Texas 2025 - 89th Regular

Texas House Bill HB541 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1	89R3195 RDR-D
2	2	By: Shaheen H.B. No. 541
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the provision of direct patient care by physicians and
10	10	health care practitioners.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subchapter F, Chapter 162, Occupations Code, is
13	13	transferred to Subtitle A, Title 3, Occupations Code, redesignated
14	14	as Chapter 117, Occupations Code, and amended to read as follows:
15	15	CHAPTER 117 [SUBCHAPTER F]. DIRECT PATIENT [PRIMARY] CARE
16	16	Sec. 117.001 [162.251]. DEFINITIONS. In this chapter
17	17	[subchapter]:
18	18	(1) "Direct fee" means a fee charged by a physician or
19	19	health care practitioner to a patient or a patient's designee for
20	20	health [primary medical] care services provided by, or to be
21	21	provided by, the physician or practitioner to the patient. The term
22	22	includes a fee in any form, including a:
23	23	(A) monthly retainer;
24	24	(B) membership fee;
25	25	(C) subscription fee;
26	26	(D) fee paid under a direct patient care [medical
27	27	service] agreement; or
28	28	(E) fee for a service, visit, or episode of care.
29	29	(2) "Direct patient [primary] care" means a health
30	30	[primary medical] care service provided by a physician or health
31	31	care practitioner to a patient in return for payment in accordance
32	32	with a direct fee. The term includes telemedicine medical services
33	33	and telehealth services, as those terms are defined by Section
34	34	111.001, provided using a technology platform.
35	35	(3) "Direct patient care agreement" means a signed
36	36	written agreement under which a physician or health care
37	37	practitioner agrees to provide health care services to a patient in
38	38	exchange for a direct fee for a period of time that is entered into
39	39	by the physician or practitioner and:
40	40	(A) the patient;
41	41	(B) the patient's legal representative,
42	42	guardian, or employer on behalf of the patient; or
43	43	(C) the patient's legal representative's or
44	44	guardian's employer on behalf of the patient.
45	45	(4) "Health care practitioner" means an individual who
46	46	holds a license, certificate, permit, or other authorization issued
47	47	under this title to engage in a health care profession and who
48	48	provides health care in the ordinary course of business or practice
49	49	of a profession. The term does not include a physician.
50	50	(5) "Health care service" means any care, service, or
51	51	procedure provided by a physician or health care practitioner. The
52	52	term includes any medical or psychological diagnosis, treatment,
53	53	evaluation, advice, or other service that affects the structure or
54	54	function of the human body ["Medical service agreement" means a
55	55	signed written agreement under which a physician agrees to provide
56	56	direct primary care services for a patient in exchange for a direct
57	57	fee for a period of time that is entered into by the physician and:
58	58	[(A) the patient;
59	59	[(B) the patient's legal representative,
60	60	guardian, or employer on behalf of the patient; or
61	61	[(C) the patient's legal representative's or
62	62	guardian's employer on behalf of the patient].
63	63	(6) [(4)] "Physician" means a person licensed to
64	64	practice medicine in this state. The term includes a professional
65	65	association or professional limited liability company owned
66	66	entirely by an individual licensed under Subtitle B [this
67	67	subtitle].
68	68	[(5) "Primary medical care service" means a routine or
69	69	general health care service of the type provided at the time a
70	70	patient seeks preventive care or first seeks health care services
71	71	for a specific health concern, is a patient's main source for
72	72	regular health care services, and includes:
73	73	[(A) promoting and maintaining mental and
74	74	physical health and wellness;
75	75	[(B) preventing disease;
76	76	[(C) screening, diagnosing, and treating acute
77	77	or chronic conditions caused by disease, injury, or illness;
78	78	[(D) providing patient counseling and education;
79	79	and
80	80	[(E) providing a broad spectrum of preventive and
81	81	curative health care over a period of time.]
82	82	Sec. 117.002 [162.252]. APPLICABILITY OF CHAPTER
83	83	[SUBCHAPTER]. This chapter [subchapter] does not apply to workers'
84	84	compensation insurance coverage as defined by Section 401.011,
85	85	Labor Code.
86	86	Sec. 117.003 [162.253]. DIRECT PATIENT [PRIMARY] CARE NOT
87	87	INSURANCE. (a) A physician or health care practitioner providing
88	88	direct patient [primary] care is not an insurer or health
89	89	maintenance organization, and the physician or practitioner is not
90	90	subject to regulation by the Texas Department of Insurance for the
91	91	direct patient [primary] care.
92	92	(b) A direct patient care [medical service] agreement is not
93	93	health or accident insurance or coverage under Title 8, Insurance
94	94	Code, and is not subject to regulation by the Texas Department of
95	95	Insurance.
96	96	(c) A physician or health care practitioner is not required
97	97	to obtain a certificate of authority under the Insurance Code to
98	98	market, sell, or offer a direct patient care [medical service]
99	99	agreement or provide direct patient [primary] care.
100	100	(d) A physician or health care practitioner providing
101	101	direct patient [primary] care does not violate Section 1204.055,
102	102	Insurance Code.
103	103	Sec. 117.004 [162.254]. BILLING INSURER OR HEALTH
104	104	MAINTENANCE ORGANIZATION PROHIBITED. A physician or health care
105	105	practitioner may not bill an insurer or health maintenance
106	106	organization for direct patient [primary] care that is paid under a
107	107	direct patient care [medical service] agreement.
108	108	Sec. 117.005 [162.255]. INTERFERENCE PROHIBITED. (a) The
109	109	Texas Medical Board [board] or another state agency may not
110	110	prohibit, interfere with, initiate a legal or administrative
111	111	proceeding against, or impose a fine or penalty against:
112	112	(1) a physician or health care practitioner solely
113	113	because the physician or practitioner provides direct patient
114	114	[primary] care; or
115	115	(2) a person solely because the person pays a direct
116	116	fee for direct patient [primary] care.
117	117	(b) A health insurer, health maintenance organization, or
118	118	health care provider as that term is defined by Section 105.001
119	119	may not prohibit, interfere with, or initiate a legal proceeding
120	120	against:
121	121	(1) a physician or health care practitioner solely
122	122	because the physician or practitioner provides direct patient
123	123	[primary] care; or
124	124	(2) a person solely because the person pays a direct
125	125	fee for direct patient [primary] care.
126	126	Sec. 117.006 [162.256]. REQUIRED DISCLOSURE. A physician
127	127	or health care practitioner providing direct patient [primary] care
128	128	shall provide written or electronic notice to the patient that a
129	129	direct patient care [medical service] agreement for direct patient
130	130	[primary] care is not insurance, prior to entering into the
131	131	agreement.
132	132	SECTION 2. The changes in law made by this Act apply only to
133	133	an agreement entered into on or after the effective date of this
134	134	Act. An agreement entered into before the effective date of this
135	135	Act is governed by the law applicable to the agreement immediately
136	136	before the effective date of this Act, and that law is continued in
137	137	effect for that purpose.
138	138	SECTION 3. This Act takes effect immediately if it receives
139	139	a vote of two-thirds of all the members elected to each house, as
140	140	provided by Section 39, Article III, Texas Constitution. If this
141	141	Act does not receive the vote necessary for immediate effect, this
142	142	Act takes effect September 1, 2025.