26 Tex. Admin. Code § 509.69 - Fees and Prices

(a) In this section, "unconscionable price" means a price that is more than 200 percent of the average price for the same or a substantially similar product or service provided to other individuals by health care facilities located in the same or nearest county to the county in which the freestanding emergency medical care facility is located, as applicable, according to data collected by the Texas Department of State Health Services under Texas Health and Safety Code (HSC) Chapter 108 (relating to Health Care Data Collection).

(b) In accordance with HSC §254.160 (relating to Prohibited Practices During Declared State of Disaster), during a state of disaster declared by the Governor under Texas Government Code Chapter 418 (relating to Emergency Management), a facility may not:

(1) charge an individual an unconscionable price for a product or service provided at the facility; or

(2) knowingly or intentionally charge a third-party payor, including a health benefit plan insurer, a price higher than the price charged to an individual for the same product or service based on the payor's liability for payment or partial payment of the product or service.

(c) Subsection (b)(2) of this section does not prohibit a facility from:

(1) offering an uninsured individual a cash discount for a particular product or service; or

(2) accepting directly from an individual full payment for a health care product or service in lieu of submitting a claim to the individual's health benefit plan.

(d) In accordance with HSC §254.1556 (relating to Disclosure of Certain Prices and Fees During Declared Disaster; Construction), a facility that provides testing or vaccination for an infectious disease for which a state of disaster has been declared under Texas Government Code Chapter 418, shall disclose the price the facility charges for the test or vaccine and any facility fees, supply costs, and other costs associated with the test or vaccine in accordance with the disclosure requirements described by HSC §254.156 (relating to Disclosure Statement Required).

(e) In accordance with HSC §254.1555 (relating to Certain Fees Prohibited), a facility that provides a health care service, including testing or vaccination, to an individual accessing the service from the individual's vehicle may not charge the individual or a third-party payor a facility or observation fee.

(f) Pursuant to HSC §254.207 (relating to Enforcement), and except for good cause shown, the Texas Health and Human Services Commission shall impose the following applicable penalty on a facility licensed under this chapter and HSC Chapter 254 (relating to Freestanding Emergency Medical Care Facilities) that violates subsection (b) of this section or HSC §254.160:

(1) for the first violation, an administrative penalty of $10,000;

(2) for the second violation:

(A) an administrative penalty of $50,000; and

(B) a suspension of the facility's license for 30 days; and

(3) for the third violation, a permanent revocation of the facility's license.

(g) This section may not be construed as expanding the type of health care services a facility is authorized to provide under HSC Chapter 254 or this chapter.

Notes

26 Tex. Admin. Code § 509.69

Adopted by Texas Register, Volume 47, Number 44, November 4, 2022, TexReg 7423, eff. 11/10/2022