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A BILL TO BE ENTITLED
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AN ACT
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relating to direct payment for certain health care provided by a |
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hospital. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 311, Health and Safety |
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Code, is amended by adding Section 311.006 to read as follows: |
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Sec. 311.006. DIRECT PAYMENT TO HOSPITAL. (a) In this |
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section: |
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(1) "Enrollee" means an individual who is enrolled in |
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a health benefit plan or otherwise entitled to coverage under a |
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health benefit plan. |
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(2) "Health benefit plan" means any individual or |
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group arrangement with a public or private entity under which the |
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entity will pay for, reimburse expenses for, or otherwise contract |
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with a health care provider for the provision of health care |
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services, supplies, or devices to a patient. The term includes an |
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arrangement with: |
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(A) an insurance company; |
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(B) the sponsor or administrator of a |
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self-insured health benefit plan; |
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(C) a group hospital service corporation |
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operating under Chapter 842, Insurance Code; |
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(D) a health maintenance organization operating |
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under Chapter 843, Insurance Code; |
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(E) the state Medicaid program, including the |
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Medicaid managed care program operating under Chapter 540, |
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Government Code; |
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(F) a health benefit plan offered or administered |
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by or on behalf of this state or a political subdivision of this |
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state or an agency or instrumentality of the state or a political |
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subdivision of this state, including: |
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(i) a basic coverage plan under Chapter |
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1551, Insurance Code; |
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(ii) a basic plan under Chapter 1575, |
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Insurance Code; |
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(iii) a primary care coverage plan under |
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Chapter 1579, Insurance Code; and |
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(iv) a plan providing basic coverage under |
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Chapter 1601, Insurance Code; or |
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(G) any other entity providing a health insurance |
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or health benefit plan subject to regulation by the Texas |
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Department of Insurance. |
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(3) "Health care service" means a service to diagnose, |
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prevent, alleviate, cure, or heal a human illness or injury that is |
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provided to an individual by a physician or other health care |
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provider. |
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(4) "Hospital" means a public or private institution |
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licensed under Chapter 241. The term does not include an ambulatory |
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surgical center licensed under Chapter 243. |
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(b) At the request of a patient who is not an enrollee, and |
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subject to Subsection (c), a hospital must accept directly from the |
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patient full payment for a health care service provided by the |
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hospital. |
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(c) A request under Subsection (b) must be made not later |
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than the 60th day after the date on which the patient receives a |
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bill for or other final accounting of the health care service |
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provided. |
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(d) Notwithstanding Section 552.003, Insurance Code, or any |
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other law, the amount of the payment for a health care service for |
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which a hospital accepts payment as described by Subsection (b) for |
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a service provided by the hospital may not be more than 25 percent |
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greater than the lowest contracted rate for the health care service |
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that the hospital has agreed to accept as payment in full as a |
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contracted, preferred, or participating provider of a health |
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benefit plan other than: |
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(1) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 540, Government Code; |
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(2) the child health plan program operated under |
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Chapter 62; or |
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(3) Medicare benefits. |
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SECTION 2. This Act takes effect September 1, 2025. |