SB 1264 by Sen. Kelly Hancock is a revolutionary bill that will end the practice of sending patients surprise medical bills in Texas. Thanks to this bill, Texas now has one of the strongest patient protection laws in the country when it comes to surprise billing.
Ends surprise billing by out-of-network doctors and facilities when patients have little or no choice over who provides their care. Specifically:
When patients are treated by out-of-network providers in an emergency.
When patients are treated by out-of-network providers at an in-network facility.
Removes patients from the middle of the payment dispute resolution process between health care providers and insurers.
Ensures patients will only be responsible for their applicable co-pay, coinsurance or deductible payments from the first medical bill.
SB 1037 by Sen. Larry Taylor adds an additional surprise billing protection this year. Texas patients will no longer have to worry about whether surprise medical bills from out-of-network emergency or facility-based providers will negatively impact their credit score.
Protects consumers’ credit scores from being affected by surprise medical bills when they have little or no choice over who provides their care.
Prohibits consumer reporting agencies from including medical debt (excluding applicable co-pays, coinsurance or deductibles) on a patient’s credit report when the debt is owed to an out-of-network emergency care or facility-based provider, as long as the patient had health insurance at the time of service.
HB 1941 by Rep. Dade Phelan creates a strong protection for Texas patients by essentially prohibiting freestanding emergency rooms (FSERs) from price-gouging patients for care. Many Texas FSERs have used a combination of confusing language, deceptive advertising and misleading pricing to draw patients in and leave them with outrageously-high medical bills for emergency and routine care.
Protects patients from financially-devastating FSER charges when they seek help in a personal emergency.
Prevents FSERs from charging “unconscionable” prices over 200% of what hospitals ERs charge for the same care.
Grants the state the power to take action against FSERs who engage in price-gouging.
HB 2041 by Rep. Tom Oliverson addresses Texas’ freestanding emergency room (FSER) transparency issue, in which many FSERs use confusing language and deceptive advertising to mislead or lie to patients about their network status and pricing. These deceptive practices leave Texans with outrageously-high medical bills and debt.
Requires FSERs to notify patients about any applicable facility and observation fees before providing a service.
Prohibits FSERs from posting a health plan’s logo unless they are in that health plan’s network.
Prohibits FSERs from using language suggesting they "take” or “accept” a patient’s insurance unless they are an in-network provider with that plan.
Requires FSERs to post a notice declaring the facility may be out of network with a patient’s health plan.
HB 2536 by Rep. Tom Oliverson addresses the high cost of prescription drugs by requiring drug manufacturers to provide real transparency into their cost-increase decisions. The bill also creates a requirement that health insurers and pharmacy benefit managers (PBMs) submit annual drug cost transparency reports. HB 2536:
Requires drug manufacturers to submit a report to the Texas Health and Human Services Commission (HHSC) when they have a price increase for a specific drug’s wholesale acquisition cost of at least 15% within a calendar year or at least 40% over a three-year period.
The report would have to include a detailed statement about what caused the price increase, company-level research and development costs for the most recent year, and more.
Requires PBMs to submit an annual report to the Texas Department of Insurance (TDI) with information including aggregated rebates, fees, and price protection payments collected from drug manufacturers.
Requires health insurers to submit an annual report to TDI with information including the names of the 25 most frequently prescribed drugs, percent increase in annual net spending for drugs, and percent increase in premiums attributable to drugs.
Requires HHSC to post these reports online for access by the general public.