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A BILL TO BE ENTITLED
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AN ACT
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relating to the inclusion of direct primary care fees as qualified |
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medical expenses applied toward insurance deductibles in certain |
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state health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1551, Insurance Code, is amended by |
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adding Subchapter K to read as follows: |
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SUBCHAPTER K. DIRECT PRIMARY CARE SERVICES |
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Sec. 1551.501. DEFINITIONS. In this subchapter: |
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(1) "Direct fee" means a fee charged by a physician to a |
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patient or a patient's designee for primary medical care services |
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provided by, or to be provided by, the physician to the patient. |
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The term includes a fee in any form, including a: |
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(A) monthly retainer; |
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(B) membership fee; |
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(C) subscription fee; |
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(D) fee paid under a medical service agreement; or |
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(E) fee for a service, visit, or episode of care. |
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(2) "Direct primary care" means a primary medical care |
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service provided by a physician to a patient in return for payment |
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in accordance with a direct fee. The term include telemedicine |
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medical services and telehealth services, as those terms are |
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defined by Section 111.001, Occupations Code, provided using a |
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technology platform. |
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Sec. 1551.502. INCLUSION OF DIRECT PRIMARY CARE FEES AS |
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QUALIFIED MEDICAL EXPENSES. (a) Direct fees paid to a direct |
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primary care provider shall apply to the deductible of a |
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participant enrolled in the basic coverage provided under the |
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Employees Retirement System of Texas. |
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(b) The board of trustees shall adopt rules necessary to |
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implement this section. |
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SECTION 2. Chapter 1575, Insurance Code, is amended by |
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adding Subchapter L to read as follows: |
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SUBCHAPTER L. DIRECT PRIMARY CARE SERVICES |
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Sec. 1575.601. DEFINITIONS. In this subchapter: |
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(1) "Direct fee" means a fee charged by a physician to a |
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patient or a patient's designee for primary medical care services |
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provided by, or to be provided by, the physician to the patient. |
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The term includes a fee in any form, including a: |
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(A) monthly retainer; |
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(B) membership fee; |
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(C) subscription fee; |
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(D) fee paid under a medical service agreement; or |
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(E) fee for a service, visit, or episode of care. |
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(2) "Direct primary care" means a primary medical care |
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service provided by a physician to a patient in return for payment |
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in accordance with a direct fee. The term include telemedicine |
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medical services and telehealth services, as those terms are |
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|
defined by Section 111.001, Occupations Code, provided using a |
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|
technology platform. |
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Sec. 1575.602. INCLUSION OF DIRECT PRIMARY CARE FEES AS |
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QUALIFIED MEDICAL EXPENSES. (a) Direct fees paid to a direct |
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primary care provider shall apply to the deductible of a |
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participant enrolled in the basic coverage provided under the |
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Teacher Retirement System of Texas. |
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(b) The trustee shall adopt rules necessary to implement |
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this section. |
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SECTION 3. This Act applies only to a health benefit plan |
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delivered, issued for delivery, or renewed on or after January 1, |
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2026. |
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SECTION 4. This Act takes effect September 1, 2025. |