88R1398 MEW-F
By: Frank H.B. No. 633
A BILL TO BE ENTITLED
AN ACT
relating to the method of payment for certain health care.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1204, Insurance Code, is amended by
adding Subchapter G to read as follows:
SUBCHAPTER G. DIRECT PAYMENT OF PHYSICIAN OR HEALTH CARE PROVIDER
Sec. 1204.301. DEFINITIONS. In this subchapter:
(1) "Enrollee" means an individual who is enrolled in
a health benefit plan or otherwise entitled to coverage under a
health benefit plan.
(2) "Health benefit plan" means an individual, group,
blanket, or franchise insurance policy, a group hospital service
contract, or an individual or group subscriber contract or evidence
of coverage issued by a health maintenance organization, that
provides benefits for health care services.
(3) "Health care provider" means a person who provides
health care services under a license, certificate, registration, or
other similar evidence of regulation issued by this or another
state of the United States.
(4) "Health care service" means a service to diagnose,
prevent, alleviate, cure, or heal a human illness or injury that is
provided to an individual by a physician or other health care
provider.
(5) "Physician" means an individual licensed to
practice medicine in this or another state of the United States.
Sec. 1204.302. APPLICABILITY TO CERTAIN PLANS. In addition
to the health benefit plans described by Section 1204.301,
notwithstanding any other law, this subchapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) a plan providing basic coverage under Chapter
1601.
Sec. 1204.303. PAYMENT IN LIEU OF CLAIM FOR BENEFITS; OTHER
DIRECT PAYMENTS. (a) A physician or health care provider may not
be prohibited from accepting directly from an enrollee full payment
for a health care service in lieu of submitting a claim to the
enrollee's health benefit plan.
(b) Notwithstanding Section 552.003 or any other law, the
charge for a health care service for which a physician or health
care provider accepts a payment as described by Subsection (a) or
from a patient without a health benefit plan may not exceed the
lowest contract rate for the health care service allowable under
any health benefit plan with respect to which the physician or
health care provider is a contracted, preferred, or participating
provider.
SECTION 2. This Act takes effect September 1, 2023.