Texas 2025 - 89th Regular

Texas House Bill HB985 Compare Versions

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

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1	1	By: Harrison H.B. No. 985
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6	6	A BILL TO BE ENTITLED
7	7	AN ACT
8	8	relating to hospital-owned outpatient facilities, including
9	9	site-neutral reimbursement rates under Medicaid.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter A, Chapter 311, Health and Safety
12	12	Code, is amended by adding Section 311.006 to read as follows:
13	13	Sec. 311.006. ACQUISITION OF OUTPATIENT HEALTH CARE
14	14	FACILITIES. (a) In this section:
15	15	(1) "Commission" means the Health and Human Services
16	16	Commission.
17	17	(2) "Hospital" means a hospital licensed under Chapter
18	18	241.
19	19	(b) A hospital that acquires an outpatient health care
20	20	facility shall provide written notice of the acquisition to the
21	21	office of the attorney general and the commission.
22	22	SECTION 2. Subchapter B, Chapter 32, Human Resources Code,
23	23	is amended by adding Section 32.0286 to read as follows:
24	24	Sec. 32.0286. SITE-NEUTRAL REIMBURSEMENT RATE FOR
25	25	OUTPATIENT SERVICES. (a) In this section, "hospital-owned
26	26	outpatient facility" means a department, unit, clinic, or other
27	27	facility or organization that a hospital provider either creates or
28	28	acquires for the purpose of furnishing outpatient services. The
29	29	term includes a hospital outpatient department.
30	30	(b) Notwithstanding any other law, the commission shall
31	31	ensure the Medicaid reimbursement rate for outpatient services
32	32	provided by a hospital-owned outpatient facility is the same as the
33	33	reimbursement rate for outpatient services an independent,
34	34	physician-owned practice provides if:
35	35	(1) the outpatient services are not dependent on
36	36	technology associated with the facility; and
37	37	(2) evidence-based rationale does not support a
38	38	different reimbursement rate for a specific outpatient service.
39	39	SECTION 3. (a) In this section:
40	40	(1) "Commission" means the Health and Human Services
41	41	Commission.
42	42	(2) "Department" means the Texas Department of
43	43	Insurance.
44	44	(3) "Medicaid" means the medical assistance program
45	45	established under Chapter 32, Human Resources Code.
46	46	(b) The department, in consultation with the commission and
47	47	the office of the attorney general, shall conduct a study on the
48	48	feasibility and advisability of expanding the policy under Section
49	49	32.0286, Human Resources Code, as added by this Act, to commercial
50	50	health benefit plan issuers in this state by prohibiting the
51	51	issuers from providing provider-based billing rates for outpatient
52	52	services that are greater than the rates provided to independent,
53	53	physician-owned practices providing the same outpatient services.
54	54	(c) Not later than September 1, 2026, the department shall
55	55	prepare and submit to the legislature and the standing committees
56	56	of the legislature with primary jurisdiction over insurance and
57	57	Medicaid a report containing the results of the study conducted
58	58	under Subsection (b) of this section and any recommendations for
59	59	legislative or other action. The report must include an estimate of
60	60	any projected cost savings to health care consumers in this state
61	61	that would result from commercial health benefit plan issuers
62	62	implementing a site-neutral payment policy for outpatient
63	63	services.
64	64	SECTION 4. Not later than January 1, 2026, the executive
65	65	commissioner of the Health and Human Services Commission shall
66	66	adopt or amend rules as necessary to comply with Section 32.0286,
67	67	Human Resources Code, as added by this Act.
68	68	SECTION 5. Section 311.006, Health and Safety Code, as
69	69	added by this Act, applies only to a hospital's acquisition of an
70	70	outpatient facility on or after the effective date of this Act.
71	71	SECTION 6. If before implementing any provision of this Act
72	72	a state agency determines that a waiver or authorization from a
73	73	federal agency is necessary for implementation of that provision,
74	74	the agency affected by the provision shall request the waiver or
75	75	authorization and may delay implementing that provision until the
76	76	waiver or authorization is granted.
77	77	SECTION 7. This Act takes effect September 1, 2025.