Bill Text: TX HB985 | 2025-2026 | 89th Legislature | Introduced
Bill Title: Relating to hospital-owned outpatient facilities, including site-neutral reimbursement rates under Medicaid.
Sponsorship: Partisan Bill (Republican 1)
Status: (Introduced - Dead) 2025-03-06 - Referred to Human Services [HB985 Detail]
Download: Texas-2025-HB985-Introduced.html
| By: Harrison | H.B. No. 985 | |
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| relating to hospital-owned outpatient facilities, including | ||
| site-neutral reimbursement rates under Medicaid. | ||
| 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. ACQUISITION OF OUTPATIENT HEALTH CARE | ||
| FACILITIES. (a) In this section: | ||
| (1) "Commission" means the Health and Human Services | ||
| Commission. | ||
| (2) "Hospital" means a hospital licensed under Chapter | ||
| 241. | ||
| (b) A hospital that acquires an outpatient health care | ||
| facility shall provide written notice of the acquisition to the | ||
| office of the attorney general and the commission. | ||
| SECTION 2. Subchapter B, Chapter 32, Human Resources Code, | ||
| is amended by adding Section 32.0286 to read as follows: | ||
| Sec. 32.0286. SITE-NEUTRAL REIMBURSEMENT RATE FOR | ||
| OUTPATIENT SERVICES. (a) In this section, "hospital-owned | ||
| outpatient facility" means a department, unit, clinic, or other | ||
| facility or organization that a hospital provider either creates or | ||
| acquires for the purpose of furnishing outpatient services. The | ||
| term includes a hospital outpatient department. | ||
| (b) Notwithstanding any other law, the commission shall | ||
| ensure the Medicaid reimbursement rate for outpatient services | ||
| provided by a hospital-owned outpatient facility is the same as the | ||
| reimbursement rate for outpatient services an independent, | ||
| physician-owned practice provides if: | ||
| (1) the outpatient services are not dependent on | ||
| technology associated with the facility; and | ||
| (2) evidence-based rationale does not support a | ||
| different reimbursement rate for a specific outpatient service. | ||
| SECTION 3. (a) In this section: | ||
| (1) "Commission" means the Health and Human Services | ||
| Commission. | ||
| (2) "Department" means the Texas Department of | ||
| Insurance. | ||
| (3) "Medicaid" means the medical assistance program | ||
| established under Chapter 32, Human Resources Code. | ||
| (b) The department, in consultation with the commission and | ||
| the office of the attorney general, shall conduct a study on the | ||
| feasibility and advisability of expanding the policy under Section | ||
| 32.0286, Human Resources Code, as added by this Act, to commercial | ||
| health benefit plan issuers in this state by prohibiting the | ||
| issuers from providing provider-based billing rates for outpatient | ||
| services that are greater than the rates provided to independent, | ||
| physician-owned practices providing the same outpatient services. | ||
| (c) Not later than September 1, 2026, the department shall | ||
| prepare and submit to the legislature and the standing committees | ||
| of the legislature with primary jurisdiction over insurance and | ||
| Medicaid a report containing the results of the study conducted | ||
| under Subsection (b) of this section and any recommendations for | ||
| legislative or other action. The report must include an estimate of | ||
| any projected cost savings to health care consumers in this state | ||
| that would result from commercial health benefit plan issuers | ||
| implementing a site-neutral payment policy for outpatient | ||
| services. | ||
| SECTION 4. Not later than January 1, 2026, the executive | ||
| commissioner of the Health and Human Services Commission shall | ||
| adopt or amend rules as necessary to comply with Section 32.0286, | ||
| Human Resources Code, as added by this Act. | ||
| SECTION 5. Section 311.006, Health and Safety Code, as | ||
| added by this Act, applies only to a hospital's acquisition of an | ||
| outpatient facility on or after the effective date of this Act. | ||
| SECTION 6. If before implementing any provision of this Act | ||
| a state agency determines that a waiver or authorization from a | ||
| federal agency is necessary for implementation of that provision, | ||
| the agency affected by the provision shall request the waiver or | ||
| authorization and may delay implementing that provision until the | ||
| waiver or authorization is granted. | ||
| SECTION 7. This Act takes effect September 1, 2025. | ||
