By: Bonnen H.B. No. 5186
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to certain limitations on reimbursements paid for
  inpatient and outpatient hospital services for certain publicly
  funded health benefit plan coverage for employees and retirees.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1551.205, Insurance Code, is amended to
  read as follows:
         Sec. 1551.205.  MAXIMUM RATES FOR FACILITIES; LIMITATIONS.
  (a) Disregarding any contradictory contract terms or any other law
  to the contrary, any facility, as such term is defined by Section
  324.001 of the Health and Safety Code, that bills the group benefits
  program, its administering firm, carrier, or their designee, for
  health care services provided to an enrolled employee or dependent
  will never be entitled to a rate for such health care services thats
  exceed the rate established in the applicable rider in the General
  Appropriations Act, Article I, Employees Retirement System of
  Texas.
         (b)  A facility shall not discriminate against an employee or
  dependent, or against the program, by refusing to participate in an
  administering firm’s or health coverage plan’s network, or by
  refusing to serve an employee or dependent, or by providing health
  care services of a lower standard and quality to an employee or
  dependent than what the facility provides to other similar
  patients, because of the maximum rating schedule imposed by
  subsection (a) of this section.
         (c)  The board of trustees may not contract for or provide a
  coverage plan that:
               (1)  excludes or limits coverage or services for
  acquired immune deficiency syndrome, as defined by the Centers for
  Disease Control and Prevention of the United States Public Health
  Service, or human immunodeficiency virus infection;
               (2)  provides coverage for serious mental illness that
  is less extensive than the coverage provided for any physical
  illness; or
               (3)  may provide coverage for prescription drugs to
  assist in stopping smoking at a lower benefit level than is provided
  for other prescription drugs.
         SECTION 2.  Section 1575.104, Insurance Code, is amended to
  read as follows:
         Sec. 1575.104.  TERMS OF CONTRACT; MAXIMUM RATES FOR
  FACILITIES. (a) A contract for group coverage awarded by the
  trustee must meet the minimum benefit and financial standards
  adopted by the trustee.
         (b)  Disregarding any contradictory contract terms or any
  other law to the contrary, any facility, as such term is defined by
  Section 324.001 of the Health and Safety Code, that bills the group
  program, its administrator, carrier, or their designee, for health
  care services provided to an enrolled retiree or dependent will
  never be entitled to a rate for such health care services that
  exceeds the rate established in the applicable rider in the General
  Appropriations Act, Article III, Teacher Retirement System.
         (c)  A facility shall not discriminate against a retiree or
  dependent, or against the group program, by refusing to participate
  in a group program administrator’s or carrier’s network, or by
  refusing to serve a retiree or dependent, or by providing health
  care services of a lower standard and quality to a retiree or
  dependent than what the facility provides to other similar
  patients, because of the maximum rating schedule imposed by
  subsection (b) of this section.
         SECTION 3.  Subchapter B, Chapter 1579, Insurance Code, is
  amended by adding Section 1579.0511, Insurance Code, to read as
  follows:
         Sec. 1579.0511.  MAXIMUM RATES FOR FACILITIES. (a)
  Disregarding any contradictory contract terms or any other law to
  the contrary, any facility, as such term is defined by Section
  324.001 of the Health and Safety Code, that bills the program, its
  administering firm, health coverage plan, or their designee, for
  health care services provided to an enrolled employee or dependent
  will never be entitled to a rate for such health care services that
  exceeds the rate established in the applicable rider in the General
  Appropriations Act, Article III, Teacher Retirement System.
         (b)  A facility shall not discriminate against an employee or
  dependent, or against the program, by refusing to participate in an
  administering firm’s or health coverage plan’s network, or by
  refusing to serve an employee or dependent, or by providing health
  care services of a lower standard and quality to an employee or
  dependent than what the facility provides to other similar
  patients, because of the maximum rating schedule imposed by
  subsection (a) of this section.
         SECTION 4.  Subchapter B of Chapter 1601, Insurance Code, is
  amended by adding Section 1601.0581, Insurance Code, to read as
  follows:
         Sec. 1601.0581.  MAXIMUM RATES FOR FACILITIES. (a)
  Disregarding any contradictory contract terms or any other law to
  the contrary, any facility, as such term is defined by Section
  324.001 of the Health and Safety Code, that bills the uniform
  program, its administering carrier, or their designee, for health
  care services provided to an enrolled employee, retiree, or
  dependent will never be entitled to a rate for such health care
  services that exceeds the rate established in the applicable rider
  in the General Appropriations Act, Article III, University of Texas
  System and Texas A&M University System.
         (b)  A facility shall not discriminate against an employee,
  retiree, or dependent, or against the uniform program, by refusing
  to participate in an administering carrier’s network, or by
  refusing to serve an employee, retiree, or dependent, or by
  providing health care services of a lower standard and quality to an
  employee, retiree, or dependent than what the facility provides to
  other similar patients, because of the maximum rating schedule
  imposed by subsection (a) of this section.
         SECTION 4.  The maximum rating schedules imposed by Section
  1551.202, Insurance Code, Section 1575.104, Insurance Code, as
  amended by this Act, Section 1579.0511, Insurance Code, and Section
  1601.0581, Insurance Code, as added by this Act, shall apply to any
  bill for health care services provided by a facility with dates of
  service beginning on or after September 1, 2024.
         SECTION 5.  This Act takes effect September 1, 2023.