Texas 2025 - 89th Regular

Texas Senate Bill SB1330 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		By: Hancock S.B. No. 1330
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3		-
	2	+	(In the Senate - Filed February 14, 2025; February 28, 2025,
	3	+	read first time and referred to Committee on Health & Human
	4	+	Services; March 24, 2025, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 8, Nays 0;
	6	+	March 24, 2025, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 1330 By: Perry
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6	11		A BILL TO BE ENTITLED
7	12		AN ACT
8	13		relating to billing and reimbursement for certain medical
9	14		equipment, devices, and supplies provided to Medicare enrollees;
10	15		creating a criminal offense.
11	16		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	17		SECTION 1. Subtitle C, Title 5, Insurance Code, is amended
13	18		by adding Chapter 566 to read as follows:
14	19		CHAPTER 566. BILLING FOR CERTAIN MEDICAL EQUIPMENT, DEVICES, AND
15	20		SUPPLIES
16	21		SUBCHAPTER A. GENERAL PROVISIONS
17	22		Sec. 566.001. DEFINITIONS. In this chapter:
18	23		(1) "Assignment" means an agreement in which a
19	24		supplier agrees to accept the Medicare-approved amount as payment
20	25		for medical equipment or a medical device or supply.
21	26		(2) "Durable medical equipment" means medical
22	27		equipment that:
23	28		(A) can withstand repeated use;
24	29		(B) is expected to last at least three years;
25	30		(C) is primarily and customarily used to serve a
26	31		medical purpose;
27	32		(D) is generally not useful in the absence of an
28	33		illness or injury; and
29	34		(E) is appropriate for use in the home.
30	35		(3) "Enrollee" means an individual enrolled in
31	36		Medicare.
32	37		(4) "Medicare" means the health benefit coverage
33	38		provided under the Health Insurance for the Aged Act (42 U.S.C.
34	39		Section 1395 et seq.).
35	40		(5) "Nonparticipating supplier" means an entity or
36	41		person who:
37	42		(A) provides Medicare-covered durable medical
38	43		equipment, orthotic devices or supplies, or prosthetic devices or
39	44		supplies to Medicare enrollees; and
40	45		(B) is not enrolled in Medicare as a
41	46		participating supplier.
42	47		(6) "Orthotic device or supply" means:
43	48		(A) a custom-fitted or custom-fabricated medical
44	49		device designed to correct a deformity, improve function, or
45	50		relieve symptoms of a disease; or
46	51		(B) a medical supply related to a device
47	52		described by Paragraph (A).
48	53		(7) "Prosthetic device or supply" means:
49	54		(A) an artificial medical device designed to
50	55		replace all or part of a limb or internal organ; or
51	56		(B) a medical supply related to a device
52	57		described by Paragraph (A).
53	58		SUBCHAPTER B. REGULATION OF CERTAIN BILLING PRACTICES
54	59		Sec. 566.051. LIMITATIONS ON BILLING; NOTICE. (a) A
55	60		nonparticipating supplier may not charge an enrollee more than 115
56	61		percent of the Medicare-approved amount for durable medical
57	62		equipment, orthotic devices or supplies, or prosthetic devices or
58	63		supplies covered under Medicare for which the supplier has not
59	64		accepted written assignment unless:
60	65		(1) before the enrollee is billed, the enrollee agrees
61	66		in writing to pay the additional amount; and
62	67		(2) before receiving the durable medical equipment,
63	68		orthotic device or supply, or prosthetic device or supply, the
64	69		enrollee:
65	70		(A) enters into a rental payment plan; or
66	71		(B) pays the additional amount in full.
67	72		(b) A written agreement between a nonparticipating supplier
68	73		and enrollee under this section must provide notice to the enrollee
69	74		that:
70	75		(1) Medicare will reimburse 80 percent of the
71	76		Medicare-approved amount for durable medical equipment, orthotic
72	77		devices or supplies, or prosthetic devices or supplies covered
73	78		under Medicare; and
74	79		(2) a Medicare supplement benefit plan issuer is not
75	80		required to reimburse the nonparticipating supplier or enrollee for
76	81		the amount by which the charge exceeds 115 percent of the
77	82		Medicare-approved amount.
78	83		SUBCHAPTER C. ENFORCEMENT
79	84		Sec. 566.101. APPLICATION OF DECEPTIVE TRADE PRACTICES LAW.
80	85		A nonparticipating supplier who violates this chapter engages in a
81	86		false, misleading, or deceptive act or practice under Section
82	87		17.46, Business & Commerce Code.
83	88		Sec. 566.102. CRIMINAL OFFENSE. (a) A nonparticipating
84	89		supplier who intentionally violates this chapter commits an
85	90		offense.
86	91		(b) An offense under this section is a misdemeanor
87	92		punishable by a fine of not less than $500 or more than $1,000.
88	93		(c) Notwithstanding any other law, an offense under this
89	94		section may be prosecuted in:
90	95		(1) Travis County; or
91	96		(2) a county in which prosecution is authorized under
92	97		the Code of Criminal Procedure.
93	98		SECTION 2. Subchapter B, Chapter 1652, Insurance Code, is
94	99		amended by adding Section 1652.059 to read as follows:
95	100		Sec. 1652.059. REIMBURSEMENT FOR CERTAIN MEDICAL
96	101		EQUIPMENT, DEVICES, AND SUPPLIES. (a) In this section, terms
97	102		defined by Section 566.001 have the meanings assigned by that
98	103		section.
99	104		(b) A Medicare supplement benefit plan issuer is not
100	105		required to reimburse an enrollee or nonparticipating supplier for
101	106		the amount by which a charge for durable medical equipment,
102	107		orthotic devices or supplies, or prosthetic devices or supplies
103	108		exceeds 115 percent of the Medicare-allowed amount for the
104	109		equipment, device, or supply.
105	110		(c) This section does not prohibit a Medicare supplement
106	111		benefit plan issuer and a nonparticipating supplier from
107	112		negotiating a level and type of reimbursement for durable medical
108	113		equipment or orthotic or prosthetic devices or supplies.
109	114		SECTION 3. Chapter 566, Insurance Code, as added by this
110	115		Act, applies only to durable medical equipment or orthotic or
111	116		prosthetic devices or supplies sold on or after the effective date
112	117		of this Act.
113	118		SECTION 4. This Act takes effect September 1, 2025.
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