89R26079 SRA-F     By: Oliverson, Frank H.B. No. 3708     Substitute the following for H.B. No. 3708:     By:  VanDeaver C.S.H.B. No. 3708       A BILL TO BE ENTITLED   AN ACT   relating to charity care provided by certain nonprofit hospitals   and hospital systems and the calculation of net patient revenue for   purposes of determining the charity care provided by those   entities; authorizing an administrative penalty.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 311.045, Health and Safety Code, is   amended by adding Subsection (g) to read as follows:          (g)  Notwithstanding Section 311.042(15), when calculating   net patient revenue for the purposes of Subsection (b)(1)(C) of   this section, a nonprofit hospital or hospital system shall include   the revenue of each of its facilities and practices offering   medical services that are located in this state and under the common   governance of a single corporate parent, regardless of the   facility's or practice's distance from the corporate parent,   excepting, as provided by Subsection (d) of this section, any   facility or practice that has been designated as a disproportionate   share hospital under the state Medicaid program.          SECTION 2.  Subchapter D, Chapter 311, Health and Safety   Code, is amended by adding Section 311.0453 to read as follows:          Sec. 311.0453.  CHARITY CARE SCREENING. (a)  In this   section:                (1)  "Charity program" means a hospital's or hospital   system's financial assistance and charity care program.                (2)  "Commission" means the Health and Human Services   Commission.                (3)  "Executive commissioner" means the executive   commissioner of the commission.           (b)  This section applies only to:                 (1)  a nonprofit hospital that has not been designated   as a disproportionate share hospital under the state Medicaid   program; or                (2)  with respect to a hospital system, a facility in   the system that has not been designated as a disproportionate share   hospital under the state Medicaid program.          (c)  A nonprofit hospital or hospital system to which this   section applies shall inform each patient of the existence of, and   screen each patient for eligibility for, the hospital's or hospital   system's charity program in accordance with this section.          (d)  A nonprofit hospital or hospital system may not attempt   to pursue collection of a patient's debt unless the hospital or   hospital system verifies and documents that the patient is not   eligible for the charity program described by Subsection (c).          (e)  The executive commissioner by rule shall prescribe the   process a nonprofit hospital or hospital system must use to screen a   patient for eligibility for a charity program.  The rules adopted   under this section must provide that a nonprofit hospital or   hospital system:                (1)  may not send a billing statement to a patient   unless the hospital or hospital system has conducted the screening   required under Subsection (c);                (2)  must apply on the initial billing statement sent   to a patient any charity care discount, health insurance coverage,   or other health benefit to which the patient is entitled; and                 (3)  must include on each billing statement provided to   a patient a notice stating:                      (A)  that the hospital or hospital system has a   charity program;                      (B)  the contact information for the office or   department of the hospital or hospital system that can provide   information about the charity program; and                      (C)  if applicable, the uniform resource locator   (URL) address of an Internet website maintained by the hospital or   hospital system where the patient can view the charity program.          (f)  A patient may apply to receive charity care from a   nonprofit hospital or hospital system regardless of whether the   patient:                (1)  was screened for eligibility for the hospital's or   hospital system's charity program and was determined to be   ineligible for charity care; or                 (2)  disagrees with the amount of the charity care   discount offered by the hospital or hospital system.          (g)  If a nonprofit hospital or hospital system becomes aware   that the hospital or hospital system made an incorrect   determination regarding the appropriate amount of a charity care   discount to apply to a patient's account during the screening   required under Subsection (c) based on the information provided by   the patient at the time of the initial determination, the hospital   or hospital system shall:                (1)  either:                      (A)  refund to the patient the difference between   the amount of the charity care discount the patient should have   received and the amount of the charity care discount the patient   actually received; or                      (B)  if the patient has not made a payment to the   hospital or hospital system, reduce the amount due on the patient's   account by an amount equal to the amount described by Paragraph (A);   and                (2)  reimburse the patient for any other associated   reasonable costs, such as legal expenses and fees, incurred by the   patient in securing charity care.           (h)  If a nonprofit hospital or hospital system sells a   patient's debt to a collection agency or authorizes a collection   agency to collect the patient's debt on behalf of the hospital or   hospital system and later becomes aware that the amount of the   patient's debt should be reduced under Subsection (g), the hospital   or hospital system shall notify the collection agency within a   reasonable period of time of the hospital's or hospital system's   determination and the correct amount of the debt.           (i)  If the commission determines that a nonprofit hospital   or hospital system has failed to comply with a provision of this   section:                (1)  on the first violation, the commission shall   institute a corrective action plan for the hospital or hospital   system and publish the plan on the commission's Internet website;                (2)  on the second violation, the commission shall   provide written notice to the hospital or hospital system that, if   the hospital or hospital system fails to take action to correct the   failure to comply within the 90-day period following the date on   which the notice is provided, the commission may impose an   administrative penalty of not less than $250,000 on the hospital or   hospital system; and                (3)  on the third violation, the commission shall   notify the attorney general of the hospital's or hospital system's   repeated failure to comply with the requirements of this section,   after which the attorney general shall investigate the matter and,   if appropriate, bring an action to declare the hospital or hospital   system ineligible for the tax exemptions described by Section   311.043(b).          SECTION 3.  Section 311.045, Health and Safety Code, as   amended by this Act, applies only to a fiscal year of a hospital or   hospital system that begins on or after the effective date of this   Act.          SECTION 4.  (a)  Not later than December 1, 2025, the   executive commissioner of the Health and Human Services Commission   shall adopt the rules required by Section 311.0453, Health and   Safety Code, as added by this Act.          (b)  Section 311.0453, Health and Safety Code, as added by   this Act, applies only to a patient that is screened for the   purposes described by that section on or after January 1, 2026.          SECTION 5.  This Act takes effect immediately if it receives   a vote of two-thirds of all the members elected to each house, as   provided by Section 39, Article III, Texas Constitution.  If this   Act does not receive the vote necessary for immediate effect, this   Act takes effect September 1, 2025.