Collector - July 2020 - 24

Currently, almost 30
states have enacted
some level of surprise
billing protection, with
other states considering
similar legislation.

24

NEW MEXICO

TEXAS

New Mexico recently enacted 2019 S.B.
337, the Surprise Billing Protection Act,
which became effective January 2020.
Among other requirements, the law states
that "[a] nonparticipating provider shall
not knowingly submit a surprise bill to a
covered person."
The law also requires certain disclosures
on health facilities' websites, and requires
that "[a]ny written communication, other
than a receipt of payment, from a provider
or health insurance carrier pertaining to
a surprise bill, shall clearly state that the
covered person is responsible only for
payment of applicable in-network costsharing amounts under the covered person's
health benefits plan."
Of importance to debt collectors, the bill
also requires that "[a] collection agency
collecting medical debt from New Mexico
residents shall post a notice of consumer
rights pursuant to the Surprise Billing
Protection Act on its website."
Frustratingly, state regulators in New
Mexico have not yet provided a model
disclosure by which collection agencies can
satisfy this requirement, leaving agencies to
craft their own notices. Some commentators
have suggested that debt collectors can
comply by simply posting a statement on
their website notifying consumers that
they have rights under the Surprise Billing
Protection Act and directing consumers
to contact the state superintendent of
insurance.
However, given the lack of formal
guidance, ACA International recommends
that members consult with their own
legal counsel to determine the appropriate
wording and placement of the required
website notice of consumer rights. While
this law does not provide for a private
right of action, it will be enforced by the
superintendent of insurance. For more
information, the new law is codified at N.M.
Stat. Ann. Section 59A-57A, et seq.

Texas has also been active in this area,
recently enacting 2019 S.B. 1264, which
prohibits a non-network physician,
provider "or a person asserting a claim
as an agent (emphasis added)" from
billing a patient covered out-of-network
and receiving emergency care in any
amount greater than the patient's
responsibility under the patient's health
care plan, including applicable copayment,
coinsurance or deductible.
The law also requires a health
maintenance organization to provide a
written notice of billing prohibitions in
each explanation of benefits provided to
an enrollee or physician or provider in
connection with a health care service that
is subject to the prohibitions. Notably, the
bill allows the attorney general to bring
a civil action against any "individual
or entity" believed to be violating a law
prohibiting balance billing. For more
information, review S.B. 1264 or Tex. Ins.
Code. Section 1271., et seq.
Last year, Texas also passed 2019 S.B.
1037, a separate measure prohibiting a
consumer reporting agency (CRA) from
furnishing a consumer report containing
information related to "a collection account
with a medical industry code, if the
consumer was covered by a health benefit
plan at the time of the event giving rise
to the collection and the collection is for
an outstanding balance, after copayments,
deductibles, and coinsurance, owed to an
emergency care provider or a facility-based
provider for an out-of-network benefit claim."
The law went into effect on Sept. 1, 2019.
While the credit reporting restriction
refers to CRAs rather than furnishers,
ACA suggests members consult with their
own legal counsel and creditor clients to
determine whether any changes to their
credit reporting practices are required. For
more information, review Tex. Bus. & Com.
Code Section 20.05.

ACAINTERNATIONAL.ORG


http://www.ACAINTERNATIONAL.ORG

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