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A BILL TO BE ENTITLED
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AN ACT
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relating to the establishment of a bundled-pricing program to |
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reduce certain health care costs in the school employees and |
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retirees group benefits programs. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1575, Insurance Code, is amended by |
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adding Subchapter L to read as follows: |
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SUBCHAPTER L. BUNDLED-PRICING PROGRAM |
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Sec. 1575.551. BUNDLED-PRICING PROGRAM. (a) The trustee |
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shall develop a cost-positive bundled-pricing program for health |
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benefit plans provided under the group program. |
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(b) The bundled-pricing program must be designed to reduce |
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health care costs in the group program by contracting with a health |
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care facility, physician, or health care provider at a consolidated |
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rate for an inpatient or outpatient surgery procedure that is a |
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covered health care or medical service under a health benefit plan |
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provided under the group program. |
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(c) A consolidated rate described by Subsection (b) must |
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include all fees related to the covered surgery procedure, |
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including fees for a facility, physician, health care provider, |
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laboratory, prescription drug, or pharmacy service. |
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Sec. 1575.552. PARTICIPATION; COST-SHARING OBLIGATION. |
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(a) An enrollee may have an inpatient or outpatient surgery |
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procedure under the bundled-pricing program. |
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(b) Except as provided by Subsection (c), the trustee or a |
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health care facility, physician, or health care provider may not |
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require an enrollee to pay a deductible, copayment, coinsurance, or |
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other cost-sharing obligation for a covered surgery procedure |
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provided under the bundled-pricing program. |
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(c) The trustee may require an enrollee in the high |
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deductible health plan established under Section 1575.158 to meet |
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the enrollee's deductible before the plan pays for a covered |
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surgery procedure provided under the bundled-pricing program. |
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Sec. 1575.553. PROVIDER PARTICIPATION. (a) A health care |
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facility, physician, or health care provider is not required to |
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participate in the bundled-pricing program. |
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(b) A health care facility may not coerce a facility-based |
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provider, as defined by Section 1575.172, to participate in the |
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bundled-pricing program or accept a lower rate for an inpatient or |
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outpatient surgery procedure. |
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Sec. 1575.554. PROMPT PAYMENT. The trustee shall ensure |
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that a health care facility, physician, or health care provider |
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that participates in the bundled-pricing program receives payment |
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for a covered surgery procedure not later than the 30th day after |
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the date the administrator receives a claim for the procedure that |
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includes all information necessary for the administrator to pay the |
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claim. |
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Sec. 1575.555. BUNDLED-PRICING DISCLOSURE. A health care |
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facility, physician, or health care provider that participates in |
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the bundled-pricing program may disclose a consolidated rate for an |
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inpatient or outpatient surgery procedure on the facility's, |
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physician's, or provider's Internet website and marketing |
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materials. |
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Sec. 1575.556. PUBLICATION OF INFORMATION. The trustee |
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shall publish information on the bundled-pricing program, |
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including a list of participating health care facilities, |
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physicians, and health care providers, on the Teacher Retirement |
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System of Texas website. |
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Sec. 1575.557. RULEMAKING. The trustee may adopt rules as |
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necessary to implement this subchapter. |
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SECTION 2. Chapter 1579, Insurance Code, is amended by |
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adding Subchapter H to read as follows: |
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SUBCHAPTER H. BUNDLED-PRICING PROGRAM |
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Sec. 1579.351. BUNDLED-PRICING PROGRAM. (a) The trustee |
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shall develop a cost-positive bundled-pricing program for health |
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coverage plans provided under the program. |
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(b) The bundled-pricing program must be designed to reduce |
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health care costs in the program by contracting with a health care |
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|
facility, physician, or health care provider at a consolidated rate |
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for an inpatient or outpatient surgery procedure that is a covered |
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health care or medical service under a health coverage plan |
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provided under the program. |
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(c) A consolidated rate described by Subsection (b) must |
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include all fees related to the covered surgery procedure, |
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including fees for a facility, physician, health care provider, |
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|
laboratory, prescription drug, or pharmacy service. |
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Sec. 1579.352. PARTICIPATION; COST-SHARING OBLIGATION. |
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(a) An enrollee may have an inpatient or outpatient surgery |
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procedure under the bundled-pricing program. |
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(b) The trustee or a health care facility, physician, or |
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health care provider may not require an enrollee to pay a |
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deductible, copayment, coinsurance, or other cost-sharing |
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obligation for a covered surgery procedure provided under the |
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bundled-pricing program. |
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Sec. 1579.353. PROVIDER PARTICIPATION. (a) A health care |
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facility, physician, or health care provider is not required to |
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participate in the bundled-pricing program. |
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(b) A health care facility may not coerce a facility-based |
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|
provider, as defined by Section 1579.110, to participate in the |
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bundled-pricing program or accept a lower rate for an inpatient or |
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outpatient surgery procedure. |
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Sec. 1579.354. PROMPT PAYMENT. The trustee shall ensure |
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that a health care facility, physician, or health care provider |
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that participates in the bundled-pricing program receives payment |
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for a covered surgery procedure not later than the 30th day after |
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the date the administrator receives a claim for the procedure that |
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includes all information necessary for the administrator to pay the |
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claim. |
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Sec. 1579.355. BUNDLED-PRICING DISCLOSURE. A health care |
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facility, physician, or health care provider that participates in |
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the bundled-pricing program may disclose a consolidated rate for an |
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inpatient or outpatient surgery procedure on the facility's, |
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|
physician's, or provider's Internet website and marketing |
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|
materials. |
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Sec. 1579.356. PUBLICATION OF INFORMATION. The trustee |
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shall publish information on the bundled-pricing program, |
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including a list of participating health care facilities, |
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physicians, and health care providers, on the Teacher Retirement |
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System of Texas website. |
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Sec. 1579.357. RULEMAKING. The trustee may adopt rules as |
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necessary to implement this subchapter. |
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SECTION 3. This Act takes effect September 1, 2021. |