88th Texas Legislature

Appropriations

HB 1 General Appropriations Act

A familiar directive – "Show me the budget" – is key to understanding the priorities of the 88^th Texas Legislature. HB 1 appropriates state and federal funds to state agencies and programs for fiscal years 2024-2025. With the help of an unprecedented US$32.7bn surplus, Texas lawmakers negotiated a record US$321.3bn budget for this biennium. As a result, the state's spending plan reflects a 5.95 percent increase over the 2022-2023 budget.

HB 1 by method of finance

2022-23 amounts include supplemental appropriations made in SB 30

Source: Texas Legislative Budget Board

Chief among the major funding items are new and expanded allocations for addressing a number of the state's most pressing healthcare needs. As a consequence, general revenue funding for health and human services has increased nearly ten percent over the prior biennium.

Healthcare funding addressed by HB 1 includes behavioral health, maternal and child health, Medicaid, rural health and workforce issues. Here are the highlights:

• Behavioral health: US$9.4bn in All Funds for mental health services including US$302m for mental health community hospitals (maintaining and increasing bed capacity), US$9.4m for mental health state hospital operations and US$83m for community mental health grant programs. Includes a noteworthy US$26m increase for the state's Loan Repayment Program for Mental Health Professionals (psychiatrists, psychologists and advance practice nurses certified in mental health training) that budget writers had funded at just US$2m for the previous biennium.
• Maternal and child health: US$447.2m in All Funds for women's health programs – Family Planning Program, Healthy Texas Women and the Breast and Cervical Cancer Services Program – which is US$160.1m over current spending. A six percent increase in Medicaid reimbursement for pediatric services (physician and clinic services, well child visits) and for birth and women's health-related surgeries. Allocations include women's health program navigators and mobile health units.
• Medicaid: A total of US$80.8bn in All Funds across all three health and human services agencies (Texas Health and Human Services Commission (HHSC), Dept. of Family and Protective Services (DFPS) and Dept. of State Health Services (DSHS)), including US$2bn to support community attendant services increasing the base wage to US$10.60 an hour; and US$206.8m in rate increases for pediatric services, women's health-related surgeries, private duty nursing and ground ambulances. Additional appropriations hold trauma and safety-net hospital add-on payments at 2022-2023 budget levels (trauma at US$180m annually; safety-net at US$15m annually). Provides US$37.8m in funding support for the unwinding of continuous Medicaid coverage and directs that "full-time equivalent positions added to temporarily assist in the unwinding of continuous Medicaid coverage by phased out by June 30, 2024."

Texas is one of ten states that has not adopted Medicaid coverage expansion under the Affordable Care Act.

• Rural health: US$178.2m for rural hospitals, including increased funding for rural labor and delivery add on (from US$500 to US$1,500) for maternal healthcare and approximately US$66m in annual allocations for rural outpatient payments (a US$36m yearly increase). Appropriations of US$25m in grant funding for each fiscal year for the financial stabilization of rural hospitals, maternal care operations in rural hospitals and alternative payment model readiness for rural hospitals under the Rural Hospital Grant Program administered by HHSC. Budget writers also included US$7.4m to fund telepsychiatry consultations for rural hospitals.
• Workforce: Two year appropriations targeted for nursing education include US$25m for nursing scholarships, US$47m for the Professional Nursing Shortage Reduction program (US$19m increase) and US$7m for the Nurse Faculty Loan Repayment Program (more than a 50 percent increase). Budget allocations for physician education include US$233m for graduate medical education (a US$30m+ increase), US$80m for the Physician Education Loan Repayment Program (US$6m increase), US$16.5m for the Family Residency Physician Grant Program and the establishment of a new US$3m Rural Residency Physician Grant Program. 

Housed within HB 1 are key directives from the budget writers for agency reviews, reports and cost containment actions along with their associated appropriations. Highlights include the following:

