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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of direct patient care by physicians and |
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health care practitioners. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter F, Chapter 162, Occupations Code, is |
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transferred to Subtitle A, Title 3, Occupations Code, redesignated |
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as Chapter 117, Occupations Code, and amended to read as follows: |
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CHAPTER 117 [SUBCHAPTER F]. DIRECT PATIENT [PRIMARY] CARE |
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Sec. 117.001 [162.251]. DEFINITIONS. In this chapter |
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[subchapter]: |
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(1) "Direct fee" means a fee charged by a physician or |
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health care practitioner to a patient or a patient's designee for |
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health [primary medical] care services provided by, or to be |
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provided by, the physician or practitioner to the patient. The term |
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includes a fee in any form, including a: |
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(A) monthly retainer; |
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(B) membership fee; |
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(C) subscription fee; |
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(D) fee paid under a direct patient care [medical |
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service] agreement; or |
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(E) fee for a service, visit, or episode of care. |
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(2) "Direct patient [primary] care" means a health |
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[primary medical] care service provided by a physician or health |
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care practitioner to a patient in return for payment in accordance |
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with a direct fee. The term includes telemedicine medical services |
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and telehealth services, as those terms are defined by Section |
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111.001, provided using a technology platform. |
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(3) "Direct patient care agreement" means a signed |
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written agreement under which a physician or health care |
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practitioner agrees to provide health care services to a patient in |
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exchange for a direct fee for a period of time that is entered into |
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by the physician or practitioner and: |
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(A) the patient; |
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(B) the patient's legal representative, |
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guardian, or employer on behalf of the patient; or |
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(C) the patient's legal representative's or |
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guardian's employer on behalf of the patient. |
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(4) "Health care practitioner" means an individual who |
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holds a license, certificate, permit, or other authorization issued |
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under this title to engage in a health care profession and who |
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provides health care in the ordinary course of business or practice |
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of a profession. The term does not include a physician. |
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(5) "Health care service" means any care, service, or |
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procedure provided by a physician or health care practitioner. The |
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term includes any medical or psychological diagnosis, treatment, |
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evaluation, advice, or other service that affects the structure or |
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function of the human body ["Medical service agreement" means a |
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signed written agreement under which a physician agrees to provide |
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direct primary care services for a patient in exchange for a direct |
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fee for a period of time that is entered into by the physician and: |
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[(A) the patient; |
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[(B) the patient's legal representative, |
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guardian, or employer on behalf of the patient; or |
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[(C) the patient's legal representative's or |
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guardian's employer on behalf of the patient]. |
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(6) [(4)] "Physician" means a person licensed to |
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practice medicine in this state. The term includes a professional |
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association or professional limited liability company owned |
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entirely by an individual licensed under Subtitle B [this |
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subtitle]. |
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[(5) "Primary medical care service" means a routine or |
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general health care service of the type provided at the time a |
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patient seeks preventive care or first seeks health care services |
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for a specific health concern, is a patient's main source for |
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regular health care services, and includes: |
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[(A) promoting and maintaining mental and |
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physical health and wellness; |
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[(B) preventing disease; |
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[(C) screening, diagnosing, and treating acute |
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or chronic conditions caused by disease, injury, or illness; |
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[(D) providing patient counseling and education; |
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and |
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[(E) providing a broad spectrum of preventive and |
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curative health care over a period of time.] |
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Sec. 117.002 [162.252]. APPLICABILITY OF CHAPTER |
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[SUBCHAPTER]. This chapter [subchapter] does not apply to workers' |
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compensation insurance coverage as defined by Section 401.011, |
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Labor Code. |
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Sec. 117.003 [162.253]. DIRECT PATIENT [PRIMARY] CARE NOT |
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INSURANCE. (a) A physician or health care practitioner providing |
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direct patient [primary] care is not an insurer or health |
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maintenance organization, and the physician or practitioner is not |
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subject to regulation by the Texas Department of Insurance for the |
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direct patient [primary] care. |
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(b) A direct patient care [medical service] agreement is not |
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health or accident insurance or coverage under Title 8, Insurance |
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Code, and is not subject to regulation by the Texas Department of |
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Insurance. |
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(c) A physician or health care practitioner is not required |
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to obtain a certificate of authority under the Insurance Code to |
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market, sell, or offer a direct patient care [medical service] |
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agreement or provide direct patient [primary] care. |
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(d) A physician or health care practitioner providing |
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direct patient [primary] care does not violate Section 1204.055, |
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Insurance Code. |
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Sec. 117.004 [162.254]. BILLING INSURER OR HEALTH |
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MAINTENANCE ORGANIZATION PROHIBITED. A physician or health care |
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practitioner may not bill an insurer or health maintenance |
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organization for direct patient [primary] care that is paid under a |
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direct patient care [medical service] agreement. |
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Sec. 117.005 [162.255]. INTERFERENCE PROHIBITED. (a) The |
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Texas Medical Board [board] or another state agency may not |
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prohibit, interfere with, initiate a legal or administrative |
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proceeding against, or impose a fine or penalty against: |
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(1) a physician or health care practitioner solely |
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because the physician or practitioner provides direct patient |
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[primary] care; or |
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(2) a person solely because the person pays a direct |
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fee for direct patient [primary] care. |
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(b) A health insurer, health maintenance organization, or |
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health care provider as that term is defined by Section 105.001 |
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may not prohibit, interfere with, or initiate a legal proceeding |
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against: |
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(1) a physician or health care practitioner solely |
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because the physician or practitioner provides direct patient |
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[primary] care; or |
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(2) a person solely because the person pays a direct |
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fee for direct patient [primary] care. |
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Sec. 117.006 [162.256]. REQUIRED DISCLOSURE. A physician |
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or health care practitioner providing direct patient [primary] care |
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shall provide written or electronic notice to the patient that a |
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direct patient care [medical service] agreement for direct patient |
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[primary] care is not insurance, prior to entering into the |
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agreement. |
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SECTION 2. The changes in law made by this Act apply only to |
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an agreement entered into on or after the effective date of this |
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Act. An agreement entered into before the effective date of this |
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Act is governed by the law applicable to the agreement immediately |
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before the effective date of this Act, and that law is continued in |
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effect for that purpose. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2025. |