Texas 2023 - 88th Regular

Texas House Bill HB4352 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R6000 SCP-F
2	2	By: Harrison H.B. No. 4352
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to hospital-owned outpatient facilities, including the
8	8	adoption of site-neutral reimbursement rates under Medicaid.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subchapter A, Chapter 311, Health and Safety
11	11	Code, is amended by adding Section 311.005 to read as follows:
12	12	Sec. 311.005. ACQUISITION OF OUTPATIENT HEALTH CARE
13	13	FACILITIES. (a) In this section:
14	14	(1) "Commission" means the Health and Human Services
15	15	Commission.
16	16	(2) "Hospital" means a hospital licensed under Chapter
17	17	241.
18	18	(b) A hospital that acquires an outpatient health care
19	19	facility shall provide written notice of the acquisition to the
20	20	office of the attorney general and the commission.
21	21	SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
22	22	is amended by adding Section 32.0286 to read as follows:
23	23	Sec. 32.0286. SITE-NEUTRAL REIMBURSEMENT RATE FOR
24	24	OUTPATIENT SERVICES. (a) In this section, "hospital-owned
25	25	outpatient facility" means a department, unit, clinic, or other
26	26	facility or organization that is either created by or acquired by a
27	27	hospital provider for the purpose of furnishing outpatient
28	28	services. The term includes a hospital outpatient department.
29	29	(b) Notwithstanding any other law, the commission shall
30	30	ensure that the Medicaid reimbursement rate for outpatient services
31	31	provided by a hospital-owned outpatient facility is the same as the
32	32	reimbursement rate for outpatient services provided by an
33	33	independent, physician-owned practice if:
34	34	(1) the outpatient services are not dependent on
35	35	technology associated with the facility; and
36	36	(2) evidence-based rationale does not support a
37	37	different reimbursement rate for a specific outpatient service.
38	38	SECTION 3. (a) In this section:
39	39	(1) "Commission" means the Health and Human Services
40	40	Commission.
41	41	(2) "Department" means the Texas Department of
42	42	Insurance.
43	43	(3) "Medicaid" means the medical assistance program
44	44	established under Chapter 32, Human Resources Code.
45	45	(b) The department, in consultation with the commission and
46	46	the office of the attorney general, shall conduct a study on the
47	47	feasibility and advisability of expanding the policy under Section
48	48	32.0286, Human Resources Code, as added by this Act, to commercial
49	49	health benefit plan issuers in this state by prohibiting those
50	50	issuers from providing provider-based billing rates for outpatient
51	51	services that are greater than the rates provided to independent,
52	52	physician-owned practices providing the same outpatient services.
53	53	(c) Not later than September 1, 2024, the department shall
54	54	prepare and submit to the legislature and the standing committees
55	55	of the legislature with primary jurisdiction over insurance and
56	56	Medicaid a report containing the results of the study conducted
57	57	under Subsection (b) of this section and any recommendations for
58	58	legislative or other action. The report must include an estimate
59	59	of the projected cost savings to health care consumers in this
60	60	state, if any, that would result from implementation of a
61	61	site-neutral payment policy for outpatient services by commercial
62	62	health benefit plan issuers in this state.
63	63	SECTION 4. Not later than January 1, 2024, the executive
64	64	commissioner of the Health and Human Services Commission shall
65	65	adopt or amend rules as necessary to comply with Section 32.0286,
66	66	Human Resources Code, as added by this Act.
67	67	SECTION 5. Section 311.005, Health and Safety Code, as
68	68	added by this Act, applies only to a hospital's acquisition of an
69	69	outpatient facility on or after the effective date of this Act.
70	70	SECTION 6. If before implementing any provision of this Act
71	71	a state agency determines that a waiver or authorization from a
72	72	federal agency is necessary for implementation of that provision,
73	73	the agency affected by the provision shall request the waiver or
74	74	authorization and may delay implementing that provision until the
75	75	waiver or authorization is granted.
76	76	SECTION 7. This Act takes effect September 1, 2023.