bill counts direct primary care fees toward deductibles

The text as introduced · 490 words

By: Hughes
S.B. No. 2108

A BILL TO BE ENTITLED

AN ACT

relating to the inclusion of direct primary care fees as qualified

medical expenses applied toward insurance deductibles in certain

state health benefit plans.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 1551, Insurance Code, is amended by

adding Subchapter K to read as follows:

SUBCHAPTER K. DIRECT PRIMARY CARE SERVICES

Sec. 1551.501. DEFINITIONS. In this subchapter:

(1) "Direct fee" means a fee charged by a physician to

a patient or a patient's designee for primary medical care services

provided by, or to be provided by, the physician to the patient. The

term includes a fee in any form, including a:

(A) monthly retainer;

(B) membership fee;

(C) subscription fee;

(D) fee paid under a medical service agreement;

or

(E) fee for a service, visit, or episode of care.

(2) "Direct primary care" means a primary medical care

service provided by a physician to a patient in return for payment

in accordance with a direct fee. The term include telemedicine

medical services and telehealth services, as those terms are

defined by Section 111.001, Occupations Code, provided using a

technology platform.

Sec. 1551.502. INCLUSION OF DIRECT PRIMARY CARE FEES AS

QUALIFIED MEDICAL EXPENSES. (a) Direct fees paid to a direct

primary care provider shall apply to the deductible of a

participant enrolled in the basic coverage provided under the

Employees Retirement System of Texas.

(b) The board of trustees shall adopt rules necessary to

implement this section.

SECTION 2. Chapter 1575, Insurance Code, is amended by

adding Subchapter L to read as follows:

SUBCHAPTER L. DIRECT PRIMARY CARE SERVICES

Sec. 1575.601. DEFINITIONS. In this subchapter:

(1) "Direct fee" means a fee charged by a physician to

a patient or a patient's designee for primary medical care services

provided by, or to be provided by, the physician to the patient. The

term includes a fee in any form, including a:

(A) monthly retainer;

(B) membership fee;

(C) subscription fee;

(D) fee paid under a medical service agreement;

or

(E) fee for a service, visit, or episode of care.

(2) "Direct primary care" means a primary medical care

service provided by a physician to a patient in return for payment

in accordance with a direct fee. The term include telemedicine

medical services and telehealth services, as those terms are

defined by Section 111.001, Occupations Code, provided using a

technology platform.

Sec. 1575.602. INCLUSION OF DIRECT PRIMARY CARE FEES AS

QUALIFIED MEDICAL EXPENSES. (a) Direct fees paid to a direct

primary care provider shall apply to the deductible of a

participant enrolled in the basic coverage provided under the

Teacher Retirement System of Texas.

(b) The trustee shall adopt rules necessary to implement

this section.

SECTION 3. This Act applies only to a health benefit plan

delivered, issued for delivery, or renewed on or after January 1,

2026.

SECTION 4. This Act takes effect September 1, 2025.