The text as introduced · 551 words
89R4808 MEW-F
By: Frank
H.B. No. 1612
A BILL TO BE ENTITLED
AN ACT
relating to direct payment for certain health care provided by a
hospital.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 311, Health and Safety
Code, is amended by adding Section 311.006 to read as follows:
Sec. 311.006. DIRECT PAYMENT TO HOSPITAL. (a) In this
section:
(1) "Enrollee" means an individual who is enrolled in
a health benefit plan or otherwise entitled to coverage under a
health benefit plan.
(2) "Health benefit plan" means any individual or
group arrangement with a public or private entity under which the
entity will pay for, reimburse expenses for, or otherwise contract
with a health care provider for the provision of health care
services, supplies, or devices to a patient. The term includes an
arrangement with:
(A) an insurance company;
(B) the sponsor or administrator of a
self-insured health benefit plan;
(C) a group hospital service corporation
operating under Chapter 842, Insurance Code;
(D) a health maintenance organization operating
under Chapter 843, Insurance Code;
(E) the state Medicaid program, including the
Medicaid managed care program operating under Chapter 540,
Government Code;
(F) a health benefit plan offered or administered
by or on behalf of this state or a political subdivision of this
state or an agency or instrumentality of the state or a political
subdivision of this state, including:
(i) a basic coverage plan under Chapter
1551, Insurance Code;
(ii) a basic plan under Chapter 1575,
Insurance Code;
(iii) a primary care coverage plan under
Chapter 1579, Insurance Code; and
(iv) a plan providing basic coverage under
Chapter 1601, Insurance Code; or
(G) any other entity providing a health insurance
or health benefit plan subject to regulation by the Texas
Department of Insurance.
(3) "Health care service" means a service to diagnose,
prevent, alleviate, cure, or heal a human illness or injury that is
provided to an individual by a physician or other health care
provider.
(4) "Hospital" means a public or private institution
licensed under Chapter 241. The term does not include an ambulatory
surgical center licensed under Chapter 243.
(b) At the request of a patient who is not an enrollee, and
subject to Subsection (c), a hospital must accept directly from the
patient full payment for a health care service provided by the
hospital.
(c) A request under Subsection (b) must be made not later
than the 60th day after the date on which the patient receives a
bill for or other final accounting of the health care service
provided.
(d) Notwithstanding Section 552.003, Insurance Code, or any
other law, the amount of the payment for a health care service for
which a hospital accepts payment as described by Subsection (b) for
a service provided by the hospital may not be more than 25 percent
greater than the lowest contracted rate for the health care service
that the hospital has agreed to accept as payment in full as a
contracted, preferred, or participating provider of a health
benefit plan other than:
(1) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 540, Government Code;
(2) the child health plan program operated under
Chapter 62; or
(3) Medicare benefits.
SECTION 2. This Act takes effect September 1, 2025.
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