• Charity care and hospital transparency: Appropriates US$5m for HHSC to study and report on the financial and utilization data of licensed Texas hospitals that generate revenue from public sources and programs and/or benefit from tax exemptions, or the use of public debt. Directs HHSC to contract with a third party "familiar with the Texas hospital market" and "which may not be an entity that owns or operates a hospital" to assist with completing the report. Elements for study include "a summary of all revenue streams and their value" and "all supplemental state or federal funding sources, research grants, medical debt accounts sold to collectors and locally generated tax revenue" by facility and hospital system; and "the value of charity care, bad debt expense and the unreimbursed cost of health services by facility and hospital system," among other requirements. The deadline for the report and HHSC recommendations for improving hospital charity care reporting and transparency is December 1, 2024. Art. IX, Sec. 17.34. 
• Uncompensated trauma care payments: Directs HHSC to report on the amount of funds hospitals receive through governmental entities for uncompensated trauma care and payments received by physicians or physician groups for providing medical care to uninsured trauma patients. The deadline for this report is December 1, 2024. Art. II, Rider 37.
• Medicaid rate review for pediatric care center services: Requires HHSC to conduct an annual review of reimbursement rates for pediatric care center services delivered to children under Medicaid no later than August 31 of each year of the 2024-2025 biennium. Art. IX, Sec. 17.29.
• Children's mental health strategic plan: Directs the Statewide Behavioral Health Coordinating Council to develop a strategic plan "specific to the behavioral health of children and youth" for submission to the Legislative Budget Board and the Governor's Office by December 1, 2024. Requires the plan to incorporate "the full continuum of care needed to support children and families" and to include descriptions of who provides what services to which children, strategies to identify and address gaps in care, discussion of workforce shortages, information on funding and reimbursement and children-specific data and expenditure information. Art. IX, Sec. 10.04(g).
• HHSC cost containment: Directs HHSC to allocate US$450m in general revenue for the 2024-2025 biennium throughout the health and human services system for purposes of developing and implementing cost containment initiatives including increasing fraud, waste and abuse prevention and detection; seeking to maximize federal flexibility under the Medicaid program; achieving other programmatic and administrative efficiencies; and savings from services that include emergency telemedicine services for individuals with intellectual and developmental disabilities. Further provides that "This rider shall not be construed as limiting HHSC's ability to maximize federal flexibility under the Medicaid program, including federal flexibility that may impact amount, scope or duration of services." Art. II, Rider 21.  

SB 30 Supplemental appropriations

SB 30 makes supplemental appropriations and provides direction and adjustment authority for appropriations adopted by the 87^th Texas Legislature for the state fiscal year ending August 31, 2023. Healthcare appropriations addressed by SB 30 include curing the Medicaid shortfall, increasing capacity for mental health services and inpatient hospitals and supporting the Incubator Program for federally qualified health centers (FQHC). Here are the highlights:

• Medicaid shortfall: To cover the Medicaid shortfall from the 2022-2023 biennium, SB 30 makes supplemental appropriations to HHSC in the amount of US$2.5bn from general revenue and US$4.7bn from federal funds. Of the appropriated amount, HHSC must transfer US$5m in general revenue to the Home and Community-Based Services - Adult Mental Health program.
• New capacity for inpatient facilities and mental health services: Provides US$2.2bn in general revenue to HHSC for the construction of mental health state hospitals (US$1.6bn), new construction for mental health community facilities (US$0.5bn) and for various information technology projects and maintenance support related to mental health services (US$100m).
• FQHC Incubator Program: Allocates US$40m from general revenue to DSHS for the FQHC Incubator Program to expand services and access to existing FQHCs and FQHC look-alikes.

Effective immediately.

Behavioral health

HB 2100 Loan repayment assistance for mental health professionals

Amends the Education Code to extend eligibility for the state's student loan repayment program provided by the Texas Higher Education Coordinating Board to certain early-career mental health professionals who provide services either to patients in a state hospital or to individuals receiving community-based mental health services from a local mental health authority. This amendment aims to address the shortage of mental health professionals in Texas, particularly in the public sector.

HB 4085 Costs associated with mental health hearings

Addresses the changing environment by which demand for services requires states to contract with private mental health facilities, as public facilities are insufficient to meet the current need. Amends the Health and Safety Code relating to the payment by the state or a county of costs for certain mental health hearings or proceedings and expands the circumstances under which a county is required to reimburse a private mental health facility for court costs.

SB 26 Behavioral health innovation grants

Expands the mental health capacity of the state, especially for children and adolescents; provides a structured process for transitioning patients from state hospitals; and increases transparency and accountability for Texas community-based mental and behavioral health systems through regular audits and expanded data reporting. Establishes an innovation matching grant program to support eligible entities for community-based initiatives that promote identification of mental health issues and expands access to early intervention and treatment. Eligible grant recipients include: hospitals, mental hospitals, hospital districts, a local mental health authority, a child-care facility licensed, certified or registered by the DFPS, a county or municipality and 501(c)(3) tax-exempt organizations. Requires HHSC to develop a plan to transition a hospital that primarily provides behavioral health services to a nursing facility for individuals who require a level of care provided by nursing facilities and a high level of behavioral health support services in consultation with licensed nursing facilities. Directs the HHSC Office of Inspector General to conduct performance audits and to require financial audits of local behavioral health authorities.

