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A BILL TO BE ENTITLED
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AN ACT
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relating to the method of payment for certain health care provided |
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by a hospital. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1204, Insurance Code, is amended by |
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adding Subchapter G to read as follows: |
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SUBCHAPTER G. DIRECT PAYMENT OF HOSPITAL |
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Sec. 1204.301. DEFINITIONS. In this subchapter: |
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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 an individual, group, |
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blanket, or franchise insurance policy, a group hospital service |
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contract, or an individual or group subscriber contract or evidence |
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of coverage issued by a health maintenance organization, that |
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provides benefits for health care services. The term does not |
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include: |
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(A) the state Medicaid program, including the |
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Medicaid managed care program operated under Chapter 533, |
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Government Code; |
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(B) the child health plan program operated under |
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Chapter 62, Health and Safety Code; or |
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(C) Medicare benefits. |
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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, Health and Safety Code. The term does |
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not include an ambulatory surgical center licensed under Chapter |
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243, Health and Safety Code. |
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Sec. 1204.302. APPLICABILITY TO CERTAIN PLANS. In addition |
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to the health benefit plans described by Section 1204.301, |
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notwithstanding any other law, this subchapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) a plan providing basic coverage under Chapter |
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1601. |
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Sec. 1204.303. PAYMENT IN LIEU OF CLAIM FOR BENEFITS; OTHER |
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DIRECT PAYMENTS. (a) At the request of a patient, including a |
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patient who is an enrollee, and subject to Subsection (b), a |
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hospital must accept directly from the patient full payment for a |
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health care service provided in the hospital. If the payment is |
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made by an enrollee, the hospital must accept that payment in lieu |
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of submitting a claim to the enrollee's health benefit plan. |
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(b) A request under Subsection (a) must be made not later |
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than the 60th day after the date on which the health care service is |
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provided. |
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(c) Notwithstanding Section 552.003 or any other law, the |
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amount of the payment for a health care service for which a hospital |
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accepts payment as described by Subsection (a) for a service |
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provided in the hospital may not exceed the lowest contracted rate |
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for the health care service that the hospital has agreed to accept |
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as payment in full as a contracted, preferred, or participating |
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provider of a health benefit plan. |
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SECTION 2. This Act takes effect September 1, 2023. |