Relating to direct payment for certain health care provided by a hospital, the official text

H.B. No. 1612

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.

______________________________
______________________________

President of the Senate
Speaker of the House

I certify that H.B. No. 1612 was passed by the House on May 1,

2025, by the following vote: Yeas 139, Nays 5, 1 present, not

voting.

______________________________

Chief Clerk of the House

I certify that H.B. No. 1612 was passed by the Senate on May

25, 2025, by the following vote: Yeas 31, Nays 0.

______________________________

Secretary of the Senate

APPROVED: _____________________

Date

_____________________

Governor