SB 52 "Essential caregiver" policies

Aims to provide certainty for caregivers and consistency among state hospitals with respect to in-person visitation policies. Requires HHSC to assist state hospitals in establishing essential caregiver visitation policies and procedures. Defines "essential caregiver" as a family member, friend, guardian or other individual a patient, patient's guardian or patient's legally authorized representative selects for in-person visits. Prohibits state hospitals from denying an in-person visitation with an "essential caregiver."

Provides that hospitals (1) allow the patient, the patient's guardian or the patient's legally authorized representative or, for a minor patient, the patient's parent, guardian or managing conservator, to designate an essential caregiver; (2) establish a visitation schedule that allows at least two hours of visitation with the essential caregiver per day; (3) develop procedures for allowing physical contact between the patient and the essential caregiver; and (4) obtain the signature of the essential caregiver certifying that the individual will follow the hospital's safety protocols and any other applicable policies, procedures or rules. State hospitals may only suspend in-person visitation from an essential caregiver if it poses a serious community health risk through petitioning HHSC.

SB 1677 Funding for community mental health grants

Amends requirements for how HHSC distributes funding for certain community mental health programs. Provides that counties with less than 250,000 residents can apply for SB 292 and HB 13 funds from the 85th Texas Legislature for jail-based competency restoration, jail diversion and adolescent behavioral health. Authorizes HHSC to renew contracts for new funding under SB 292 and HB 13 so that additional entities can participate in the grant funding. Directs the Office of the State Auditor to identify issues and deficiencies in the commitment process and to undertake an audit of inmates in county jails who are waiting for a forensic hospital bed for the provision of competency restoration services.

SB 1624 Incapacitated persons

Amends the Estates Code with respect to guardianships and services for incapacitated persons and the emergency detention of certain persons with mental illness. Directs that individuals with guardians may choose and hire attorneys to advocate on their behalf in restoration or modification hearings, so long as the individuals have the capacity to contract and retain attorneys. Provides additional guidance relating to guardianship reviews and reports by court investigators and guardians ad litem with respect to evidence that may be considered in a hearing for terminating guardianship.

SB 2193 FQHC direct primary care access pilot

Provides for the operation and financing of an FQHC comprehensive direct primary care access pilot program for "working" uninsured and underinsured adults employed by small business and their dependents. Requires that the state, employer and employee will each contribute to a flat monthly membership fee paid to the FQHC where the employee receives care. Directs participating FQHCs to actively solicit gifts, grants and donations for services provided by the program in an effort to reduce employer costs.

Effective immediately.

Healthcare facilities

HB 6 Fentanyl overdose

Amends the Health and Safety Code to transfer certain opiates, including fentanyl, from Penalty Group 1 to Penalty Group 1-B of the Texas Controlled Substances Act. Requires that if a medical examiner for purposes of the death certificate determines that an individual was poisoned by a Penalty Group 1-B controlled substance, the medical examiner should list "homicide" as the manner of death. Creates a criminal offense of murder for knowingly manufacturing or delivering the listed controlled substances in Penalty Group 1-B that result in death. Establishes as a defense to prosecution that the actor's conduct in manufacturing or delivering the controlled substances was authorized under the Texas Controlled Substances Act, or other state or federal law.

HB 49 Hospital investigation reports

Permits public access to certain information in the possession of HHSC obtained in connection with a complaint and/or investigation concerning a hospital or licensed mental hospital to the extent personally identifiable information of a patient or healthcare provider is not included. Allows the following information under state public information law to be disclosed: (1) the number of HHSC investigations into the hospital or licensed mental hospital; (2) the outcome of each investigation HHSC conducted, including if it issued a reprimand, denial or revocation of a license, the adoption of a corrective action plan or imposition of an administrative penalty and the penalty amount; and (3) an investigative report issued by HHSC to address any alleged violation. 

HB 617 Telemedicine/telehealth pilot project

Provides statutory authorization for a telehealth services pilot project to be jointly administered by the Commission on State Emergency Communications and Texas Tech Health Sciences Center (TTHSC) for purposes of providing emergency medical services instruction and emergency prehospital care instruction to rural area trauma facilities and emergency medical services providers through TTHSC.

HB 1890 Hospital at home program

Requires HHSC to establish minimum standards for the operation of a hospital at home program that are "as stringent" as standards established by the Centers for Medicare and Medicaid Services under the Acute Hospital Care at Home waiver program. Authorizes HHSC to establish and assess a fee as part of the application process for approving a hospital at home program. 

Effective immediately.

HB 3162 End of life decisions

Amends current law relating to advanced directives and a healthcare provider's ability to remove life-sustaining care from patients where continuing care is considered futile. Increases the notice period required for a patient's family to attempt the transfer of the patient to another facility from ten days to 25 calendar days. Requires that healthcare providers perform any procedures that are needed to facilitate a transfer before the 25-day countdown to terminating treatment begins. Removes a healthcare provider's ability to consider "quality of life" when determining whether to terminate treatment. Increases the notice period for families to discuss a patient's directive from 48 hours to seven calendar days. Requires healthcare providers to report certain non-identifying patient information any time a decision to terminate care is made.

SB 25 Nursing education

Increases state support for nursing-related postsecondary education, including scholarships to nursing students, loan repayment assistance to nurses and nursing faculty and grants to nursing education programs.

Effective immediately.

SB 240 Violence prevention in healthcare facilities

Directs healthcare facilities to establish a workplace violence prevention committee for the development of policies and a plan of action on how to prevent and respond to incidents of workplace violence. Requires facilities to provide post-incident services (including acute medical treatment if necessary), and to protect employees' rights to report the incident internally and to law enforcement without retaliation. Tasks the appropriate licensing agency to take disciplinary action against a person who violates these requirements.

SB 401 Price gouging of medical staffing services

Amends current law relating to prices charged by a medical staffing services agency during certain designated public health disaster periods. Prohibits the provision of medical staffing services to a healthcare organization or other entity at an "exorbitant or excessive price." Applies only to a medical staffing services agency that provides physician assistants, surgical assistants, licensed nurses and registered nurse aids. Imposes a civil penalty in an amount not to exceed US$10,000 per violation. Authorizes the consumer protection division of the Office of Attorney General to bring an action in the name of the state to temporarily or permanently restrain or enjoin persons from violating this Act.

SB 490 Price transparency

Requires a healthcare provider (defined as a facility licensed, certified or otherwise authorized to provide healthcare services or supplies, including a hospital) to send an itemized bill of each medical service provided, the amount the provider will accept as payment in full for that service and a plain language description of the service provided prior to collecting money from the patient. Requires providers to transmit the itemized bill, which may be provided electronically, including through a patient portal or the provider's website, within 30 days after receiving final payment from a third party. Prohibits providers from pursuing debt collection against a patient unless requirements under this Act are met. 

SB 773 Medical Freedom Act

Amends the Health and Safety Code to make patients with "severe chronic diseases" eligible to access and use an investigational drug, biological product or device under specified circumstances. Requires a patient's physician, in consultation with the patient, to consider all treatment options currently approved by the Food and Drug Administration (FDA), to determine which options are "unavailable or unlikely to provide relief" to the patient and to recommend or prescribe, in writing, the patient's use of the specific class of investigation drug, biological product or device.

Effective immediately.

SB 840 Assaulting hospital personnel

Also referred to as the Jacqueline "Jackie" Pokuaa and Katie "Annette" Flowers Act, SB 840 increases the penalty for assaulting "hospital personnel" from a Class A misdemeanor to a third-degree felony when the victim is a person the actor knows is hospital personnel and the act occurs while the person is located on hospital property, including all land and buildings owned or leased by the hospital. Hospital personnel includes nurses, physicians, physician assistants, maintenance or janitorial staff, receptionists and other personnel who are employed by or work in a hospital.

SB 1467 [VETOED] Disclosure of sensitive test results

In response to the 21st Century Cures Act, this legislation would have prohibited "sensitive test results" from being disclosed to a patient or their representative by electronic means "by a person or entity who administers or controls the patient's electronic health record" until at least three days after the sensitive test results are finalized. Vetoed SB 1467 sought to avoid the disclosure of "life-changing test results" through impersonal electronic means before hearing about it first from the physician, though it would have been limited to pathology reports or radiology reports that have a reasonable likelihood of finding a malignancy, or a result that may reveal a genetic marker. In his June 18, 2023 veto message, Governor Greg Abbott stated that "While Senate Bill No. 1467 is important, it is simply not as important as cutting property taxes. At this time, the legislature must concentrate on delivering property tax cuts to Texans. This bill can be reconsidered at a future special session only after property tax relief is passed." 

Hospital authorities, districts and county hospitals

The provider participation program

The Texas Legislature has authorized certain hospital districts and counties to collect "mandatory" payments from hospitals to fund local provider participation funds (LPPFs), which, in turn, could be used to fund intergovernmental transfers to the state to help pay for the nonfederal share of Medicaid matching funds. These taxes, which must be uniform, prohibit the LPPF funds from holding any healthcare institution harmless. Such funds are a critical source of revenue for the Texas Medicaid program and hospitals that provide care to underserved communities throughout the state.

• HB 1925 Provides for the continuation of a healthcare provider participation program by the Harris County Hospital District.
• HB 3456 Provides for the continuation of certain healthcare provider participation programs in this state (hospital districts in Dallas, El Paso and Tarrant counties).
• HB 4700 Authorizes the creation and operation of a healthcare provider participation program by the Nacogdoches County Hospital District.
• HB 4835 Authorizes the creation and operation of certain healthcare provider participation programs in counties bordering the Neches River that are not served by a hospital district and have a population of more than 250,000 (Jefferson County). Repeals provisions that provide for such program in the City of Beaumont.

Effective September 1, 2023, except Section 1 takes effect September 1, 2025.

• HB 4928 Provides for the continuation of certain healthcare provider participation programs in counties with a hospital district bordering Oklahoma (Wichita County).
• SB 699 Provides for the continuation of a healthcare provider participation program by the Travis County Hospital District.
• SB 849 Provides for the continuation of a healthcare provider participation program by the El Paso County Hospital District.

HB 492 Mental health services district

Authorizes the Midland County Hospital District and the Ector County Hospital District to create and operate a special district to provide mental health services to area residents. In the previous legislative session, the state appropriated US$40m for a behavioral health center in the Permian Basin. This law creates the mental health services district to operate, fund and maintain that facility and will help to address the need for mental health treatment in West Texas.

HB 3191 Hospital district governing boards

Amends current law relating to the election process for a hospital district's board of directors. Specifically, creates a mechanism for resignation of a board member that fails to appear at board meetings, aligns various provisions with the Election and Government Codes and provides additional options regarding duration of board member terms.

HB 4553 Department of Information Resources (DIR)

Amends the Government Code to establish a comprehensive list of customers, including public hospitals, hospital districts and hospital authorities, eligible for Department of Information Resources (DIR) products and services. Allows for public hospitals, hospital districts and hospital authorities to request access to DIR services and operations, including information resources, information resources technology and the deployment, development and maintenance of software applications.

HB 4844 Nueces County Hospital District

Authorizes the Nueces County Hospital District to utilize a broker for the sale of real property as opposed to using the public bidding system.

Effective immediately.

SB 1097 Decatur Hospital Authority

Amends current law to allow certain municipal hospital authorities that enter into a contract to sell a hospital owned by the authority to "waive[] governmental immunity to suit for the purpose of adjudicating a claim for breach of the contract" and "indemnify the purchaser of the hospital according to the terms of the contract." Applies only to a municipal hospital authority wholly located in a county with a population of less than 70,000. SB 1097 is intended to only impact Decatur Hospital Authority's sale of its hospital to a "national healthcare facility operator."

Effective immediately.

SB 2406 Authority for a hospital water well

Authorizes hospitals in Jefferson County, defined as hospitals located in a county that has a population of more than 250,000 and that borders the Neches River, to drill a water well on hospital property for purposes of producing water to supplement the hospital's water supply in the event of an emergency or natural disaster.

Insurance and managed care

HB 711 Anticompetitive clauses in provider network contracts

Amends the Insurance Code to prohibit providers from offering or entering into provider network contracts with general contracting entities, which is broadly defined and would include health insurers, third party administrators, independent practice associations and other provider networks, which contain anti-steering, anti-tiering, gag or most favored nation clauses. Providers may not amend or renew existing provider network contracts which retain any of these clauses. Any of these anti-competitive clauses are void and unenforceable. However, the remaining contract provisions will remain in effect. Health benefit plans which include incentives designed to steer enrollees to use specific providers or include a tiered network have a fiduciary duty to the enrollee to engage in that conduct only for the primary benefit of that enrollee.

Provisions in existing provider network contracts will remain enforceable until the earlier of the effective date of an amendment eliminating the provision or December 31, 2023.

Effective immediately.

HB 1592 Balance billing

Amends the Insurance Code's balance billing prohibitions and out-of-network dispute resolution procedures to allow self-insured or self-funded ERISA health benefit plans to elect to be subject to the Texas surprise billing laws rather than the federal No Surprises Act. The Texas Department of Insurance (TDI) will adopt a form and process for these self-funded and self-insured plans to make that election, which will apply for the relevant plan year. Directs TDI to adopt rules implementing the new law no later than December 1 , 2023.

HB 2002 Out-of-pocket medical expenses

Amends the PPO/EPO Act under the Insurance Code to require the insurer to credit toward an insured's deductible and maximum out-of-pocket expenses any amounts the insured directly pays to a physician or healthcare provider for medically necessary services and supplies so long as a claim is not submitted to the insurer and the amount paid is less than the average discounted rate for the service or supply paid to an equivalent provider under the benefit plan. These changes are intended to allow patients to access a provider's cash pay prices which may be lower than the contracted rates the provider has negotiated with the patient's benefit plan and have the amounts paid by the patient count toward satisfaction of their deductible, or out-of-pocket maximum. The insurer is not required to credit the amount if the amount paid by the individual is higher than the plan's average contracted rate for the same service.

Applies only to health benefit plans issued or renewed on or after January 1 , 2024.

HB 3359 Network adequacy standards

Responds to concerns about the lack of in-network providers under many insureds' PPO plans by amending the Insurance Code to codify network adequacy standards for preferred provider benefit plans. Expands plans' reimbursement obligations to out-of-network providers to expressly include post-emergency stabilization care. New network adequacy standards include maximum travel time and distance standards by specific provider type and maximum appointment wait time standards. Carriers must meet these standards prior to offering the networks. Insurers may request a waiver of the network adequacy standards, but such request will require a public hearing and gives TDI the ability to conduct an examination of the insurer.

In addition to the network adequacy standards, amends the Insurance Code to prohibit an insurer from unilaterally making adverse material changes to the preferred provider contract, which includes any change that would decrease the provider's compensation or payment, lower the provider's tier or change the administrative procedures in a way that may reasonably be expected to significantly increase the provider's administrative expenses, or decrease payment to the provider. A list of changes that are not considered to be adverse material changes is also included. Any adverse material changes must be agreed to in writing and may not go into effect for a period of 120 days from the date of the provider's written agreement. In proposing such amendments, the insurer must notify the provider of its choice not to agree to the amendment. However, the Insurance Code further states that the adverse material change prohibitions do not apply to contracts (1) with an unspecified and indefinite duration, (2) with no stated or automatic renewal period or event and (3) that may only be terminated by notice from one party to the other.

The changes apply only to an insurance policy that is issued or renewed on or after September 1, 2024. The maximum appointment wait time standards apply only to an insurance policy that is issued or renewed on or after September 1, 2025. The additional insurer reporting requirements will not take effect until October 1, 2024. The adverse material change prohibitions apply only to a contract entered into, amended, or renewed on or after the effective date of this Act.

HB 4500 Electronic verification of health benefits

Requires commercial insurance plans to provide an Internet portal for the verification of patient eligibility and patient cost sharing responsibility "at all times" for physicians and healthcare providers for hospitals or freestanding emergency facilities.

Effective January 1, 2024.

SB 989 Biomarker testing coverage

Amends the Insurance Code to require coverage for a new mandated benefit for biomarker testing of patients for the purpose of diagnosis, treatment, appropriate management or ongoing monitoring of the patient's disease or condition. The test must be supported by medical and scientific evidence.

Applies only to health benefit plans issued or renewed on or after January 1, 2024.

SB 1003 Provider directories

Builds upon the provider directory requirements enacted in 2019 for listing physicians or providers who practice at in-network facilities. Removes the language for specific providers to be listed and instead implements a general "facility-based physician or provider" definition. Clarifies that health benefit plans will not be required to include providers employed by the hospital.

Provider directories and websites must be updated not later than January 1, 2024.

SB 1286 Prompt payment

Amends the HMO and PPO Acts under the Insurance Code to allow extensions of a provider's claims submission deadlines or the plan's prompt payment deadlines due to a catastrophic event that substantially interferes with normal business operations. Authorizes TDI to approve, disapprove or limit requests for relief from claim-handling deadlines.

SB 1342 Third party liability requirements

Updates Texas statutes to reflect changes in federal law regarding third party liability requirements. Intent of the changes is to ensure that when Medicaid beneficiaries also have third party insurance, Medicaid is the payor of last resort and that the federal changes enacted in 2022 are enforceable at the state level. 

SB 2476 Balance billing

Extends the balance billing prohibitions under the state surprise billing laws to out-of-network emergency medical services providers (excluding air ambulance). Authorizes a political subdivision to submit a rate "it sets, controls or regulates" that a health benefit plan must pay for covered transportation services provided by out-of-network emergency medical services providers, adjusted annually for inflation. If the political subdivision has not submitted a rate, the health benefit plan must pay the lesser of the provider's billed charge or 325.0 percent of the current Medicare rate. Creates time frames within which an HMO must pay the non-network emergency medical services provider's claim. The payment amounts and claims payment time frames expire September 1, 2025.

Applies only to emergency medical services provided on or after January 1, 2024.

Maternal and child health

Several important legislative initiatives impacting maternal and child health were passed that range from controversial bans on gender transition to the popular Medicaid expansion of postpartum care for twelve months.

HB 12 Extending postpartum care for Medicaid mothers

Amends the Human Resources Code concerning Medicaid coverage for pregnant women by requiring HHSC to provide medical assistance for not less than 6 months, but also adds an extension of 12 months following delivery. According to the Texas Medical Association, 50 percent of pregnancy related deaths occur after 60 days post-partum.

Effective immediately.

HB 63 Reporting child abuse

Amends the Family Code and prohibits Child Protective Services (CPS) and DFPS from accepting a report of child abuse from an individual without the individual's name, telephone number, address and details regarding the specific nature of the abuse or neglect. If the report comes into CPS or DFPS via a toll-free number, representatives are required to notify the caller that they are not authorized to accept an anonymous report of abuse or neglect, and the report, if oral, is required to be recorded.

HB 1575 Health outcomes for pregnant women

Requires HHSC to adopt standardized assessment questions to screen for, identify and aggregate data regarding nonmedical health related needs of pregnant women eligible for Medicaid or the Alternatives to Abortion Program, including the establishment of separate provider types for community health workers and doulas.

HB 1649 Fertility preservation

Requires coverage by health benefit plans for fertility preservation services for cancer patients. Directs that a healthcare facility at which a child will begin receiving chemotherapy or radiation that may directly or indirectly cause impaired fertility must notify the child's parents or legal guardians of the risk of impaired fertility from treatment before treatment begins.

HB 2478 Newborn/infant screening tests

Seeks to preserve access to an approved DSHS laboratory seven days a week to perform newborn and infant screening tests. While funds are appropriated and authorized for this use, the bill not does require that DSHS use the funds for this purpose.

HB 3058 Serious pregnancy complications

Creates a new affirmative defense for physicians or healthcare providers when the physician or provider "exercised reasonable medical judgment in providing medical treatment to a pregnant woman in response to (1) an ectopic pregnancy at any location, or (2) a preventable premature rupture of membranes." The affirmative defense also applies to a pharmacist or pharmacy that receives, processes or dispenses a prescription drug or medication order in conjunction with such actions.

HB 3550 Prescribed pediatric extended care centers

Amends current law relating to standards for and services provided by prescribed pediatric extended care centers (PPECCs), including the adoption of rules governing Medicaid reimbursement for transportation services.

SB 14 Child gender transitioning

Amends the Health and Safety Code to prohibit the provision of gender transitioning or reassignment procedures and treatments, specifically defined at Section 161.702, performed for the purpose of transitioning a child's sex as determined by the sex organs, chromosomes and endogenous profiles of the child, or affirming the child's perception of the child's sex if that perception is inconsistent with the child's biological sex. Disallows Medicaid and CHIP coverage of prohibited gender transitioning or reassignment care.

Provides exceptions for specific indications, including precocious puberty, medically verifiable genetic disorder of sex development, failure to maintain normal sex chromosome structure for males and females as determined by a physician and for those individuals for whom a prescription drug is part of a continuing course of treatment that began prior to June 1, 2023. However, in this instance, the child must be receiving 12 or more sessions of mental health counseling and be weaned off of the prescription drug over a period of time in a safe and medically appropriate manner.

Adds the provision of gender transition care to the list actions for which a physician may lose their license under the Occupations Code. Requires the Texas Medical Board (TMB) to revoke the license of a physician who violates this Act.

Medicaid/government programs

HB 113 Community health workers in Medicaid managed care

Ensures that community health workers are categorized in the quality improvement bucket of the Medical Loss Ratio, as opposed to the administrative expense side.

Effective immediately.

