Bill > SB1330

This bill establishes new regulations for billing and reimbursement of medical equipment for Medicare enrollees in Texas, focusing on nonparticipating suppliers (medical equipment providers not formally enrolled in Medicare). The bill defines various medical equipment categories like durable medical equipment, orthotic devices, and prosthetic devices, and limits how much these nonparticipating suppliers can charge Medicare enrollees. Specifically, suppliers cannot charge more than 115% of the Medicare-approved amount unless the enrollee agrees in writing and either enters a rental payment plan or pays the additional amount upfront. The bill requires suppliers to provide clear notice to enrollees about Medicare's 80% reimbursement rate and that Medicare supplement plans are not required to cover charges exceeding the 115% threshold. Additionally, the bill creates a criminal offense for intentionally violating these billing regulations, with misdemeanor penalties ranging from $500 to $1,000, which can be prosecuted in Travis County or other authorized counties. The law will apply to medical equipment sold on or after September 1, 2025, and aims to protect Medicare enrollees from excessive billing practices by nonparticipating medical equipment suppliers.

Business and Industry, Health and Social Services

https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=SB1330