(a) A facility shall comply with the following balance billing requirements.
- (1) A facility may not violate a law that prohibits the facility from billing a patient who is an insured, participant, or enrollee in a managed care plan an amount greater than an applicable copayment, coinsurance, and deductible under the insured's, participant's, or enrollee's managed care plan or that imposes a requirement related to that prohibition.
- (2) A facility shall comply with Senate Bill 1264, 86th Legislature, Regular Session, 2019, and with related Texas Department of Insurance rules at 28 TAC Chapter 21, Subchapter OO §§21.4901 - 21.4904 (relating to Disclosures by Out-of-Network Providers) to the extent this subchapter applies to the facility.
- (b) A facility shall comply with the itemized bill requirements under Texas Health and Safety Code §185.002.
Source Note:The provisions of this §509.67 adopted to be effective April 15, 2021, 46 TexReg 2426; amended to be effective August 18, 2024, 49 TexReg 6220.