The bill would amend the Insurance Code relating to method of payment for certain medical care and contract arrangements. The bill would require certain health benefit plans to allow a provider to accept payment in full directly from a patient in lieu of filing a claim, and would allow providers and patients to agree to cash prices as long as the price is no more than the lowest price the provider has negotiated with any payer for the services. The bill would also prohibit contracting entities from using most favored nation clauses in provider contracts. The plans administrated by Teacher Retirement System, UT System Administration, and Texas A&M University System Administration have indicated no significant fiscal impact.

Based on information provided by Employees Retirement System (ERS), the impact of the bill on the Group Benefits Program cannot be determined. The bill would require network agreement modifications, which could be detrimental to in-network contracting and cost containment activities. ERS would be responsible for ensuring enrollees understand the impact of not filing claims, such as cost-sharing related to the annual maximum deductibles if not paid through the health plan.

Based on information provided by the Health and Human Services Commission (HHSC), the impact of the bill on Medicaid and the Children's Health Insurance Program (CHIP) cannot be determined at this time because it is unknown if contracts between Medicaid and CHIP managed care organizations (MCOs) and their network providers contain most favored nations clauses. If the contracts do, then there could be an impact to the rates paid to providers by MCOs.

LEGISLATIVE BUDGET BOARD
Austin, Texas

FISCAL NOTE, 87TH LEGISLATIVE REGULAR SESSION


April 13, 2021

TO:	Honorable Tom Oliverson, Chair, House Committee on Insurance

FROM:	Jerry McGinty, Director, Legislative Budget Board

IN RE:	HB4051 by Frank (Relating to method of payment for certain medical care and contract arrangements.), As Introduced