Bill > HB1225

This bill establishes a bundled-pricing program for the state employees group benefits program designed to reduce health care costs by creating a consolidated payment system for surgical procedures. The program allows the board of trustees to contract with health care facilities, physicians, and providers at a single, comprehensive rate that covers all related fees for a specific surgery, including facility, physician, laboratory, anesthesia, and pharmacy services. Participation is voluntary for providers, and the bill includes protections to prevent coercion or discrimination against providers who choose not to participate. The program requires pre-approval of procedures by a third-party administrator, who must ensure the quality of care is comparable to existing network providers and that the procedure's cost is lower than traditional pricing. Patients will typically not have to pay additional out-of-pocket costs, except for those in the consumer-directed health plan who may need to meet their deductible first. The board of trustees must publish program information, including participating providers and their rates, on the Employees Retirement System of Texas website. The bill explicitly prohibits any unauthorized practice of medicine and allows the board to adopt necessary rules for implementation, with the program set to take effect on September 1, 2025.

Government Affairs

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB1225