BILL ANALYSIS

C.S.H.B. 1945

By: Bonnen, Greg

Public Health

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Direct primary care is an innovative model for delivering and purchasing health care services that gives physicians and their patients an alternative to the third-party, fee-for-service system. In most instances, patients have unlimited access to their doctor—in person and by phone or
e-mail—for a full range of comprehensive primary care services in exchange for a flat fee.
C.S.H.B. 1945 seeks to improve access to direct primary care by providing for these arrangements outside the scope of state insurance regulation.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

C.S.H.B. 1945 amends the Occupations Code to establish that a physician providing direct primary care, defined by the bill as a primary medical care service provided by a physician to a patient in return for payment in accordance with a direct fee, is not an insurer or health maintenance organization and that the physician is not subject to regulation by the Texas Department of Insurance (TDI) for the direct primary care. The bill establishes that a medical service agreement under which a physician agrees to provide direct primary care services for a patient in exchange for a direct fee is not health or accident insurance or coverage under the Insurance Code and is not subject to regulation by TDI. The bill establishes that a physician is not required to obtain a certificate of authority under the Insurance Code to market, sell, or offer a medical service agreement or provide direct primary care and that a physician providing direct primary care does not violate Insurance Code provisions relating to contractual responsibility for deductibles and copayments.

C.S.H.B. 1945 prohibits a physician from billing an insurer or health maintenance organization for direct primary care that is paid under a medical service agreement. The bill prohibits the Texas Medical Board or another state agency from prohibiting, interfering with, initiating a legal or administrative proceeding against, or imposing a fine or penalty against a physician solely because the physician provides direct primary care or against a person solely because the person pays a direct fee for direct primary care. The bill prohibits a health insurer, health maintenance organization, or health care provider from prohibiting, interfering with, or initiating a legal proceeding against a physician solely because the physician provides direct primary care or against a person solely because the person pays a direct fee for direct primary care. The bill's provisions do not apply to workers' compensation insurance coverage as defined by the Labor Code.

EFFECTIVE DATE

On passage, or, if the bill does not receive the necessary vote, September 1, 2015.

COMPARISON OF ORIGINAL AND SUBSTITUTE

While C.S.H.B. 1945 may differ from the original in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the introduced and committee substitute versions of the bill.

INTRODUCED	HOUSE COMMITTEE SUBSTITUTE
SECTION 1.  Chapter 162, Occupations Code, is amended by adding Subchapter F to read as follows: SUBCHAPTER F.  DIRECT PRIMARY CARE Sec. 162.251.  DEFINITIONS. No equivalent provision. Sec. 162.252.  DIRECT PRIMARY CARE NOT INSURANCE.  No equivalent provision. Sec. 162.253.  INTERFERENCE PROHIBITED.	SECTION 1.  Chapter 162, Occupations Code, is amended by adding Subchapter F to read as follows: SUBCHAPTER F.  DIRECT PRIMARY CARE Sec. 162.251.  DEFINITIONS. Sec. 162.252.  APPLICABILITY OF SUBCHAPTER.  This subchapter does not apply to workers' compensation insurance coverage as defined by Section 401.011, Labor Code. Sec. 162.253.  DIRECT PRIMARY CARE NOT INSURANCE.  Sec. 162.254.  BILLING INSURER OR HEALTH MAINTENANCE ORGANIZATION PROHIBITED. A physician may not bill an insurer or health maintenance organization for direct primary care that is paid under a medical service agreement. Sec. 162.255.  INTERFERENCE PROHIBITED.
SECTION 2.  This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution.  If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2015.	SECTION 2. Same as introduced version.