Texas 2025 - 89th Regular

Texas House Bill HB3150 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R8495 SCF-F
2	2	By: Paul H.B. No. 3150
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to billing and reimbursement for certain medical
10	10	equipment, devices, and supplies provided to Medicare enrollees;
11	11	creating a criminal offense.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Subtitle C, Title 5, Insurance Code, is amended
14	14	by adding Chapter 566 to read as follows:
15	15	CHAPTER 566. BILLING FOR CERTAIN MEDICAL EQUIPMENT, DEVICES, AND
16	16	SUPPLIES
17	17	SUBCHAPTER A. GENERAL PROVISIONS
18	18	Sec. 566.001. DEFINITIONS. In this chapter:
19	19	(1) "Assignment" means an agreement in which a
20	20	supplier agrees to accept the Medicare-approved amount as payment
21	21	for medical equipment or a medical device or supply.
22	22	(2) "Durable medical equipment" means medical
23	23	equipment that:
24	24	(A) can withstand repeated use;
25	25	(B) is expected to last at least three years;
26	26	(C) is primarily and customarily used to serve a
27	27	medical purpose;
28	28	(D) is generally not useful in the absence of an
29	29	illness or injury; and
30	30	(E) is appropriate for use in the home.
31	31	(3) "Enrollee" means an individual enrolled in
32	32	Medicare.
33	33	(4) "Medicare" means the health benefit coverage
34	34	provided under the Health Insurance for the Aged Act (42 U.S.C.
35	35	Section 1395 et seq.).
36	36	(5) "Nonparticipating supplier" means an entity or
37	37	person who:
38	38	(A) provides Medicare-covered durable medical
39	39	equipment, orthotic devices or supplies, or prosthetic devices or
40	40	supplies to Medicare enrollees; and
41	41	(B) is not enrolled in Medicare as a
42	42	participating supplier.
43	43	(6) "Orthotic device or supply" means:
44	44	(A) a custom-fitted or custom-fabricated medical
45	45	device designed to correct a deformity, improve function, or
46	46	relieve symptoms of a disease; or
47	47	(B) a medical supply related to a device
48	48	described by Paragraph (A).
49	49	(7) "Prosthetic device or supply" means:
50	50	(A) an artificial medical device designed to
51	51	replace all or part of a limb or internal organ; or
52	52	(B) a medical supply related to a device
53	53	described by Paragraph (A).
54	54	SUBCHAPTER B. REGULATION OF CERTAIN BILLING PRACTICES
55	55	Sec. 566.051. LIMITATIONS ON BILLING; NOTICE. (a) A
56	56	nonparticipating supplier may not charge an enrollee more than 115
57	57	percent of the Medicare-approved amount for durable medical
58	58	equipment, orthotic devices or supplies, or prosthetic devices or
59	59	supplies covered under Medicare for which the supplier has not
60	60	accepted written assignment unless:
61	61	(1) before the enrollee is billed, the enrollee agrees
62	62	in writing to pay the additional amount; and
63	63	(2) before receiving the durable medical equipment,
64	64	orthotic device or supply, or prosthetic device or supply, the
65	65	enrollee pays the additional amount in full.
66	66	(b) A written agreement between a nonparticipating supplier
67	67	and enrollee under this section must provide notice to the enrollee
68	68	that:
69	69	(1) Medicare will reimburse 80 percent of the
70	70	Medicare-approved amount for durable medical equipment, orthotic
71	71	devices or supplies, or prosthetic devices or supplies covered
72	72	under Medicare; and
73	73	(2) a Medicare supplement benefit plan issuer is not
74	74	required to reimburse the nonparticipating supplier or enrollee for
75	75	the amount by which the charge exceeds 115 percent of the
76	76	Medicare-approved amount.
77	77	SUBCHAPTER C. ENFORCEMENT
78	78	Sec. 566.101. APPLICATION OF DECEPTIVE TRADE PRACTICES LAW.
79	79	A nonparticipating supplier who violates this chapter engages in a
80	80	false, misleading, or deceptive act or practice under Section
81	81	17.46, Business & Commerce Code.
82	82	Sec. 566.102. CRIMINAL OFFENSE. (a) A nonparticipating
83	83	supplier who intentionally violates this chapter commits an
84	84	offense.
85	85	(b) An offense under this section is a misdemeanor
86	86	punishable by a fine of not less than $500 or more than $1,000.
87	87	(c) Notwithstanding any other law, an offense under this
88	88	section may be prosecuted in:
89	89	(1) Travis County; or
90	90	(2) a county in which prosecution is authorized under
91	91	the Code of Criminal Procedure.
92	92	SECTION 2. Subchapter B, Chapter 1652, Insurance Code, is
93	93	amended by adding Section 1652.059 to read as follows:
94	94	Sec. 1652.059. REIMBURSEMENT FOR CERTAIN MEDICAL
95	95	EQUIPMENT, DEVICES, AND SUPPLIES. (a) In this section, terms
96	96	defined by Section 566.001 have the meanings assigned by that
97	97	section.
98	98	(b) A Medicare supplement benefit plan issuer is not
99	99	required to reimburse an enrollee or nonparticipating supplier for
100	100	the amount by which a charge for durable medical equipment,
101	101	orthotic devices or supplies, or prosthetic devices or supplies
102	102	exceeds 115 percent of the Medicare-allowed amount for the
103	103	equipment, device, or supply.
104	104	(c) This section does not prohibit a Medicare supplement
105	105	benefit plan issuer and a nonparticipating supplier from
106	106	negotiating a level and type of reimbursement for durable medical
107	107	equipment or orthotic or prosthetic devices or supplies.
108	108	SECTION 3. Chapter 566, Insurance Code, as added by this
109	109	Act, applies only to durable medical equipment or orthotic or
110	110	prosthetic devices or supplies sold on or after the effective date
111	111	of this Act.
112	112	SECTION 4. This Act takes effect September 1, 2025.