TX State Updates - 2015 Jan 02 No.04

On May 28, 2015, Gov. Abbott signed SB 425 into law which requires free standing emergency care rooms to post signs at any facility entrance, in each patient room, where the person pays for services and on the facility’s website containing:

Information so that an individual is fully aware that they are seeking services in a free standing emergency room (rather than an urgent care clinic);

Whether the facility participates in a provider network, and the providers working in the facility that do not participate in each network;

A statement that out-of-network providers may bill separately from the facility;

The minimum and maximum amounts the physician charges and the what the facility fee is likely to be per visit.

Further, SB 425 entitles consumers to a right to mediation if the balance bill after cost-sharing exceeds $1,000. This option is currently only available to patients of hospital emergency rooms.

While not directly relevant to employers sponsoring group health plans, this legislation aims to promote price transparency for consumers. Many consumers visit free standing emergency rooms but think they are visiting an urgent care facility, which can result in a much higher bill. Employers with employees in Texas may consider reviewing their plan materials to determine if co-payments or co-insurance changes depending on whether employees visit a free standing emergency room or an urgent care clinic, and clearly communicating the difference to covered employees and their covered spouses and dependents.

The law is effective Sept. 1, 2015, although free standing emergency rooms are not required to comply with the fee notice requirements until Jan. 1, 2016.

SB 425 »