SB30 - Relating to recovery of health care-related damages in certain civil actions.

  89R31559 SCL-D     By: Schwertner, et al. S.B. No. 30     (Bonnen)     Substitute the following for S.B. No. 30:  No.       A BILL TO BE ENTITLED   AN ACT   relating to recovery of health care-related damages in certain   civil actions.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 41.001, Civil Practice and Remedies   Code, is amended by adding Subdivisions (6-a), (6-b), (6-c), (6-d),   (14), (15), and (16) to read as follows:                 (6-a)     "Health care expenses" means amounts paid or   owed or that may be paid or owed to a provider for health care   services, supplies, or devices provided to a patient.                 (6-b)     "Health care services" means services provided   by a provider to an individual to diagnose, prevent, alleviate,   cure, treat, or heal the individual's condition, illness, or   injury, including:                       (A)     rehabilitative services provided to the   individual; or                       (B)     personal care provided to the individual on a   short-term or long-term basis.                 (6-c)     "Injured individual" means the individual whose   injury or death is the subject of a civil action to which Section   14.015 applies.                 (6-d)     "Letter of protection" means an agreement,   regardless of the name, that includes an express or implied promise   of payment to a health care provider from a judgment or settlement   of an injured individual's civil action or that makes a payment to   the provider contingent on the resolution of the action.                 (14)  "Physician" means:                       (A)     an individual licensed to practice medicine;   and                       (B)     a professional association, partnership,   limited liability partnership, or other type of entity formed or   organized by an individual physician or group of physicians to   provide medical care to patients.                 (15)     "Provider" means a person, including an   individual, partnership, professional association, corporation,   facility, or institution, who is licensed, certified, registered,   chartered, or otherwise authorized, in this state or elsewhere, to   provide health care services, including:                       (A)  an acupuncturist;                       (B)  a chiropractor;                       (C)  a dentist;                       (D)     a health care institution of a type described   by Section 74.001(a)(11);                       (E)  a health care collaborative;                       (F)  a nonprofit health organization;                       (G)     a nurse, including a licensed vocational   nurse, nurse practitioner, and registered nurse;                       (H)  an occupational therapist;                       (I)  an ophthalmologist;                       (J)  an optometrist;                       (K)  a pharmacist;                       (L)  a physical therapist;                       (M)  a physician;                       (N)  a physician's assistant;                       (O)  a licensed professional counselor;                       (P)  a psychologist;                       (Q)  a podiatrist; and                       (R)  a speech therapist.                 (16)     "Third-party payor" means an entity, plan, or   program that has a legal or contractual obligation to pay,   reimburse, or otherwise contract with a provider to pay the   provider for the provision of a health care service, supply, or   device to a patient, including:                       (A)     an insurance company providing health or   dental insurance;                       (B)     an employer-provided plan or any other   sponsor or administrator of a health or dental plan;                       (C)     a health maintenance organization operating   under Chapter 843, Insurance Code, an insurer providing a preferred   provider benefit plan under Chapter 1301, Insurance Code, or other   similar entity;                       (D)  Medicare;                       (E)     the state Medicaid program, including the   Medicaid managed care program operating under Chapter 540,   Government Code; and                       (F)     workers' compensation insurance or insurance   provided instead of subscribing to workers' compensation   insurance.          SECTION 2.  Chapter 41, Civil Practice and Remedies Code, is   amended by adding Sections 41.015, 41.016, and 41.017 to read as   follows:           Sec.   41.015.     ADMISSIBLE EVIDENCE OF HEALTH CARE EXPENSES.     (a)   This section applies to any civil action in which the claimant   seeks recovery of health care expenses as economic damages in a   personal injury or wrongful death action.           (b)     If there is a conflict between this section and Section   41.0105, this section controls.           (c)     If a third-party payor paid for a health care service,   supply, or device provided to an injured individual, the evidence   that may be offered to prove the amount of the economic damages that   may be awarded to the claimant for that service, supply, or device   is limited to evidence of the amount the third-party payor paid plus   amounts paid by an insured for coinsurance, deductibles, or   copayments related to the service, supply, or device.           (d)     If Subsection (c) does not apply, the evidence that may   be offered regarding the reasonable value of the necessary health   care services, supplies, or devices provided to the injured   individual or that in reasonable probability will need to be   provided to the injured individual in the future includes:                 (1)     evidence of   amounts paid by non-third-party payors   to providers for each health care service, supply, or device, but   not to purchase an account receivable or as a loan, if paid without   a formal or informal agreement for the provider to refund, rebate,   or remit money to the payor, injured individual, claimant, or   claimant's attorney or anyone associated with the payor, injured   individual, claimant, or claimant's attorney; and                 (2)  any of the following:                       (A)     the Medicare allowable amount applicable at   the time and place the service, supply, or device was provided;                       (B)     the maximum allowable reimbursement amount   under the medical fee guidelines prescribed by Subtitle A, Title 5,   Labor Code, applicable at the time and place the service, supply, or   device was provided;                       (C)     the 50th percentile of amounts allowed to   participating providers in the geozip and during the calendar   quarter in which the service, supply, or device was provided;                       (D)     if, within the time a claimant's affidavit   under Section 18.001(d) must be served, the claimant serves a   notice of intent to rely on the following:                             (i)     the average amounts collected by the   provider during the one-year period preceding the date the service,   supply, or device was provided; or                             (ii)     the provider's range of contracted   rates with commercial insurers regulated by the Texas Department of   Insurance in effect on the date the service, supply, or device was   provided; and                       (E)     the provider's billed charges for the   service, supply, or device provided to the injured individual.           (e)     A party may not compel a provider by a pretrial   discovery request or by subpoena to provide evidence that may be   admissible under Subsection (d)(2)(D) unless the claimant serves a   notice of intent under that subsection.           (f)     Except as provided by rules adopted by the supreme   court, for each service, supply, or device provided to the injured   individual, a health care provider's statements or invoices   submitted into evidence must provide:                 (1)  an industry-recognized billing code;                 (2)     a description of the service, supply, or device;   and                 (3)     the date each service, supply, or device was   provided to the injured individual.           Sec.   41.016.     CLAIMANT DISCLOSURE REQUIREMENTS IN ACTION FOR   HEALTH CARE EXPENSES; CERTAIN MATTERS ADMISSIBLE.   (a)   In addition   to other items that may be required to be provided by rule, court   decision, or other law, in an action to which Section 41.015   applies, a claimant shall disclose or provide to each other party:                 (1)  any letter of protection related to the action;                 (2)     any oral or written agreement under which a   provider may refund, rebate, or remit money to a payor, injured   individual, claimant, claimant's attorney, or person associated   with the payor, injured individual, claimant, or claimant's   attorney;    & [Text truncated for display. 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