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A BILL TO BE ENTITLED
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AN ACT
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relating to hospital-owned outpatient facilities, including |
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site-neutral reimbursement rates under Medicaid. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 311, Health and Safety |
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Code, is amended by adding Section 311.006 to read as follows: |
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Sec. 311.006. ACQUISITION OF OUTPATIENT HEALTH CARE |
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FACILITIES. (a) In this section: |
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(1) "Commission" means the Health and Human Services |
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Commission. |
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(2) "Hospital" means a hospital licensed under Chapter |
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241. |
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(b) A hospital that acquires an outpatient health care |
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facility shall provide written notice of the acquisition to the |
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office of the attorney general and the commission. |
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SECTION 2. Subchapter B, Chapter 32, Human Resources Code, |
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is amended by adding Section 32.0286 to read as follows: |
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Sec. 32.0286. SITE-NEUTRAL REIMBURSEMENT RATE FOR |
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OUTPATIENT SERVICES. (a) In this section, "hospital-owned |
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outpatient facility" means a department, unit, clinic, or other |
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facility or organization that a hospital provider either creates or |
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acquires for the purpose of furnishing outpatient services. The |
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term includes a hospital outpatient department. |
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(b) Notwithstanding any other law, the commission shall |
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ensure the Medicaid reimbursement rate for outpatient services |
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provided by a hospital-owned outpatient facility is the same as the |
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reimbursement rate for outpatient services an independent, |
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physician-owned practice provides if: |
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(1) the outpatient services are not dependent on |
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technology associated with the facility; and |
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(2) evidence-based rationale does not support a |
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different reimbursement rate for a specific outpatient service. |
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SECTION 3. (a) In this section: |
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(1) "Commission" means the Health and Human Services |
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Commission. |
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(2) "Department" means the Texas Department of |
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Insurance. |
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(3) "Medicaid" means the medical assistance program |
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established under Chapter 32, Human Resources Code. |
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(b) The department, in consultation with the commission and |
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the office of the attorney general, shall conduct a study on the |
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feasibility and advisability of expanding the policy under Section |
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32.0286, Human Resources Code, as added by this Act, to commercial |
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health benefit plan issuers in this state by prohibiting the |
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issuers from providing provider-based billing rates for outpatient |
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services that are greater than the rates provided to independent, |
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physician-owned practices providing the same outpatient services. |
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(c) Not later than September 1, 2026, the department shall |
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prepare and submit to the legislature and the standing committees |
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of the legislature with primary jurisdiction over insurance and |
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Medicaid a report containing the results of the study conducted |
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under Subsection (b) of this section and any recommendations for |
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legislative or other action. The report must include an estimate of |
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any projected cost savings to health care consumers in this state |
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that would result from commercial health benefit plan issuers |
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implementing a site-neutral payment policy for outpatient |
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services. |
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SECTION 4. Not later than January 1, 2026, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt or amend rules as necessary to comply with Section 32.0286, |
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Human Resources Code, as added by this Act. |
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SECTION 5. Section 311.006, Health and Safety Code, as |
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added by this Act, applies only to a hospital's acquisition of an |
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outpatient facility on or after the effective date of this Act. |
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SECTION 6. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 7. This Act takes effect September 1, 2025. |