By: Alders H.B. No. 3015
A BILL TO BE ENTITLED
AN ACT
relating to the inclusion of direct primary care fees as qualified
medical expenses applied toward insurance deductibles in certain
state health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1551, Insurance Code, is amended by
adding Subchapter K to read as follows:
SUBCHAPTER K. DIRECT PRIMARY CARE SERVICES
Sec. 1551.501. DEFINITIONS. In this subchapter:
(1) "Direct fee" means a fee charged by a physician to a
patient or a patient's designee for primary medical care services
provided by, or to be provided by, the physician to the patient.
The term includes a fee in any form, including a:
(A) monthly retainer;
(B) membership fee;
(C) subscription fee;
(D) fee paid under a medical service agreement; or
(E) fee for a service, visit, or episode of care.
(2) "Direct primary care" means a primary medical care
service provided by a physician to a patient in return for payment
in accordance with a direct fee. The term include telemedicine
medical services and telehealth services, as those terms are
defined by Section 111.001, Occupations Code, provided using a
technology platform.
Sec. 1551.502. INCLUSION OF DIRECT PRIMARY CARE FEES AS
QUALIFIED MEDICAL EXPENSES. (a) Direct fees paid to a direct
primary care provider shall apply to the deductible of a
participant enrolled in the basic coverage provided under the
Employees Retirement System of Texas.
(b) The board of trustees shall adopt rules necessary to
implement this section.
SECTION 2. Chapter 1575, Insurance Code, is amended by
adding Subchapter L to read as follows:
SUBCHAPTER L. DIRECT PRIMARY CARE SERVICES
Sec. 1575.601. DEFINITIONS. In this subchapter:
(1) "Direct fee" means a fee charged by a physician to a
patient or a patient's designee for primary medical care services
provided by, or to be provided by, the physician to the patient.
The term includes a fee in any form, including a:
(A) monthly retainer;
(B) membership fee;
(C) subscription fee;
(D) fee paid under a medical service agreement; or
(E) fee for a service, visit, or episode of care.
(2) "Direct primary care" means a primary medical care
service provided by a physician to a patient in return for payment
in accordance with a direct fee. The term include telemedicine
medical services and telehealth services, as those terms are
defined by Section 111.001, Occupations Code, provided using a
technology platform.
Sec. 1575.602. INCLUSION OF DIRECT PRIMARY CARE FEES AS
QUALIFIED MEDICAL EXPENSES. (a) Direct fees paid to a direct
primary care provider shall apply to the deductible of a
participant enrolled in the basic coverage provided under the
Teacher Retirement System of Texas.
(b) The trustee shall adopt rules necessary to implement
this section.
SECTION 3. This Act applies only to a health benefit plan
delivered, issued for delivery, or renewed on or after January 1,
2026.
SECTION 4. This Act takes effect September 1, 2025.