Texas House Bill HB985

Texas 2025 - 89th Regular

• Filed: 11/12/24

Caption

Relating to hospital-owned outpatient facilities, including site-neutral reimbursement rates under Medicaid.

Impact

The provisions of HB985 are expected to significantly influence healthcare financing by ensuring that reimbursement rates for outpatient services are consistent, regardless of the facility's ownership structure. By requiring the state health commission to enforce site-neutral reimbursement, the bill aims to minimize disparities in payment rates, which could lead to more competitive and fair pricing in the outpatient healthcare market. Additionally, a study will be conducted to explore the possibility of extending site-neutral policies to commercial health benefit plans, thus expanding the bill's impact beyond Medicaid to private insurance coverage as well.

Summary

House Bill 985 (HB985) aims to create regulations regarding hospital-owned outpatient facilities in Texas, particularly focusing on establishing site-neutral reimbursement rates under the Medicaid program. The bill mandates that hospitals notifying state authorities when they acquire outpatient facilities and promotes reimbursement equivalency between hospital-owned outpatient facilities and independent physician-owned practices, barring cases where technological dependence or differing medical rationale justifies higher rates. This approach intends to standardize payment mechanisms for outpatient services, thereby potentially lowering costs for patients and payers alike. The implementation of this bill is targeted to take effect on September 1, 2025.

Contention

While the bill has been framed as a means to enhance cost efficiency and accessibility in outpatient care, there are potential points of contention regarding how site-neutral reimbursement rates may affect the financial viability of hospital-owned outpatient facilities. Some argue that this could lead to reduced revenues for hospitals that rely on higher reimbursement rates to support their operations. Moreover, further examination of the bill's potential impacts on access to specialized outpatient services is necessary, as disparities in service availability could arise if hospitals opt to limit offerings in response to stricter reimbursement practices. The balance between cost control and maintaining comprehensive service access will be pivotal in evaluating the bill's overall effectiveness.

Texas Constitutional Statutes Affected

Health And Safety Code

• Chapter 311. Powers And Duties Of Hospitals
  • Section: New Section

Human Resources Code

• Chapter 32. Medical Assistance Program
  • Section: New Section