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A BILL TO BE ENTITLED
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AN ACT
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relating to the establishment of a bundled-pricing program to |
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reduce certain health care costs in the state employees group |
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benefits program. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1551, Insurance Code, is amended by |
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adding Subchapter K to read as follows: |
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SUBCHAPTER K. BUNDLED-PRICING PROGRAM |
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Sec. 1551.501. BUNDLED-PRICING PROGRAM. (a) The board of |
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trustees shall develop a cost-positive bundled-pricing program for |
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health benefit plans provided under the group benefits program. |
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(b) The bundled-pricing program must be designed to reduce |
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health care costs in the group benefits program by contracting with |
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a health care facility, physician, or health care provider at a |
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consolidated rate for an inpatient or outpatient surgery procedure |
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that is a covered health care or medical service under a health |
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benefit plan provided under the group benefits program. |
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(c) A consolidated rate described by Subsection (b) must |
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include all fees related to the covered surgery procedure, |
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including fees for a facility, physician, health care provider, |
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laboratory, prescription drug, or pharmacy service. |
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Sec. 1551.502. PARTICIPATION; COST-SHARING OBLIGATION. |
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(a) A participant may have an inpatient or outpatient surgery |
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procedure under the bundled-pricing program. |
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(b) Except as provided by Subsection (c), the board of |
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trustees or a health care facility, physician, or health care |
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provider may not require a participant to pay a deductible, |
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copayment, coinsurance, or other cost-sharing obligation for a |
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covered surgery procedure provided under the bundled-pricing |
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program. |
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(c) The board of trustees may require a participant in the |
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state consumer-directed health plan established under Section |
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1551.452 to meet the participant's deductible before the plan pays |
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for a covered surgery procedure provided under the bundled-pricing |
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program. |
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Sec. 1551.503. PROVIDER PARTICIPATION. (a) A health care |
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facility, physician, or health care provider is not required to |
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participate in the bundled-pricing program. |
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(b) A health care facility may not coerce a facility-based |
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provider, as defined by Section 1551.229, to participate in the |
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bundled-pricing program or accept a lower rate for an inpatient or |
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outpatient surgery procedure. |
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Sec. 1551.504. PROMPT PAYMENT. The board of trustees shall |
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ensure that a health care facility, physician, or health care |
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provider that participates in the bundled-pricing program receives |
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payment for a covered surgery procedure not later than the 30th day |
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after the date the administrator receives a claim for the procedure |
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that includes all information necessary for the administrator to |
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pay the claim. |
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Sec. 1551.505. BUNDLED-PRICING DISCLOSURE. A health care |
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facility, physician, or health care provider that participates in |
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the bundled-pricing program may disclose a consolidated rate for an |
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inpatient or outpatient surgery procedure on the facility's, |
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physician's, or provider's Internet website and marketing |
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materials. |
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Sec. 1551.506. PUBLICATION OF INFORMATION. The board of |
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trustees shall publish information on the bundled-pricing program, |
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including a list of participating health care facilities, |
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physicians, and health care providers, on the Employees Retirement |
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System of Texas website. |
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Sec. 1551.507. RULEMAKING. The board of trustees may adopt |
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rules as necessary to implement this subchapter. |
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SECTION 2. This Act takes effect September 1, 2021. |