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A BILL TO BE ENTITLED
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AN ACT
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relating to certain limitations on reimbursements paid for |
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inpatient and outpatient hospital services for certain publicly |
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funded health benefit plan coverage for employees and retirees. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1551.205, Insurance Code, is amended to |
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read as follows: |
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Sec. 1551.205. MAXIMUM RATES FOR FACILITIES; LIMITATIONS. |
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(a) Disregarding any contradictory contract terms or any other law |
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to the contrary, any facility, as such term is defined by Section |
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324.001 of the Health and Safety Code, that bills the group benefits |
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program, its administering firm, carrier, or their designee, for |
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health care services provided to an enrolled employee or dependent |
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will never be entitled to a rate for such health care services thats |
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exceed the rate established in the applicable rider in the General |
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Appropriations Act, Article I, Employees Retirement System of |
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Texas. |
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(b) A facility shall not discriminate against an employee or |
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dependent, or against the program, by refusing to participate in an |
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administering firm’s or health coverage plan’s network, or by |
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refusing to serve an employee or dependent, or by providing health |
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care services of a lower standard and quality to an employee or |
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dependent than what the facility provides to other similar |
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patients, because of the maximum rating schedule imposed by |
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subsection (a) of this section. |
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(c) The board of trustees may not contract for or provide a |
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coverage plan that: |
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(1) excludes or limits coverage or services for |
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acquired immune deficiency syndrome, as defined by the Centers for |
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Disease Control and Prevention of the United States Public Health |
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Service, or human immunodeficiency virus infection; |
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(2) provides coverage for serious mental illness that |
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is less extensive than the coverage provided for any physical |
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illness; or |
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(3) may provide coverage for prescription drugs to |
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assist in stopping smoking at a lower benefit level than is provided |
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for other prescription drugs. |
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SECTION 2. Section 1575.104, Insurance Code, is amended to |
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read as follows: |
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Sec. 1575.104. TERMS OF CONTRACT; MAXIMUM RATES FOR |
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FACILITIES. (a) A contract for group coverage awarded by the |
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trustee must meet the minimum benefit and financial standards |
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adopted by the trustee. |
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(b) Disregarding any contradictory contract terms or any |
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other law to the contrary, any facility, as such term is defined by |
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Section 324.001 of the Health and Safety Code, that bills the group |
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program, its administrator, carrier, or their designee, for health |
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care services provided to an enrolled retiree or dependent will |
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never be entitled to a rate for such health care services that |
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exceeds the rate established in the applicable rider in the General |
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Appropriations Act, Article III, Teacher Retirement System. |
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(c) A facility shall not discriminate against a retiree or |
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dependent, or against the group program, by refusing to participate |
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in a group program administrator’s or carrier’s network, or by |
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refusing to serve a retiree or dependent, or by providing health |
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care services of a lower standard and quality to a retiree or |
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dependent than what the facility provides to other similar |
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patients, because of the maximum rating schedule imposed by |
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subsection (b) of this section. |
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SECTION 3. Subchapter B, Chapter 1579, Insurance Code, is |
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amended by adding Section 1579.0511, Insurance Code, to read as |
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follows: |
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Sec. 1579.0511. MAXIMUM RATES FOR FACILITIES. (a) |
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Disregarding any contradictory contract terms or any other law to |
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the contrary, any facility, as such term is defined by Section |
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324.001 of the Health and Safety Code, that bills the program, its |
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administering firm, health coverage plan, or their designee, for |
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health care services provided to an enrolled employee or dependent |
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will never be entitled to a rate for such health care services that |
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exceeds the rate established in the applicable rider in the General |
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Appropriations Act, Article III, Teacher Retirement System. |
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(b) A facility shall not discriminate against an employee or |
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dependent, or against the program, by refusing to participate in an |
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administering firm’s or health coverage plan’s network, or by |
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refusing to serve an employee or dependent, or by providing health |
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care services of a lower standard and quality to an employee or |
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dependent than what the facility provides to other similar |
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patients, because of the maximum rating schedule imposed by |
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subsection (a) of this section. |
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SECTION 4. Subchapter B of Chapter 1601, Insurance Code, is |
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amended by adding Section 1601.0581, Insurance Code, to read as |
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follows: |
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Sec. 1601.0581. MAXIMUM RATES FOR FACILITIES. (a) |
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Disregarding any contradictory contract terms or any other law to |
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the contrary, any facility, as such term is defined by Section |
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324.001 of the Health and Safety Code, that bills the uniform |
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program, its administering carrier, or their designee, for health |
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care services provided to an enrolled employee, retiree, or |
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dependent will never be entitled to a rate for such health care |
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services that exceeds the rate established in the applicable rider |
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in the General Appropriations Act, Article III, University of Texas |
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System and Texas A&M University System. |
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(b) A facility shall not discriminate against an employee, |
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retiree, or dependent, or against the uniform program, by refusing |
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to participate in an administering carrier’s network, or by |
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refusing to serve an employee, retiree, or dependent, or by |
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providing health care services of a lower standard and quality to an |
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employee, retiree, or dependent than what the facility provides to |
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other similar patients, because of the maximum rating schedule |
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imposed by subsection (a) of this section. |
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SECTION 4. The maximum rating schedules imposed by Section |
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1551.202, Insurance Code, Section 1575.104, Insurance Code, as |
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amended by this Act, Section 1579.0511, Insurance Code, and Section |
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1601.0581, Insurance Code, as added by this Act, shall apply to any |
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bill for health care services provided by a facility with dates of |
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service beginning on or after September 1, 2024. |
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SECTION 5. This Act takes effect September 1, 2023. |