HB3015 - Relating to the application of direct primary care fees to insurance deductibles in certain state health benefit plans.

      By: Alders, et al. H.B. No. 3015       A BILL TO BE ENTITLED   AN ACT   relating to the application of direct primary care fees to   insurance deductibles in certain state health benefit plans.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 1551, Insurance Code, is amended by   adding Subchapter K to read as follows:   SUBCHAPTER K. DIRECT PRIMARY CARE SERVICES           Sec. 1551.501.  DEFINITIONS. In this subchapter:                 (1)     "Direct fee" means a fee charged by a physician to   a patient or a patient's designee for primary medical care services   provided by, or to be provided by, the physician to the patient.   The term includes a fee in any form, including a:                       (A)  monthly retainer;                       (B)  membership fee;                       (C)  subscription fee;                       (D)     fee paid under a medical service agreement;   or                       (E)  fee for a service, visit, or episode of care.                 (2)     "Direct primary care" means a primary medical care   service provided by a physician to a patient in return for payment   in accordance with a direct fee. The term includes telemedicine   medical services and telehealth services, as those terms are   defined by Section 111.001, Occupations Code, provided using a   technology platform.           Sec.   1551.502.     APPLICATION OF DIRECT PRIMARY CARE FEES TO   DEDUCTIBLES. (a) A direct fee paid to a direct primary care   provider must apply to a participant's deductible for a health   benefit plan provided under the group benefits program.           (b)     Notwithstanding Subsection (a), if the board of   trustees believes that applying a direct fee paid to a direct   primary care provider for a participant's deductible under this   subchapter would cause the high deductible health plan, as that   term is defined by Section 223, Internal Revenue Code of 1986, to no   longer qualify for a health savings account under that section, the   board of trustees shall seek an opinion from the attorney general   regarding the applicability of this subchapter to that high   deductible health plan. If the attorney general confirms that the   high deductible health plan would be disqualified, this subchapter   will not apply to the high deductible health plan.          SECTION 2.  Chapter 1575, Insurance Code, is amended by   adding Subchapter L to read as follows:   SUBCHAPTER L. DIRECT PRIMARY CARE SERVICES           Sec. 1575.551.  DEFINITIONS. In this subchapter:                 (1)     "Direct fee" means a fee charged by a physician to   a patient or a patient's designee for primary medical care services   provided by, or to be provided by, the physician to the patient.   The term includes a fee in any form, including a:                       (A)  monthly retainer;                       (B)  membership fee;                       (C)  subscription fee;                       (D)     fee paid under a medical service agreement;   or                       (E)  fee for a service, visit, or episode of care.                 (2)     "Direct primary care" means a primary medical care   service provided by a physician to a patient in return for payment   in accordance with a direct fee. The term includes telemedicine   medical services and telehealth services, as those terms are   defined by Section 111.001, Occupations Code, provided using a   technology platform.           Sec.   1575.552.     APPLICATION OF DIRECT PRIMARY CARE FEES TO   DEDUCTIBLES. (a) A direct fee paid to a direct primary care   provider must apply to an enrollee's deductible for a basic plan   provided under the group program.           (b)     Notwithstanding Subsection (a), if the trustee believes   that applying a direct fee paid to a direct primary care provider   for an enrollee's deductible under this subchapter would cause the   high deductible health plan, as that term is defined by Section 223,   Internal Revenue Code of 1986, to no longer qualify for a health   savings account under that section, the trustee shall seek an   opinion from the attorney general regarding the applicability of   this subchapter to that high deductible health plan.   If the   attorney general confirms that the high deductible health plan   would be disqualified, this subchapter will not apply to the high   deductible health plan.            SECTION 3.  Chapter 1579, Insurance Code, is amended by   adding Subchapter H to read as follows:   SUBCHAPTER H. DIRECT PRIMARY CARE SERVICES           Sec. 1579.351.  DEFINITIONS. In this subchapter:                 (1)     "Direct fee" means a fee charged by a physician to   a patient or a patient's designee for primary medical care services   provided by, or to be provided by, the physician to the patient.   The term includes a fee in any form, including a:                       (A)  monthly retainer;                       (B)  membership fee;                       (C)  subscription fee;                       (D)     fee paid under a medical service agreement;   or                       (E)  fee for a service, visit, or episode of care.                 (2)     "Direct primary care" means a primary medical care   service provided by a physician to a patient in return for payment   in accordance with a direct fee. The term includes telemedicine   medical services and telehealth services, as those terms are   defined by Section 111.001, Occupations Code, provided using a   technology platform.           Sec.   1579.352.     APPLICATION OF DIRECT PRIMARY CARE FEES TO   DEDUCTIBLES. (a) A direct fee paid to a direct primary care   provider must apply to an enrollee's deductible for a health   coverage plan provided under this chapter.           (b)     Notwithstanding Subsection (a), if the trustee believes   that applying a direct fee paid to a direct primary care provider   for an enrollee's deductible under this subchapter would cause the   high deductible health plan, as that term is defined by Section 223,   Internal Revenue Code of 1986, to no longer qualify for a health   savings account under that section, the trustee shall seek an   opinion from the attorney general regarding the applicability of   this subchapter to that high deductible health plan.   If the   attorney general confirms that the high deductible health plan   would be disqualified, this subchapter will not apply to the high   deductible health plan.          SECTION 4.  The changes in law made by this Act apply only to   a plan year that commences on or after January 1, 2026.          SECTION 5.  This Act takes effect September 1, 2025.