Texas Senate Bill SB1112

Texas 2025 - 89th Regular

• Filed: 2/5/25

Caption

Relating to the determination of fees, charges, and rates for certain benefits under Medicaid.

Impact

With the proposed changes, SB1112 could inherently influence financial policies related to Medicaid, particularly in how medical providers set their charges for services. By excluding fees associated with membership discount programs from the calculation of usual and customary rates, the bill seeks to ensure that Medicaid reimbursements are based on standard charges that prevail in the community rather than artificially discounted rates. This could lead to increased clarity in billing practices and financial expectations for providers participating in Medicaid.

Summary

Senate Bill 1112 addresses the parameters surrounding the determination of fees, charges, and rates concerning specific benefits under Medicaid in Texas. The bill aims to standardize the approach taken by state agencies when assessing the usual and customary fees for medical assistance. SB1112 states that unless limited by state or federal law, the fees charged for medical services must reflect what is generally prevalent in the community. This is intended to ensure that providers are compensated fairly based on local market conditions.

Contention

Notably, there may be contention around the implementation of SB1112 due to its emphasis on potentially limiting the inclusion of various fee models currently utilized by healthcare providers. Critics might argue that it could disadvantage certain groups or healthcare models that rely on fee-based membership discounts, possibly affecting accessibility to care for low-income residents. Furthermore, the bill stipulates that if federal authorization or waiver is necessary before implementing certain provisions, this could raise concerns about delays or complications in executing the new standards, making the bill's practical effects contingent on federal cooperation.

Texas Constitutional Statutes Affected

Human Resources Code

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