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89(R) HB 1612 - Enrolled version - Bill Text
H.B. No. 1612
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.
The bill or other final accounting must notify the
patient of the ability to make a request under Subsection (b).
(d)
Notwithstanding Section 552.003, Insurance Code, or any
other law, in accepting payments as described by Subsection (b) for
health care services provided by the hospital, a hospital may
charge patients amounts that are either:
(1)
not more than 25 percent greater than the amounts
generally billed, as defined by 26 C.F.R. Section 1.501(r)-1, for a
health care service; or
(2)
not more than 50 percent greater than the lowest
contracted rate for a 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:
(A)
the state Medicaid program, including the
Medicaid managed care program operated under Chapter 540,
Government Code;
(B)
the child health plan program operated under
Chapter 62; or
(C) Medicare benefits.
(e)
Nothing in this section precludes a patient from
receiving from a hospital charity care that the patient would
otherwise qualify for or be entitled to.
SECTION 2. This Act takes effect September 1, 2025.
______________________________
______________________________
President of the Senate
Speaker of the House
I certify that H.B. No. 1612 was passed by the House on May 1,
2025, by the following vote: Yeas 139, Nays 5, 1 present, not
voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1612 was passed by the Senate on May
25, 2025, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor