Texas § HS.311.006 - DIRECT PAYMENT TO HOSPITAL

§ HS.311.006. DIRECT PAYMENT TO HOSPITAL

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. Added by Acts 2025, 89th Leg., R.S., Ch. 565 (H.B. 1612 ), Sec. 1, eff. September 1, 2025. SUBCHAPTER B. EMERGENCY SERVICES