Texas 2023 - 88th Regular

Texas House Bill HB633 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R23974 MEW-F
2	2	By: Frank, Harless, Collier H.B. No. 633
3	3	Substitute the following for H.B. No. 633:
4	4	By: Harless C.S.H.B. No. 633
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the method of payment for certain health care provided
10	10	by a hospital.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 1204, Insurance Code, is amended by
13	13	adding Subchapter G to read as follows:
14	14	SUBCHAPTER G. DIRECT PAYMENT OF HOSPITAL
15	15	Sec. 1204.301. DEFINITIONS. In this subchapter:
16	16	(1) "Enrollee" means an individual who is enrolled in
17	17	a health benefit plan or otherwise entitled to coverage under a
18	18	health benefit plan.
19	19	(2) "Health benefit plan" means an individual, group,
20	20	blanket, or franchise insurance policy, a group hospital service
21	21	contract, or an individual or group subscriber contract or evidence
22	22	of coverage issued by a health maintenance organization, that
23	23	provides benefits for health care services. The term does not
24	24	include:
25	25	(A) the state Medicaid program, including the
26	26	Medicaid managed care program operated under Chapter 533,
27	27	Government Code;
28	28	(B) the child health plan program operated under
29	29	Chapter 62, Health and Safety Code; or
30	30	(C) Medicare benefits.
31	31	(3) "Health care service" means a service to diagnose,
32	32	prevent, alleviate, cure, or heal a human illness or injury that is
33	33	provided to an individual by a physician or other health care
34	34	provider.
35	35	(4) "Hospital" means a public or private institution
36	36	licensed under Chapter 241, Health and Safety Code. The term does
37	37	not include an ambulatory surgical center licensed under Chapter
38	38	243, Health and Safety Code.
39	39	Sec. 1204.302. APPLICABILITY TO CERTAIN PLANS. In addition
40	40	to the health benefit plans described by Section 1204.301,
41	41	notwithstanding any other law, this subchapter applies to:
42	42	(1) a basic coverage plan under Chapter 1551;
43	43	(2) a basic plan under Chapter 1575;
44	44	(3) a primary care coverage plan under Chapter 1579;
45	45	and
46	46	(4) a plan providing basic coverage under Chapter
47	47	1601.
48	48	Sec. 1204.303. PAYMENT IN LIEU OF CLAIM FOR BENEFITS; OTHER
49	49	DIRECT PAYMENTS. (a) At the request of a patient, including a
50	50	patient who is an enrollee, and subject to Subsection (b), a
51	51	hospital must accept directly from the patient full payment for a
52	52	health care service provided in the hospital. If the payment is
53	53	made by an enrollee, the hospital must accept that payment in lieu
54	54	of submitting a claim to the enrollee's health benefit plan.
55	55	(b) A request under Subsection (a) must be made not later
56	56	than the 60th day after the date on which the health care service is
57	57	provided.
58	58	(c) Notwithstanding Section 552.003 or any other law, the
59	59	amount of the payment for a health care service for which a hospital
60	60	accepts payment as described by Subsection (a) for a service
61	61	provided in the hospital may not exceed the lowest contracted rate
62	62	for the health care service that the hospital has agreed to accept
63	63	as payment in full as a contracted, preferred, or participating
64	64	provider of a health benefit plan.
65	65	SECTION 2. This Act takes effect September 1, 2023.