Section 564.28 - Billing Requirements(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 § 185.002.26 Tex. Admin. Code § 564.28
Adopted by Texas Register, Volume 46, Number 15, April 9, 2021, TexReg 2435, eff. 4/15/2021; Amended by Texas Register, Volume 49, Number 33, August 16, 2024, TexReg 6221, eff. 8/18/2024