89R3195 RDR-D
By: Shaheen H.B. No. 541
A BILL TO BE ENTITLED
AN ACT
relating to the provision of direct patient care by physicians and
health care practitioners.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter F, Chapter 162, Occupations Code, is
transferred to Subtitle A, Title 3, Occupations Code, redesignated
as Chapter 117, Occupations Code, and amended to read as follows:
CHAPTER 117 [SUBCHAPTER F]. DIRECT PATIENT [PRIMARY] CARE
Sec. 117.001 [162.251]. DEFINITIONS. In this chapter
[subchapter]:
(1) "Direct fee" means a fee charged by a physician or
health care practitioner to a patient or a patient's designee for
health [primary medical] care services provided by, or to be
provided by, the physician or practitioner 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 direct patient care [medical
service] agreement; or
(E) fee for a service, visit, or episode of care.
(2) "Direct patient [primary] care" means a health
[primary medical] care service provided by a physician or health
care practitioner to a patient in return for payment in accordance
with a direct fee. The term includes telemedicine medical services
and telehealth services, as those terms are defined by Section
111.001, provided using a technology platform.
(3) "Direct patient care agreement" means a signed
written agreement under which a physician or health care
practitioner agrees to provide health care services to a patient in
exchange for a direct fee for a period of time that is entered into
by the physician or practitioner and:
(A) the patient;
(B) the patient's legal representative,
guardian, or employer on behalf of the patient; or
(C) the patient's legal representative's or
guardian's employer on behalf of the patient.
(4) "Health care practitioner" means an individual who
holds a license, certificate, permit, or other authorization issued
under this title to engage in a health care profession and who
provides health care in the ordinary course of business or practice
of a profession. The term does not include a physician.
(5) "Health care service" means any care, service, or
procedure provided by a physician or health care practitioner. The
term includes any medical or psychological diagnosis, treatment,
evaluation, advice, or other service that affects the structure or
function of the human body ["Medical service agreement" means a
signed written agreement under which a physician agrees to provide
direct primary care services for a patient in exchange for a direct
fee for a period of time that is entered into by the physician and:
[(A) the patient;
[(B) the patient's legal representative,
guardian, or employer on behalf of the patient; or
[(C) the patient's legal representative's or
guardian's employer on behalf of the patient].
(6) [(4)] "Physician" means a person licensed to
practice medicine in this state. The term includes a professional
association or professional limited liability company owned
entirely by an individual licensed under Subtitle B [this
subtitle].
[(5) "Primary medical care service" means a routine or
general health care service of the type provided at the time a
patient seeks preventive care or first seeks health care services
for a specific health concern, is a patient's main source for
regular health care services, and includes:
[(A) promoting and maintaining mental and
physical health and wellness;
[(B) preventing disease;
[(C) screening, diagnosing, and treating acute
or chronic conditions caused by disease, injury, or illness;
[(D) providing patient counseling and education;
and
[(E) providing a broad spectrum of preventive and
curative health care over a period of time.]
Sec. 117.002 [162.252]. APPLICABILITY OF CHAPTER
[SUBCHAPTER]. This chapter [subchapter] does not apply to workers'
compensation insurance coverage as defined by Section 401.011,
Labor Code.
Sec. 117.003 [162.253]. DIRECT PATIENT [PRIMARY] CARE NOT
INSURANCE. (a) A physician or health care practitioner providing
direct patient [primary] care is not an insurer or health
maintenance organization, and the physician or practitioner is not
subject to regulation by the Texas Department of Insurance for the
direct patient [primary] care.
(b) A direct patient care [medical service] agreement is not
health or accident insurance or coverage under Title 8, Insurance
Code, and is not subject to regulation by the Texas Department of
Insurance.
(c) A physician or health care practitioner is not required
to obtain a certificate of authority under the Insurance Code to
market, sell, or offer a direct patient care [medical service]
agreement or provide direct patient [primary] care.
(d) A physician or health care practitioner providing
direct patient [primary] care does not violate Section 1204.055,
Insurance Code.
Sec. 117.004 [162.254]. BILLING INSURER OR HEALTH
MAINTENANCE ORGANIZATION PROHIBITED. A physician or health care
practitioner may not bill an insurer or health maintenance
organization for direct patient [primary] care that is paid under a
direct patient care [medical service] agreement.
Sec. 117.005 [162.255]. INTERFERENCE PROHIBITED. (a) The
Texas Medical Board [board] or another state agency may not
prohibit, interfere with, initiate a legal or administrative
proceeding against, or impose a fine or penalty against:
(1) a physician or health care practitioner solely
because the physician or practitioner provides direct patient
[primary] care; or
(2) a person solely because the person pays a direct
fee for direct patient [primary] care.
(b) A health insurer, health maintenance organization, or
health care provider as that term is defined by Section 105.001
may not prohibit, interfere with, or initiate a legal proceeding
against:
(1) a physician or health care practitioner solely
because the physician or practitioner provides direct patient
[primary] care; or
(2) a person solely because the person pays a direct
fee for direct patient [primary] care.
Sec. 117.006 [162.256]. REQUIRED DISCLOSURE. A physician
or health care practitioner providing direct patient [primary] care
shall provide written or electronic notice to the patient that a
direct patient care [medical service] agreement for direct patient
[primary] care is not insurance, prior to entering into the
agreement.
SECTION 2. The changes in law made by this Act apply only to
an agreement entered into on or after the effective date of this
Act. An agreement entered into before the effective date of this
Act is governed by the law applicable to the agreement immediately
before the effective date of this Act, and that law is continued in
effect for that purpose.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2025.