87R2299 SCL-D
 
  By: Gates H.B. No. 571
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the establishment of a bundled-pricing program to
  reduce certain health care costs in the state employees group
  benefits program.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1551, Insurance Code, is amended by
  adding Subchapter K to read as follows:
  SUBCHAPTER K. BUNDLED-PRICING PROGRAM
         Sec. 1551.501.  BUNDLED-PRICING PROGRAM. (a) The board of
  trustees shall develop a cost-positive bundled-pricing program for
  health benefit plans provided under the group benefits program.
         (b)  The bundled-pricing program must be designed to reduce
  health care costs in the group benefits program by contracting with
  a health care facility, physician, or health care provider at a
  consolidated rate for an inpatient or outpatient surgery procedure
  that is a covered health care or medical service under a health
  benefit plan provided under the group benefits program. 
         (c)  A consolidated rate described by Subsection (b) must
  include all fees related to the covered surgery procedure,
  including fees for a facility, physician, health care provider,
  laboratory, prescription drug, or pharmacy service.
         Sec. 1551.502.  PARTICIPATION; COST-SHARING OBLIGATION.
  (a) A participant may have an inpatient or outpatient surgery
  procedure under the bundled-pricing program.
         (b)  Except as provided by Subsection (c), the board of
  trustees or a health care facility, physician, or health care
  provider may not require a participant to pay a deductible,
  copayment, coinsurance, or other cost-sharing obligation for a
  covered surgery procedure provided under the bundled-pricing
  program.
         (c)  The board of trustees may require a participant in the
  state consumer-directed health plan established under Section
  1551.452 to meet the participant's deductible before the plan pays
  for a covered surgery procedure provided under the bundled-pricing
  program.
         Sec. 1551.503.  PROVIDER PARTICIPATION. (a) A health care
  facility, physician, or health care provider is not required to
  participate in the bundled-pricing program. 
         (b)  A health care facility may not coerce a facility-based
  provider, as defined by Section 1551.229, to participate in the
  bundled-pricing program or accept a lower rate for an inpatient or
  outpatient surgery procedure.
         Sec. 1551.504.  PROMPT PAYMENT. The board of trustees shall
  ensure that a health care facility, physician, or health care
  provider that participates in the bundled-pricing program receives
  payment for a covered surgery procedure not later than the 30th day
  after the date the administrator receives a claim for the procedure
  that includes all information necessary for the administrator to
  pay the claim.
         Sec. 1551.505.  BUNDLED-PRICING DISCLOSURE. A health care
  facility, physician, or health care provider that participates in
  the bundled-pricing program may disclose a consolidated rate for an
  inpatient or outpatient surgery procedure on the facility's,
  physician's, or provider's Internet website and marketing
  materials.
         Sec. 1551.506.  PUBLICATION OF INFORMATION. The board of
  trustees shall publish information on the bundled-pricing program,
  including a list of participating health care facilities,
  physicians, and health care providers, on the Employees Retirement
  System of Texas website.
         Sec. 1551.507.  RULEMAKING. The board of trustees may adopt
  rules as necessary to implement this subchapter.
         SECTION 2.  This Act takes effect September 1, 2021.