HB 1488 Medicaid support for sickle cell disease

Requires collaboration between HHSC and the sickle cell task force to support education in sickle cell disease for Medicaid providers. Provides that Medicaid managed care plans reflect sickle cell clinical practice guidelines and use HHSC data for greater healthcare outcomes improvement for Medicaid enrollees diagnosed with sickle cell disease.

HB 3286 Medicaid/CHIP drug benefits

Amends current law to require the Medicaid/CHIP vendor drug program to include all drugs and national drug codes available on the federal Medicaid Drug Rebate Program. Importantly, for new life-saving drugs being developed for children, requires that HHSC establish an expedited review process for considering requests from managed care organizations to add drugs to the preferred drug list and grant temporary non-preferred access to new drugs until they are reviewed by the utilization review board.

HB 2727 Remote patient monitoring

Adds FQHCs and rural health clinics as entities eligible for reimbursement for remote patient monitoring services under Medicaid. Directs HHSC to identify and provide home telemonitoring services to persons who have conditions and exhibit risk factors "other than those expressly authorized" for which HHSC "determines the provision of home telemonitoring services would be cost-effective and clinically effective" including high risk pregnancies. May require waiver approval from CMS.

Effective immediately.

SB 745 Medicaid fraud prevention

Among the most significant change for providers this legislative session is the expansion of the Texas Medicaid Fraud Prevention Act (TMFPA) which now provides that the Office of Attorney General may investigate and pursue civil enforcement actions and recover funds from providers regarding all "health care programs." Defines the term "Health Care Program" to mean the Medicaid, CHIP or the Healthy Texas Women Program.

Physicians

HB 1998 Regulation of physicians

Directs the TMB to annually subscribe each licensee to the National Practitioner Data Bank's continuous query feature and to maintain a publicly available and updated profile of disciplinary actions against physicians including with respect to any license(s) in other states. Requires the TMB to submit the fingerprints of any licensees who do not have a set of fingerprints on file to the Department of Public Safety for a criminal background check and increases the penalty for making a false statement in a license application, or under oath, to obtain a medical license from a Class A misdemeanor to a felony.

Prescription drugs

HB 25 Wholesale prescription drug importation program

Directs HHSC to establish a wholesale prescription drug importation program and to implement the program by contracting with one or more prescription drug wholesalers and Canadian suppliers. Provides that HHSC shall develop a registration process for health benefit plan issuers, healthcare providers and pharmacies to obtain and dispense prescription drugs imported under the program. Requires the program to meet federal requirements for the importation of prescription drugs, obtain approval from the FDA as necessary and only import drugs that meet FDA standards.

Privacy

HB 2545 Genetic data privacy protections

Establishes genetic data protections for Texans by adding a new Chapter 503A to the Business and Commerce Code and sets out provisions that limit the use of an individual's genetic data for commercial purposes by direct-to-individual genetic testing companies. Provides that Chapter 503A does not apply to healthcare providers and institutions of higher education. Authorizes the imposition of a civil penalty in an amount not to exceed US$2,500 for each violation.

Public health

HB 44 Immunization status

Prohibits a provider participating in Medicaid or CHIP, including any provider participating in the network of a managed care organization that contracts with HHSC to provide services under Medicaid or CHIP, from refusing services to clients because of their immunization status. Disallows HHSC from reimbursing a provider that violates this provision until HHSC determines the provider is in compliance with this provision. This prohibition on reimbursement applies only to the individual physician or physician(s) in violation; it does not apply to an entire provider group or medical organization. Exempts providers that are specialists in oncology or organ transplant services from the requirements of this provision.

SB 29 Pandemic restrictions

Amends current law relating to prohibited governmental entity implementation or enforcement of a vaccine mandate, mask requirement or private business or school closure to prevent the spread of COVID-19. Prohibits governmental entities from implementing, ordering, or otherwise imposing a mandate that requires a person to wear a face mask or other face covering to prevent the spread of COVID-19 with three exceptions (1) a state supported living center; (2) a facility operated by the Texas Department of Criminal Justice, or the Texas Juvenile Justice Department, or a municipal or county jail; and (3) a hospital or other healthcare facility owned by a governmental entity. Further prohibits a governmental entity from implementing, ordering or otherwise imposing a mandate requiring the closure of a private business, public school, open-enrollment charter school or private school to prevent the spread of COVID-19.

Special thanks to Kathleen Rubinstein, Erin Riley, Jessie Johnson, Hayley White and Michelle Arnold for assisting in the preparation of this article.