Relating to the establishment of the state health benefit plan reimbursement review board and the reimbursement for health care services or supplies provided under certain state-funded health benefit plans.
Impact
The bill's impact lies in its efforts to standardize and regulate the reimbursement process for healthcare services provided under state health benefit plans. By establishing clear protocols for reimbursement, it aims to ensure that facilities receive consistent payments for services rendered to enrollees, thereby preventing financial discrepancies that could arise from varying billing practices across facilities. The requirement for facilities to consider the reimbursement as full payment is particularly significant, as it prevents additional out-of-pocket costs for enrollees beyond copayments, coinsurance, or deductibles specified in their health plans.
Summary
House Bill 5186, introduced by Representative Bonnen, establishes the state health benefit plan reimbursement review board. This board's primary objective is to manage and control present and future cost growth for state-funded health benefit plans while ensuring that enrollees continue to have access to high-quality healthcare services and supplies. The bill specifies the formation of a board comprising key legislative leaders, including the lieutenant governor and the speaker of the house, and outlines the framework for conducting meetings and reaching decisions about reimbursement structures.
Sentiment
Overall, the sentiment surrounding HB 5186 appears to be generally supportive, particularly among legislators concerned with health care affordability and accessibility for public employees. Supporters argue that this bill provides a necessary mechanism to control rising healthcare costs while safeguarding enrollees' access to essential services. However, some concerns may arise regarding how universally the reimbursement standards can be applied across a diverse array of healthcare providers and services.
Contention
Notable points of contention may arise regarding the board's authority and its impact on local healthcare providers. Some stakeholders might argue that a one-size-fits-all reimbursement structure may not adequately address the nuanced needs of different healthcare facilities, particularly those in underserved areas. The bill also raises questions about how effectively it can maintain quality of care while controlling costs—which is a delicate balance in healthcare policy.
Texas Constitutional Statutes Affected
Insurance Code
Chapter 1551. Texas Employees Group Benefits Act
Section: New Section
Chapter 1575. Texas Public School Employees Group Benefits Program
Section: New Section
Chapter 1579. Texas School Employees Uniform Group Health Coverage
Section: New Section
Chapter 1601. Uniform Insurance Benefits Act For Employees Of The University Of Texas System And The Texas A&m University System
Identical
Relating to certain limitations on reimbursements paid for inpatient and outpatient hospital services for certain publicly funded health benefit plan coverage for employees and retirees.
Relating to certain limitations on reimbursements paid for inpatient and outpatient hospital services for certain publicly funded health benefit plan coverage for employees and retirees.
Relating to pricing for health care services and supplies and reimbursement for those services or supplies under certain health benefit plans; imposing penalties.
Sets level for healthcare benefits; requires employee contributions; prohibits reimbursement of Medicare Part B; adds member to SHBP/SEHBP plan design committees; requires retirees to purchase health benefits through exchanges; provides subsidies for out-of-pocket costs.
Relating to certain group and individual health benefit plans and the provision of health care benefits under health care plans through provider networks.
Sets level for health care benefits; requires employee contributions; prohibits reimbursement of Medicare Part B; adds member to SHBP/SEHBP plan design committees; requires retirees to purchase health benefits through exchanges; provides subsides for out-of-pocket costs.
An Act Concerning Reimbursement For Health Care And Clinical Services Provided At State Expense And Establishing A Task Force To Maximize Reimbursements For Covered Benefits And Services Provided By State Agencies.