or hospital system's net patient revenue, provided that charity care and government-sponsored indigent health care are provided in an amount equal to at least eight percent of net patient revenue.
Scope of Practice/Facility Issues - Did Not Pass:
HB 2028 (John Zerwas)/SB 2427 (Bob Deuell) - Regarding the delegation of cosmetic and certain dermatological treatments. Only a physician or a physician may delegate to a qualified physician assistant: the administration of botulinum toxin injections, administration of dermal fillers, cosmetic or aesthetic medical treatments or the use of a laser or intense pulsed light device that is a prescriptive device.
Facility Issues - Did Not Pass
HB 3749 (Coleman) - Relating to itemized statements provided by certain health care facilities. The bill would require facilities to itemize their billing statements with regards to medical devices and drugs.
Nursing Issues - Did Not Pass
HB 1489 (Senfronia Thompson) - Relating to the practice of nursing; providing civil penalties. This bill is supported by the National Nurses Organizing Committee and establishes a mandatory nurse to patient ratio. This is similar to the nursing laws in California.
Ownership/Imaging - Did Not Pass
HB 2279 (Thompson) - Relating to the provision of and billing for certain diagnostic imaging services. The bill would create new burdens on physician imagers and new billing requirements.
HB 2259 (Thompson)/SB 1461 (Duncan) - Relating to the registration of diagnostic imaging equipment, the accreditation of diagnostic imaging facilities, and the regulation of diagnostic imaging providers. The bill would require a burdensome and costly (a) registration of MRI, CT, and PET and (b) reporting of patient referrals and study.
Health IT (Medicaid) - Did Not Pass
SB 288 (Jane Nelson)-Relating to the review of a Medicaid recipient's electronic medication history by a Medicaid provider.
SB 289 (Jane Nelson) - Relating to ensuring that health information technology used in the medical assistance and child health plan programs conforms to certain standards.
SB 286 (Jane Nelson) - Also referred to as the "Medicaid Health Passport."
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