By: Bonnen H.B. No. 5186
A BILL TO BE ENTITLED
AN ACT
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.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1551.205, Insurance Code, is amended to
read as follows:
Sec. 1551.205. MAXIMUM RATES FOR FACILITIES; LIMITATIONS.
(a) Disregarding any contradictory contract terms or any other law
to the contrary, any facility, as such term is defined by Section
324.001 of the Health and Safety Code, that bills the group benefits
program, its administering firm, carrier, or their designee, for
health care services provided to an enrolled employee or dependent
will never be entitled to a rate for such health care services thats
exceed the rate established in the applicable rider in the General
Appropriations Act, Article I, Employees Retirement System of
Texas.
(b) A facility shall not discriminate against an employee or
dependent, or against the program, by refusing to participate in an
administering firm’s or health coverage plan’s network, or by
refusing to serve an employee or dependent, or by providing health
care services of a lower standard and quality to an employee or
dependent than what the facility provides to other similar
patients, because of the maximum rating schedule imposed by
subsection (a) of this section.
(c) The board of trustees may not contract for or provide a
coverage plan that:
(1) excludes or limits coverage or services for
acquired immune deficiency syndrome, as defined by the Centers for
Disease Control and Prevention of the United States Public Health
Service, or human immunodeficiency virus infection;
(2) provides coverage for serious mental illness that
is less extensive than the coverage provided for any physical
illness; or
(3) may provide coverage for prescription drugs to
assist in stopping smoking at a lower benefit level than is provided
for other prescription drugs.
SECTION 2. Section 1575.104, Insurance Code, is amended to
read as follows:
Sec. 1575.104. TERMS OF CONTRACT; MAXIMUM RATES FOR
FACILITIES. (a) A contract for group coverage awarded by the
trustee must meet the minimum benefit and financial standards
adopted by the trustee.
(b) Disregarding any contradictory contract terms or any
other law to the contrary, any facility, as such term is defined by
Section 324.001 of the Health and Safety Code, that bills the group
program, its administrator, carrier, or their designee, for health
care services provided to an enrolled retiree or dependent will
never be entitled to a rate for such health care services that
exceeds the rate established in the applicable rider in the General
Appropriations Act, Article III, Teacher Retirement System.
(c) A facility shall not discriminate against a retiree or
dependent, or against the group program, by refusing to participate
in a group program administrator’s or carrier’s network, or by
refusing to serve a retiree or dependent, or by providing health
care services of a lower standard and quality to a retiree or
dependent than what the facility provides to other similar
patients, because of the maximum rating schedule imposed by
subsection (b) of this section.
SECTION 3. Subchapter B, Chapter 1579, Insurance Code, is
amended by adding Section 1579.0511, Insurance Code, to read as
follows:
Sec. 1579.0511. MAXIMUM RATES FOR FACILITIES. (a)
Disregarding any contradictory contract terms or any other law to
the contrary, any facility, as such term is defined by Section
324.001 of the Health and Safety Code, that bills the program, its
administering firm, health coverage plan, or their designee, for
health care services provided to an enrolled employee or dependent
will never be entitled to a rate for such health care services that
exceeds the rate established in the applicable rider in the General
Appropriations Act, Article III, Teacher Retirement System.
(b) A facility shall not discriminate against an employee or
dependent, or against the program, by refusing to participate in an
administering firm’s or health coverage plan’s network, or by
refusing to serve an employee or dependent, or by providing health
care services of a lower standard and quality to an employee or
dependent than what the facility provides to other similar
patients, because of the maximum rating schedule imposed by
subsection (a) of this section.
SECTION 4. Subchapter B of Chapter 1601, Insurance Code, is
amended by adding Section 1601.0581, Insurance Code, to read as
follows:
Sec. 1601.0581. MAXIMUM RATES FOR FACILITIES. (a)
Disregarding any contradictory contract terms or any other law to
the contrary, any facility, as such term is defined by Section
324.001 of the Health and Safety Code, that bills the uniform
program, its administering carrier, or their designee, for health
care services provided to an enrolled employee, retiree, or
dependent will never be entitled to a rate for such health care
services that exceeds the rate established in the applicable rider
in the General Appropriations Act, Article III, University of Texas
System and Texas A&M University System.
(b) A facility shall not discriminate against an employee,
retiree, or dependent, or against the uniform program, by refusing
to participate in an administering carrier’s network, or by
refusing to serve an employee, retiree, or dependent, or by
providing health care services of a lower standard and quality to an
employee, retiree, or dependent than what the facility provides to
other similar patients, because of the maximum rating schedule
imposed by subsection (a) of this section.
SECTION 4. The maximum rating schedules imposed by Section
1551.202, Insurance Code, Section 1575.104, Insurance Code, as
amended by this Act, Section 1579.0511, Insurance Code, and Section
1601.0581, Insurance Code, as added by this Act, shall apply to any
bill for health care services provided by a facility with dates of
service beginning on or after September 1, 2024.
SECTION 5. This Act takes effect September 1, 2023.