Texas 2021 - 87th Regular

Texas House Bill HB1527 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	87R5121 SCL-D
2	2	By: Gates H.B. No. 1527
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the establishment of a bundled-pricing program to
8	8	reduce certain health care costs in the school employees and
9	9	retirees group benefits programs.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Chapter 1575, Insurance Code, is amended by
12	12	adding Subchapter L to read as follows:
13	13	SUBCHAPTER L. BUNDLED-PRICING PROGRAM
14	14	Sec. 1575.551. BUNDLED-PRICING PROGRAM. (a) The trustee
15	15	shall develop a cost-positive bundled-pricing program for health
16	16	benefit plans provided under the group program.
17	17	(b) The bundled-pricing program must be designed to reduce
18	18	health care costs in the group program by contracting with a health
19	19	care facility, physician, or health care provider at a consolidated
20	20	rate for an inpatient or outpatient surgery procedure that is a
21	21	covered health care or medical service under a health benefit plan
22	22	provided under the group program.
23	23	(c) A consolidated rate described by Subsection (b) must
24	24	include all fees related to the covered surgery procedure,
25	25	including fees for a facility, physician, health care provider,
26	26	laboratory, prescription drug, or pharmacy service.
27	27	Sec. 1575.552. PARTICIPATION; COST-SHARING OBLIGATION.
28	28	(a) An enrollee may have an inpatient or outpatient surgery
29	29	procedure under the bundled-pricing program.
30	30	(b) Except as provided by Subsection (c), the trustee or a
31	31	health care facility, physician, or health care provider may not
32	32	require an enrollee to pay a deductible, copayment, coinsurance, or
33	33	other cost-sharing obligation for a covered surgery procedure
34	34	provided under the bundled-pricing program.
35	35	(c) The trustee may require an enrollee in the high
36	36	deductible health plan established under Section 1575.158 to meet
37	37	the enrollee's deductible before the plan pays for a covered
38	38	surgery procedure provided under the bundled-pricing program.
39	39	Sec. 1575.553. PROVIDER PARTICIPATION. (a) A health care
40	40	facility, physician, or health care provider is not required to
41	41	participate in the bundled-pricing program.
42	42	(b) A health care facility may not coerce a facility-based
43	43	provider, as defined by Section 1575.172, to participate in the
44	44	bundled-pricing program or accept a lower rate for an inpatient or
45	45	outpatient surgery procedure.
46	46	Sec. 1575.554. PROMPT PAYMENT. The trustee shall ensure
47	47	that a health care facility, physician, or health care provider
48	48	that participates in the bundled-pricing program receives payment
49	49	for a covered surgery procedure not later than the 30th day after
50	50	the date the administrator receives a claim for the procedure that
51	51	includes all information necessary for the administrator to pay the
52	52	claim.
53	53	Sec. 1575.555. BUNDLED-PRICING DISCLOSURE. A health care
54	54	facility, physician, or health care provider that participates in
55	55	the bundled-pricing program may disclose a consolidated rate for an
56	56	inpatient or outpatient surgery procedure on the facility's,
57	57	physician's, or provider's Internet website and marketing
58	58	materials.
59	59	Sec. 1575.556. PUBLICATION OF INFORMATION. The trustee
60	60	shall publish information on the bundled-pricing program,
61	61	including a list of participating health care facilities,
62	62	physicians, and health care providers, on the Teacher Retirement
63	63	System of Texas website.
64	64	Sec. 1575.557. RULEMAKING. The trustee may adopt rules as
65	65	necessary to implement this subchapter.
66	66	SECTION 2. Chapter 1579, Insurance Code, is amended by
67	67	adding Subchapter H to read as follows:
68	68	SUBCHAPTER H. BUNDLED-PRICING PROGRAM
69	69	Sec. 1579.351. BUNDLED-PRICING PROGRAM. (a) The trustee
70	70	shall develop a cost-positive bundled-pricing program for health
71	71	coverage plans provided under the program.
72	72	(b) The bundled-pricing program must be designed to reduce
73	73	health care costs in the program by contracting with a health care
74	74	facility, physician, or health care provider at a consolidated rate
75	75	for an inpatient or outpatient surgery procedure that is a covered
76	76	health care or medical service under a health coverage plan
77	77	provided under the program.
78	78	(c) A consolidated rate described by Subsection (b) must
79	79	include all fees related to the covered surgery procedure,
80	80	including fees for a facility, physician, health care provider,
81	81	laboratory, prescription drug, or pharmacy service.
82	82	Sec. 1579.352. PARTICIPATION; COST-SHARING OBLIGATION.
83	83	(a) An enrollee may have an inpatient or outpatient surgery
84	84	procedure under the bundled-pricing program.
85	85	(b) The trustee or a health care facility, physician, or
86	86	health care provider may not require an enrollee to pay a
87	87	deductible, copayment, coinsurance, or other cost-sharing
88	88	obligation for a covered surgery procedure provided under the
89	89	bundled-pricing program.
90	90	Sec. 1579.353. PROVIDER PARTICIPATION. (a) A health care
91	91	facility, physician, or health care provider is not required to
92	92	participate in the bundled-pricing program.
93	93	(b) A health care facility may not coerce a facility-based
94	94	provider, as defined by Section 1579.110, to participate in the
95	95	bundled-pricing program or accept a lower rate for an inpatient or
96	96	outpatient surgery procedure.
97	97	Sec. 1579.354. PROMPT PAYMENT. The trustee shall ensure
98	98	that a health care facility, physician, or health care provider
99	99	that participates in the bundled-pricing program receives payment
100	100	for a covered surgery procedure not later than the 30th day after
101	101	the date the administrator receives a claim for the procedure that
102	102	includes all information necessary for the administrator to pay the
103	103	claim.
104	104	Sec. 1579.355. BUNDLED-PRICING DISCLOSURE. A health care
105	105	facility, physician, or health care provider that participates in
106	106	the bundled-pricing program may disclose a consolidated rate for an
107	107	inpatient or outpatient surgery procedure on the facility's,
108	108	physician's, or provider's Internet website and marketing
109	109	materials.
110	110	Sec. 1579.356. PUBLICATION OF INFORMATION. The trustee
111	111	shall publish information on the bundled-pricing program,
112	112	including a list of participating health care facilities,
113	113	physicians, and health care providers, on the Teacher Retirement
114	114	System of Texas website.
115	115	Sec. 1579.357. RULEMAKING. The trustee may adopt rules as
116	116	necessary to implement this subchapter.
117	117	SECTION 3. This Act takes effect September 1, 2021.