In addition to H.B. 307 (discussed in a prior post), H.B. 1566 and its companion bill, S.B. 507, propose to expand the requirement for mediation of balance bills.

Currently, Chapter 1467 of the Texas Insurance Code requires a facility-based physician to mediate balance bills upon the request of the patient if the patient is responsible to a facility-based physician, after copayments, deductibles, and coinsurance, including the amount unpaid by the administrator or insurer, for an amount greater than $500 and either (i) the facility-based physician fails to disclose projected amounts for which the patient may be responsible and the circumstances under which the enrollee would be responsible for those amounts; or (ii) the facility-based physician makes the disclosures but the amount billed is greater than the maximum amount projected in the disclosure.

H.B. 1566, authored by Rep. John Frullo (Dist. 84, Lubbock) and S.B. 507, authored by Sen. Kelly Hancock (Dist. 9, Dallas/Tarrant County) would expand the mediation requirement above to apply to: (i) “emergency care providers;” and (ii) facility-based providers that are not physicians. The term “emergency care” is not defined, but, because the term “facility-based” should encompass providers working in a hospital or free-standing emergency department, the changes seem targeted at urgent care clinics that do not meet the definition of a “facility” – those clinics that only submit claims for professional services (CMS 1500 paper claim) and do not bill for facility services (CMS UB-04 paper claim).

It is early in the 85th Legislature so it is impossible to determine the likelihood of these bills passing; but with the fact that H.B. 1566 and S.B. 507 have been filed with identical language, if the bills make it out of committee in their respective chambers it seems as if there are reasonable chances of these changes becoming law.