HB1612 - Relating to direct payment for certain health care provided by a hospital.

      H.B. No. 1612         AN ACT   relating to direct payment for certain health care provided by a   hospital.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subchapter A, Chapter 311, Health and Safety   Code, is amended by adding Section 311.006 to read as follows:           Sec.   311.006.     DIRECT PAYMENT TO HOSPITAL. (a)   In this   section:                 (1)     "Enrollee" means an individual who is enrolled in   a health benefit plan or otherwise entitled to coverage under a   health benefit plan.                 (2)     "Health benefit plan" means any individual or   group arrangement with a public or private entity under which the   entity will pay for, reimburse expenses for, or otherwise contract   with a health care provider for the provision of health care   services, supplies, or devices to a patient. The term includes an   arrangement with:                       (A)  an insurance company;                       (B)     the sponsor or administrator of a   self-insured health benefit plan;                       (C)     a group hospital service corporation   operating under Chapter 842, Insurance Code;                       (D)     a health maintenance organization operating   under Chapter 843, Insurance Code;                       (E)     the state Medicaid program, including the   Medicaid managed care program operating under Chapter 540,   Government Code;                       (F)     a health benefit plan offered or administered   by or on behalf of this state or a political subdivision of this   state or an agency or instrumentality of the state or a political   subdivision of this state, including:                             (i)     a basic coverage plan under Chapter   1551, Insurance Code;                             (ii)     a basic plan under Chapter 1575,   Insurance Code;                             (iii)     a primary care coverage plan under   Chapter 1579, Insurance Code; and                             (iv)     a plan providing basic coverage under   Chapter 1601, Insurance Code; or                       (G)     any other entity providing a health insurance   or health benefit plan subject to regulation by the Texas   Department of Insurance.                 (3)     "Health care service" means a service to diagnose,   prevent, alleviate, cure, or heal a human illness or injury that is   provided to an individual by a physician or other health care   provider.                 (4)     "Hospital" means a public or private institution   licensed under Chapter 241. The term does not include an ambulatory   surgical center licensed under Chapter 243.           (b)     At the request of a patient who is not an enrollee, and   subject to Subsection (c), a hospital must accept directly from the   patient full payment for a health care service provided by the   hospital.           (c)     A request under Subsection (b) must be made not later   than the 60th day after the date on which the patient receives a   bill for or other final accounting of the health care service   provided.   The bill or other final accounting must notify the   patient of the ability to make a request under Subsection (b).           (d)     Notwithstanding Section 552.003, Insurance Code, or any   other law, in accepting payments as described by Subsection (b) for   health care services provided by the hospital, a hospital may   charge patients amounts that are either:                 (1)     not more than 25 percent greater than the amounts   generally billed, as defined by 26 C.F.R. Section 1.501(r)-1, for a   health care service; or                 (2)     not more than 50 percent greater than the lowest   contracted rate for a health care service that the hospital has   agreed to accept as payment in full as a contracted, preferred, or   participating provider of a health benefit plan other than:                       (A)     the state Medicaid program, including the   Medicaid managed care program operated under Chapter 540,   Government Code;                       (B)     the child health plan program operated under   Chapter 62; or                       (C)  Medicare benefits.           (e)     Nothing in this section precludes a patient from   receiving from a hospital charity care that the patient would   otherwise qualify for or be entitled to.          SECTION 2.  This Act takes effect September 1, 2025.       ______________________________ ______________________________      President of the Senate Speaker of the House                   I certify that H.B. No. 1612 was passed by the House on May 1,   2025, by the following vote:  Yeas 139, Nays 5, 1 present, not   voting.     ______________________________   Chief Clerk of the House                 I certify that H.B. No. 1612 was passed by the Senate on May   25, 2025, by the following vote:  Yeas 31, Nays 0.     ______________________________   Secretary of the Senate       APPROVED:  _____________________                      Date                           _____________________                    Governor