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89(R) HB 3015 - Engrossed version - Bill Text
By: Alders, et al.
H.B. No. 3015
A BILL TO BE ENTITLED
AN ACT
relating to the application of direct primary care fees to
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 includes 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.
APPLICATION OF DIRECT PRIMARY CARE FEES TO
DEDUCTIBLES. (a) A direct fee paid to a direct primary care
provider must apply to a participant's deductible for a health
benefit plan provided under the group benefits program.
(b)
Notwithstanding Subsection (a), if the board of
trustees believes that applying a direct fee paid to a direct
primary care provider for a participant's deductible under this
subchapter would cause the high deductible health plan, as that
term is defined by Section 223, Internal Revenue Code of 1986, to no
longer qualify for a health savings account under that section, the
board of trustees shall seek an opinion from the attorney general
regarding the applicability of this subchapter to that high
deductible health plan. If the attorney general confirms that the
high deductible health plan would be disqualified, this subchapter
will not apply to the high deductible health plan.
SECTION 2. Chapter 1575, Insurance Code, is amended by
adding Subchapter L to read as follows:
SUBCHAPTER L. DIRECT PRIMARY CARE SERVICES
Sec. 1575.551. 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 includes telemedicine
medical services and telehealth services, as those terms are
defined by Section 111.001, Occupations Code, provided using a
technology platform.
Sec.
1575.552.
APPLICATION OF DIRECT PRIMARY CARE FEES TO
DEDUCTIBLES. (a) A direct fee paid to a direct primary care
provider must apply to an enrollee's deductible for a basic plan
provided under the group program.
(b)
Notwithstanding Subsection (a), if the trustee believes
that applying a direct fee paid to a direct primary care provider
for an enrollee's deductible under this subchapter would cause the
high deductible health plan, as that term is defined by Section 223,
Internal Revenue Code of 1986, to no longer qualify for a health
savings account under that section, the trustee shall seek an
opinion from the attorney general regarding the applicability of
this subchapter to that high deductible health plan.
If the
attorney general confirms that the high deductible health plan
would be disqualified, this subchapter will not apply to the high
deductible health plan.
SECTION 3. Chapter 1579, Insurance Code, is amended by
adding Subchapter H to read as follows:
SUBCHAPTER H. DIRECT PRIMARY CARE SERVICES
Sec. 1579.351. 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 includes telemedicine
medical services and telehealth services, as those terms are
defined by Section 111.001, Occupations Code, provided using a
technology platform.
Sec.
1579.352.
APPLICATION OF DIRECT PRIMARY CARE FEES TO
DEDUCTIBLES. (a) A direct fee paid to a direct primary care
provider must apply to an enrollee's deductible for a health
coverage plan provided under this chapter.
(b)
Notwithstanding Subsection (a), if the trustee believes
that applying a direct fee paid to a direct primary care provider
for an enrollee's deductible under this subchapter would cause the
high deductible health plan, as that term is defined by Section 223,
Internal Revenue Code of 1986, to no longer qualify for a health
savings account under that section, the trustee shall seek an
opinion from the attorney general regarding the applicability of
this subchapter to that high deductible health plan.
If the
attorney general confirms that the high deductible health plan
would be disqualified, this subchapter will not apply to the high
deductible health plan.
SECTION 4. The changes in law made by this Act apply only to
a plan year that commences on or after January 1, 2026.
SECTION 5. This Act takes effect September 1, 2025.