Harrison Site-Neutral Bill Hinges On An Undefined ‘Evidence-Based Rationale’

The text as introduced · 579 words

By: Harrison
H.B. No. 985

A BILL TO BE ENTITLED

AN ACT

relating to hospital-owned outpatient facilities, including

site-neutral reimbursement rates under Medicaid.

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. ACQUISITION OF OUTPATIENT HEALTH CARE

FACILITIES. (a) In this section:

(1) "Commission" means the Health and Human Services

Commission.

(2) "Hospital" means a hospital licensed under Chapter

241.

(b) A hospital that acquires an outpatient health care

facility shall provide written notice of the acquisition to the

office of the attorney general and the commission.

SECTION 2. Subchapter B, Chapter 32, Human Resources Code,

is amended by adding Section 32.0286 to read as follows:

Sec. 32.0286. SITE-NEUTRAL REIMBURSEMENT RATE FOR

OUTPATIENT SERVICES. (a) In this section, "hospital-owned

outpatient facility" means a department, unit, clinic, or other

facility or organization that a hospital provider either creates or

acquires for the purpose of furnishing outpatient services. The

term includes a hospital outpatient department.

(b) Notwithstanding any other law, the commission shall

ensure the Medicaid reimbursement rate for outpatient services

provided by a hospital-owned outpatient facility is the same as the

reimbursement rate for outpatient services an independent,

physician-owned practice provides if:

(1) the outpatient services are not dependent on

technology associated with the facility; and

(2) evidence-based rationale does not support a

different reimbursement rate for a specific outpatient service.

SECTION 3. (a) In this section:

(1) "Commission" means the Health and Human Services

Commission.

(2) "Department" means the Texas Department of

Insurance.

(3) "Medicaid" means the medical assistance program

established under Chapter 32, Human Resources Code.

(b) The department, in consultation with the commission and

the office of the attorney general, shall conduct a study on the

feasibility and advisability of expanding the policy under Section

32.0286, Human Resources Code, as added by this Act, to commercial

health benefit plan issuers in this state by prohibiting the

issuers from providing provider-based billing rates for outpatient

services that are greater than the rates provided to independent,

physician-owned practices providing the same outpatient services.

(c) Not later than September 1, 2026, the department shall

prepare and submit to the legislature and the standing committees

of the legislature with primary jurisdiction over insurance and

Medicaid a report containing the results of the study conducted

under Subsection (b) of this section and any recommendations for

legislative or other action. The report must include an estimate of

any projected cost savings to health care consumers in this state

that would result from commercial health benefit plan issuers

implementing a site-neutral payment policy for outpatient

services.

SECTION 4. Not later than January 1, 2026, the executive

commissioner of the Health and Human Services Commission shall

adopt or amend rules as necessary to comply with Section 32.0286,

Human Resources Code, as added by this Act.

SECTION 5. Section 311.006, Health and Safety Code, as

added by this Act, applies only to a hospital's acquisition of an

outpatient facility on or after the effective date of this Act.

SECTION 6. If before implementing any provision of this Act

a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 7. This Act takes effect September 1, 2025.