Bill Text: TX HB633 | 2023-2024 | 88th Legislature | Comm Sub
Bill Title: Relating to the method of payment for certain health care provided by a hospital.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2023-05-08 - Postponed 8/17/24 10:00 AM [HB633 Detail]
Download: Texas-2023-HB633-Comm_Sub.html
| 88R23974 MEW-F | |||
| By: Frank, Harless, Collier | H.B. No. 633 | ||
| Substitute the following for H.B. No. 633: | |||
| By: Harless | C.S.H.B. No. 633 | ||
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| relating to the method of payment for certain health care provided | ||
| by a hospital. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1204, Insurance Code, is amended by | ||
| adding Subchapter G to read as follows: | ||
| SUBCHAPTER G. DIRECT PAYMENT OF HOSPITAL | ||
| Sec. 1204.301. DEFINITIONS. In this subchapter: | ||
| (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 an individual, group, | ||
| blanket, or franchise insurance policy, a group hospital service | ||
| contract, or an individual or group subscriber contract or evidence | ||
| of coverage issued by a health maintenance organization, that | ||
| provides benefits for health care services. The term does not | ||
| include: | ||
| (A) the state Medicaid program, including the | ||
| Medicaid managed care program operated under Chapter 533, | ||
| Government Code; | ||
| (B) the child health plan program operated under | ||
| Chapter 62, Health and Safety Code; or | ||
| (C) Medicare benefits. | ||
| (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, Health and Safety Code. The term does | ||
| not include an ambulatory surgical center licensed under Chapter | ||
| 243, Health and Safety Code. | ||
| Sec. 1204.302. APPLICABILITY TO CERTAIN PLANS. In addition | ||
| to the health benefit plans described by Section 1204.301, | ||
| notwithstanding any other law, this subchapter applies to: | ||
| (1) a basic coverage plan under Chapter 1551; | ||
| (2) a basic plan under Chapter 1575; | ||
| (3) a primary care coverage plan under Chapter 1579; | ||
| and | ||
| (4) a plan providing basic coverage under Chapter | ||
| 1601. | ||
| Sec. 1204.303. PAYMENT IN LIEU OF CLAIM FOR BENEFITS; OTHER | ||
| DIRECT PAYMENTS. (a) At the request of a patient, including a | ||
| patient who is an enrollee, and subject to Subsection (b), a | ||
| hospital must accept directly from the patient full payment for a | ||
| health care service provided in the hospital. If the payment is | ||
| made by an enrollee, the hospital must accept that payment in lieu | ||
| of submitting a claim to the enrollee's health benefit plan. | ||
| (b) A request under Subsection (a) must be made not later | ||
| than the 60th day after the date on which the health care service is | ||
| provided. | ||
| (c) Notwithstanding Section 552.003 or any other law, the | ||
| amount of the payment for a health care service for which a hospital | ||
| accepts payment as described by Subsection (a) for a service | ||
| provided in the hospital may not exceed the lowest contracted rate | ||
| for the 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. | ||
| SECTION 2. This Act takes effect September 1, 2023. | ||
