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

89(R) SB 30 - House Committee Report version - Bill Text

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;

(3)

the identity of any provider who provided health

care services to the injured individual in relation to the

injury-causing event and provide an authorization to all other

parties to the case that will allow those parties to obtain from the

provider all of the injured individual's medical records relating

to that event; and

(4)

if the injured individual was referred to a

provider for services and the provider's medical records, billing

statements, or testimony will be presented to the trier of fact in

the action:

(A)

the name, address, and telephone number of

the person who made the referral, regardless of whether that person

is the injured individual's attorney; and

(B)

if the person making the referral was not the

injured individual's attorney, the relationship between the person

making the referral and the injured individual or the injured

individual's attorney.

(b)

On request by a party to an action to which Section

41.015 applies, a provider who provided a health care service,

supply, or device to an injured individual in relation to the

injury-causing event that is the subject of the action shall

provide the following information to all parties to the action:

(1)

an anonymized list of persons an attorney to the

action referred to the provider in the preceding two years;

(2)

the date and amount of each payment made to the

provider in the preceding two years by, through, or at the direction

of the attorney;

(3)

if applicable, each person anonymously described

under Subdivision (1) on whose behalf a payment described by

Subdivision (2) was made; and

(4)

other aspects of any financial relationship

between the referring attorney and the provider.

(c)

For purposes of Subsection (b), a referral is considered

to have been made by the injured individual's attorney even if made

by another person when the injured individual's attorney knew or

had reason to know that the referral would be made.

(d)

In an action to which Section 41.015 applies, the

following matters shall be admitted into evidence if offered by any

party:

(1)

the injured individual's medical records relating

to the injury-causing event;

(2)

if a provider's medical records, billing

statements, or testimony will be presented to the trier of fact in

the action, any letter of protection relating to that provider;

(3)

if the injured individual was referred to a health

care provider for services by the injured individual's attorney and

that provider's medical records, billing statements, or testimony

will be presented to the trier of fact in the action, the

information disclosed under Subsection (b); and

(4)

treatment guidelines and drug formularies

approved by the Workers' Compensation Division of the Texas

Department of Insurance as evidence relating to the necessity of

health care services provided to the injured individual.

Sec.

41.017.

RULES OF EVIDENCE IN ACTION FOR HEALTH CARE

EXPENSES. Except as otherwise provided by Sections 41.015 and

41.016, the Texas Rules of Evidence govern an action to which

Section 41.015 applies.

SECTION 3. The changes in law made by this Act apply to an

action:

(1) commenced on or after the effective date of this

Act; or

(2) pending on the effective date of this Act and in

which a trial, or a new trial or retrial following a motion, appeal,

or otherwise, begins on or after January 1, 2026.

SECTION 4. 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.