84R18094 SCL-F
By: Bonnen of Galveston, Simpson, Fallon, H.B. No. 1945
et al.
A BILL TO BE ENTITLED
AN ACT
relating to the provision of direct primary care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 162, Occupations Code, is amended by
adding Subchapter F to read as follows:
SUBCHAPTER F. DIRECT PRIMARY CARE
Sec. 162.251. 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.
(3) "Medical service agreement" means a signed written
agreement under which a physician agrees to provide direct primary
care services for a patient in exchange for a direct fee for a
period of time that is entered into by the physician and:
(A) the patient;
(B) the patient's legal representative,
guardian, or employer on behalf of the patient; or
(C) the patient's legal representative's or
guardian's employer on behalf of the patient.
(4) "Physician" includes a professional association
or professional limited liability company owned entirely by an
individual licensed under this subtitle.
(5) "Primary medical care service" means a routine or
general health care service of the type provided at the time a
patient seeks preventive care or first seeks health care services
for a specific health concern, is a patient's main source for
regular health care services, and includes:
(A) promoting and maintaining mental and
physical health and wellness;
(B) preventing disease;
(C) screening, diagnosing, and treating acute or
chronic conditions caused by disease, injury, or illness;
(D) providing patient counseling and education;
and
(E) providing a broad spectrum of preventive and
curative health care over a period of time.
Sec. 162.252. APPLICABILITY OF SUBCHAPTER. This subchapter
does not apply to workers' compensation insurance coverage as
defined by Section 401.011, Labor Code.
Sec. 162.253. DIRECT PRIMARY CARE NOT INSURANCE. (a) A
physician providing direct primary care is not an insurer or health
maintenance organization, and the physician is not subject to
regulation by the Texas Department of Insurance for the direct
primary care.
(b) A medical service agreement is not health or accident
insurance or coverage under Title 8, Insurance Code, and is not
subject to regulation by the Texas Department of Insurance.
(c) A physician is not required to obtain a certificate of
authority under the Insurance Code to market, sell, or offer a
medical service agreement or provide direct primary care.
(d) A physician providing direct primary care does not
violate Section 1204.055, Insurance Code.
Sec. 162.254. BILLING INSURER OR HEALTH MAINTENANCE
ORGANIZATION PROHIBITED. A physician may not bill an insurer or
health maintenance organization for direct primary care that is
paid under a medical service agreement.
Sec. 162.255. INTERFERENCE PROHIBITED. (a) The board or
another state agency may not prohibit, interfere with, initiate a
legal or administrative proceeding against, or impose a fine or
penalty against:
(1) a physician solely because the physician provides
direct primary care; or
(2) a person solely because the person pays a direct
fee for direct primary care.
(b) A health insurer, health maintenance organization, or
health care provider as that term is defined by Section 105.001 may
not prohibit, interfere with, or initiate a legal proceeding
against:
(1) a physician solely because the physician provides
direct primary care; or
(2) a person solely because the person pays a direct
fee for direct primary care.
SECTION 2. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2015.