87R5121 SCL-D
By: Gates H.B. No. 1527
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of a bundled-pricing program to
reduce certain health care costs in the school employees and
retirees group benefits programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1575, Insurance Code, is amended by
adding Subchapter L to read as follows:
SUBCHAPTER L. BUNDLED-PRICING PROGRAM
Sec. 1575.551. BUNDLED-PRICING PROGRAM. (a) The trustee
shall develop a cost-positive bundled-pricing program for health
benefit plans provided under the group program.
(b) The bundled-pricing program must be designed to reduce
health care costs in the group program by contracting with a health
care facility, physician, or health care provider at a consolidated
rate for an inpatient or outpatient surgery procedure that is a
covered health care or medical service under a health benefit plan
provided under the group program.
(c) A consolidated rate described by Subsection (b) must
include all fees related to the covered surgery procedure,
including fees for a facility, physician, health care provider,
laboratory, prescription drug, or pharmacy service.
Sec. 1575.552. PARTICIPATION; COST-SHARING OBLIGATION.
(a) An enrollee may have an inpatient or outpatient surgery
procedure under the bundled-pricing program.
(b) Except as provided by Subsection (c), the trustee or a
health care facility, physician, or health care provider may not
require an enrollee to pay a deductible, copayment, coinsurance, or
other cost-sharing obligation for a covered surgery procedure
provided under the bundled-pricing program.
(c) The trustee may require an enrollee in the high
deductible health plan established under Section 1575.158 to meet
the enrollee's deductible before the plan pays for a covered
surgery procedure provided under the bundled-pricing program.
Sec. 1575.553. PROVIDER PARTICIPATION. (a) A health care
facility, physician, or health care provider is not required to
participate in the bundled-pricing program.
(b) A health care facility may not coerce a facility-based
provider, as defined by Section 1575.172, to participate in the
bundled-pricing program or accept a lower rate for an inpatient or
outpatient surgery procedure.
Sec. 1575.554. PROMPT PAYMENT. The trustee shall ensure
that a health care facility, physician, or health care provider
that participates in the bundled-pricing program receives payment
for a covered surgery procedure not later than the 30th day after
the date the administrator receives a claim for the procedure that
includes all information necessary for the administrator to pay the
claim.
Sec. 1575.555. BUNDLED-PRICING DISCLOSURE. A health care
facility, physician, or health care provider that participates in
the bundled-pricing program may disclose a consolidated rate for an
inpatient or outpatient surgery procedure on the facility's,
physician's, or provider's Internet website and marketing
materials.
Sec. 1575.556. PUBLICATION OF INFORMATION. The trustee
shall publish information on the bundled-pricing program,
including a list of participating health care facilities,
physicians, and health care providers, on the Teacher Retirement
System of Texas website.
Sec. 1575.557. RULEMAKING. The trustee may adopt rules as
necessary to implement this subchapter.
SECTION 2. Chapter 1579, Insurance Code, is amended by
adding Subchapter H to read as follows:
SUBCHAPTER H. BUNDLED-PRICING PROGRAM
Sec. 1579.351. BUNDLED-PRICING PROGRAM. (a) The trustee
shall develop a cost-positive bundled-pricing program for health
coverage plans provided under the program.
(b) The bundled-pricing program must be designed to reduce
health care costs in the program by contracting with a health care
facility, physician, or health care provider at a consolidated rate
for an inpatient or outpatient surgery procedure that is a covered
health care or medical service under a health coverage plan
provided under the program.
(c) A consolidated rate described by Subsection (b) must
include all fees related to the covered surgery procedure,
including fees for a facility, physician, health care provider,
laboratory, prescription drug, or pharmacy service.
Sec. 1579.352. PARTICIPATION; COST-SHARING OBLIGATION.
(a) An enrollee may have an inpatient or outpatient surgery
procedure under the bundled-pricing program.
(b) The trustee or a health care facility, physician, or
health care provider may not require an enrollee to pay a
deductible, copayment, coinsurance, or other cost-sharing
obligation for a covered surgery procedure provided under the
bundled-pricing program.
Sec. 1579.353. PROVIDER PARTICIPATION. (a) A health care
facility, physician, or health care provider is not required to
participate in the bundled-pricing program.
(b) A health care facility may not coerce a facility-based
provider, as defined by Section 1579.110, to participate in the
bundled-pricing program or accept a lower rate for an inpatient or
outpatient surgery procedure.
Sec. 1579.354. PROMPT PAYMENT. The trustee shall ensure
that a health care facility, physician, or health care provider
that participates in the bundled-pricing program receives payment
for a covered surgery procedure not later than the 30th day after
the date the administrator receives a claim for the procedure that
includes all information necessary for the administrator to pay the
claim.
Sec. 1579.355. BUNDLED-PRICING DISCLOSURE. A health care
facility, physician, or health care provider that participates in
the bundled-pricing program may disclose a consolidated rate for an
inpatient or outpatient surgery procedure on the facility's,
physician's, or provider's Internet website and marketing
materials.
Sec. 1579.356. PUBLICATION OF INFORMATION. The trustee
shall publish information on the bundled-pricing program,
including a list of participating health care facilities,
physicians, and health care providers, on the Teacher Retirement
System of Texas website.
Sec. 1579.357. RULEMAKING. The trustee may adopt rules as
necessary to implement this subchapter.
SECTION 3. This Act takes effect September 1, 2021.