88R23974 MEW-F
By: Frank, Harless, Collier H.B. No. 633
Substitute the following for H.B. No. 633:
By: Harless C.S.H.B. No. 633
A BILL TO BE ENTITLED
AN ACT
relating to the method of payment for certain health care provided
by a hospital.
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 HOSPITAL
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. The term does not
include:
(A) the state Medicaid program, including the
Medicaid managed care program operated under Chapter 533,
Government Code;
(B) the child health plan program operated under
Chapter 62, Health and Safety Code; or
(C) Medicare benefits.
(3) "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.
(4) "Hospital" means a public or private institution
licensed under Chapter 241, Health and Safety Code. The term does
not include an ambulatory surgical center licensed under Chapter
243, Health and Safety Code.
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) At the request of a patient, including a
patient who is an enrollee, and subject to Subsection (b), a
hospital must accept directly from the patient full payment for a
health care service provided in the hospital. If the payment is
made by an enrollee, the hospital must accept that payment in lieu
of submitting a claim to the enrollee's health benefit plan.
(b) A request under Subsection (a) must be made not later
than the 60th day after the date on which the health care service is
provided.
(c) Notwithstanding Section 552.003 or any other law, the
amount of the payment for a health care service for which a hospital
accepts payment as described by Subsection (a) for a service
provided in the hospital may not exceed the lowest contracted rate
for the health care service that the hospital has agreed to accept
as payment in full as a contracted, preferred, or participating
provider of a health benefit plan.
SECTION 2. This Act takes effect September 1, 2023.