By: Frank (Senate Sponsor - Kolkhorst, et al.) H.B. No. 1612
         (In the Senate - Received from the House May 5, 2025;
  May 5, 2025, read first time and referred to Committee on Health &
  Human Services; May 15, 2025, reported favorably by the following
  vote:  Yeas 8, Nays 0; May 15, 2025, sent to printer.)
Click here to see the committee vote
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to direct payment for certain health care provided by a
  hospital.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 311, Health and Safety
  Code, is amended by adding Section 311.006 to read as follows:
         Sec. 311.006.  DIRECT PAYMENT TO HOSPITAL. (a)  In this
  section:
               (1)  "Enrollee" means an individual who is enrolled in
  a health benefit plan or otherwise entitled to coverage under a
  health benefit plan.
               (2)  "Health benefit plan" means any individual or
  group arrangement with a public or private entity under which the
  entity will pay for, reimburse expenses for, or otherwise contract
  with a health care provider for the provision of health care
  services, supplies, or devices to a patient. The term includes an
  arrangement with:
                     (A)  an insurance company;
                     (B)  the sponsor or administrator of a
  self-insured health benefit plan;
                     (C)  a group hospital service corporation
  operating under Chapter 842, Insurance Code;
                     (D)  a health maintenance organization operating
  under Chapter 843, Insurance Code;
                     (E)  the state Medicaid program, including the
  Medicaid managed care program operating under Chapter 540,
  Government Code;
                     (F)  a health benefit plan offered or administered
  by or on behalf of this state or a political subdivision of this
  state or an agency or instrumentality of the state or a political
  subdivision of this state, including:
                           (i)  a basic coverage plan under Chapter
  1551, Insurance Code;
                           (ii)  a basic plan under Chapter 1575,
  Insurance Code;
                           (iii)  a primary care coverage plan under
  Chapter 1579, Insurance Code; and
                           (iv)  a plan providing basic coverage under
  Chapter 1601, Insurance Code; or
                     (G)  any other entity providing a health insurance
  or health benefit plan subject to regulation by the Texas
  Department of Insurance.
               (3)  "Health care service" means a service to diagnose,
  prevent, alleviate, cure, or heal a human illness or injury that is
  provided to an individual by a physician or other health care
  provider.
               (4)  "Hospital" means a public or private institution
  licensed under Chapter 241. The term does not include an ambulatory
  surgical center licensed under Chapter 243.
         (b)  At the request of a patient who is not an enrollee, and
  subject to Subsection (c), a hospital must accept directly from the
  patient full payment for a health care service provided by the
  hospital.
         (c)  A request under Subsection (b) must be made not later
  than the 60th day after the date on which the patient receives a
  bill for or other final accounting of the health care service
  provided.  The bill or other final accounting must notify the
  patient of the ability to make a request under Subsection (b).
         (d)  Notwithstanding Section 552.003, Insurance Code, or any
  other law, in accepting payments as described by Subsection (b) for
  health care services provided by the hospital, a hospital may
  charge patients amounts that are either:
               (1)  not more than 25 percent greater than the amounts
  generally billed, as defined by 26 C.F.R. Section 1.501(r)-1, for a
  health care service; or
               (2)  not more than 50 percent greater than the lowest
  contracted rate for a health care service that the hospital has
  agreed to accept as payment in full as a contracted, preferred, or
  participating provider of a health benefit plan other than:
                     (A)  the state Medicaid program, including the
  Medicaid managed care program operated under Chapter 540,
  Government Code;
                     (B)  the child health plan program operated under
  Chapter 62; or
                     (C)  Medicare benefits.
         (e)  Nothing in this section precludes a patient from
  receiving from a hospital charity care that the patient would
  otherwise qualify for or be entitled to.
         SECTION 2.  This Act takes effect September 1, 2025.
 
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