Bill Text: TX HB1527 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to the establishment of a bundled-pricing program to reduce certain health care costs in the school employees and retirees group benefits programs.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2021-03-08 - Referred to Pensions, Investments & Financial Services [HB1527 Detail]
Download: Texas-2021-HB1527-Introduced.html
87R5121 SCL-D | ||
By: Gates | H.B. No. 1527 |
|
||
|
||
relating to the establishment of a bundled-pricing program to | ||
reduce certain health care costs in the school employees and | ||
retirees group benefits programs. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 1575, Insurance Code, is amended by | ||
adding Subchapter L to read as follows: | ||
SUBCHAPTER L. BUNDLED-PRICING PROGRAM | ||
Sec. 1575.551. BUNDLED-PRICING PROGRAM. (a) The trustee | ||
shall develop a cost-positive bundled-pricing program for health | ||
benefit plans provided under the group program. | ||
(b) The bundled-pricing program must be designed to reduce | ||
health care costs in the group program by contracting with a health | ||
care facility, physician, or health care provider at a consolidated | ||
rate for an inpatient or outpatient surgery procedure that is a | ||
covered health care or medical service under a health benefit plan | ||
provided under the group program. | ||
(c) A consolidated rate described by Subsection (b) must | ||
include all fees related to the covered surgery procedure, | ||
including fees for a facility, physician, health care provider, | ||
laboratory, prescription drug, or pharmacy service. | ||
Sec. 1575.552. PARTICIPATION; COST-SHARING OBLIGATION. | ||
(a) An enrollee may have an inpatient or outpatient surgery | ||
procedure under the bundled-pricing program. | ||
(b) Except as provided by Subsection (c), the trustee or a | ||
health care facility, physician, or health care provider may not | ||
require an enrollee to pay a deductible, copayment, coinsurance, or | ||
other cost-sharing obligation for a covered surgery procedure | ||
provided under the bundled-pricing program. | ||
(c) The trustee may require an enrollee in the high | ||
deductible health plan established under Section 1575.158 to meet | ||
the enrollee's deductible before the plan pays for a covered | ||
surgery procedure provided under the bundled-pricing program. | ||
Sec. 1575.553. PROVIDER PARTICIPATION. (a) A health care | ||
facility, physician, or health care provider is not required to | ||
participate in the bundled-pricing program. | ||
(b) A health care facility may not coerce a facility-based | ||
provider, as defined by Section 1575.172, to participate in the | ||
bundled-pricing program or accept a lower rate for an inpatient or | ||
outpatient surgery procedure. | ||
Sec. 1575.554. PROMPT PAYMENT. The trustee shall ensure | ||
that a health care facility, physician, or health care provider | ||
that participates in the bundled-pricing program receives payment | ||
for a covered surgery procedure not later than the 30th day after | ||
the date the administrator receives a claim for the procedure that | ||
includes all information necessary for the administrator to pay the | ||
claim. | ||
Sec. 1575.555. BUNDLED-PRICING DISCLOSURE. A health care | ||
facility, physician, or health care provider that participates in | ||
the bundled-pricing program may disclose a consolidated rate for an | ||
inpatient or outpatient surgery procedure on the facility's, | ||
physician's, or provider's Internet website and marketing | ||
materials. | ||
Sec. 1575.556. PUBLICATION OF INFORMATION. The trustee | ||
shall publish information on the bundled-pricing program, | ||
including a list of participating health care facilities, | ||
physicians, and health care providers, on the Teacher Retirement | ||
System of Texas website. | ||
Sec. 1575.557. RULEMAKING. The trustee may adopt rules as | ||
necessary to implement this subchapter. | ||
SECTION 2. Chapter 1579, Insurance Code, is amended by | ||
adding Subchapter H to read as follows: | ||
SUBCHAPTER H. BUNDLED-PRICING PROGRAM | ||
Sec. 1579.351. BUNDLED-PRICING PROGRAM. (a) The trustee | ||
shall develop a cost-positive bundled-pricing program for health | ||
coverage plans provided under the program. | ||
(b) The bundled-pricing program must be designed to reduce | ||
health care costs in the program by contracting with a health care | ||
facility, physician, or health care provider at a consolidated rate | ||
for an inpatient or outpatient surgery procedure that is a covered | ||
health care or medical service under a health coverage plan | ||
provided under the program. | ||
(c) A consolidated rate described by Subsection (b) must | ||
include all fees related to the covered surgery procedure, | ||
including fees for a facility, physician, health care provider, | ||
laboratory, prescription drug, or pharmacy service. | ||
Sec. 1579.352. PARTICIPATION; COST-SHARING OBLIGATION. | ||
(a) An enrollee may have an inpatient or outpatient surgery | ||
procedure under the bundled-pricing program. | ||
(b) The trustee or a health care facility, physician, or | ||
health care provider may not require an enrollee to pay a | ||
deductible, copayment, coinsurance, or other cost-sharing | ||
obligation for a covered surgery procedure provided under the | ||
bundled-pricing program. | ||
Sec. 1579.353. PROVIDER PARTICIPATION. (a) A health care | ||
facility, physician, or health care provider is not required to | ||
participate in the bundled-pricing program. | ||
(b) A health care facility may not coerce a facility-based | ||
provider, as defined by Section 1579.110, to participate in the | ||
bundled-pricing program or accept a lower rate for an inpatient or | ||
outpatient surgery procedure. | ||
Sec. 1579.354. PROMPT PAYMENT. The trustee shall ensure | ||
that a health care facility, physician, or health care provider | ||
that participates in the bundled-pricing program receives payment | ||
for a covered surgery procedure not later than the 30th day after | ||
the date the administrator receives a claim for the procedure that | ||
includes all information necessary for the administrator to pay the | ||
claim. | ||
Sec. 1579.355. BUNDLED-PRICING DISCLOSURE. A health care | ||
facility, physician, or health care provider that participates in | ||
the bundled-pricing program may disclose a consolidated rate for an | ||
inpatient or outpatient surgery procedure on the facility's, | ||
physician's, or provider's Internet website and marketing | ||
materials. | ||
Sec. 1579.356. PUBLICATION OF INFORMATION. The trustee | ||
shall publish information on the bundled-pricing program, | ||
including a list of participating health care facilities, | ||
physicians, and health care providers, on the Teacher Retirement | ||
System of Texas website. | ||
Sec. 1579.357. RULEMAKING. The trustee may adopt rules as | ||
necessary to implement this subchapter. | ||
SECTION 3. This Act takes effect September 1, 2021. |