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A BILL TO BE ENTITLED
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AN ACT
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relating to the provision of direct primary care. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 162, Occupations Code, is amended by |
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adding Subchapter F to read as follows: |
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SUBCHAPTER F. DIRECT PRIMARY CARE |
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Sec. 162.251. DEFINITIONS. In this subchapter: |
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(1) "Direct fee" means a fee charged by a physician to |
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a patient or a patient's designee for primary medical care services |
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provided by, or to be provided by, the physician to the patient. |
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The term includes a fee in any form, including a: |
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(A) monthly retainer; |
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(B) membership fee; |
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(C) subscription fee; |
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(D) fee paid under a medical service agreement; |
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or |
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(E) fee for a service, visit, or episode of care. |
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(2) "Direct primary care" means a primary medical care |
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service provided by a physician to a patient in return for payment |
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in accordance with a direct fee. |
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(3) "Medical service agreement" means a signed written |
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agreement under which a physician agrees to provide direct primary |
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care services for a patient in exchange for a direct fee for a |
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period of time that is entered into by the physician and: |
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(A) the patient; |
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(B) the patient's legal representative, |
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guardian, or employer on behalf of the patient; or |
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(C) the patient's legal representative's or |
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guardian's employer on behalf of the patient. |
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(4) "Physician" includes a professional association |
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or professional limited liability company owned entirely by an |
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individual licensed under this subtitle. |
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(5) "Primary medical care service" means a routine or |
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general health care service of the type provided at the time a |
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patient seeks preventive care or first seeks health care services |
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for a specific health concern, is a patient's main source for |
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regular health care services, and includes: |
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(A) promoting and maintaining mental and |
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physical health and wellness; |
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(B) preventing disease; |
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(C) screening, diagnosing, and treating acute or |
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chronic conditions caused by disease, injury, or illness; |
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(D) providing patient counseling and education; |
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and |
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(E) providing a broad spectrum of preventive and |
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curative health care over a period of time. |
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Sec. 162.252. DIRECT PRIMARY CARE NOT INSURANCE. (a) A |
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physician providing direct primary care is not an insurer or health |
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maintenance organization, and the physician is not subject to |
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regulation by the Texas Department of Insurance for the direct |
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primary care. |
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(b) A medical service agreement is not health or accident |
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insurance or coverage under Title 8, Insurance Code, and is not |
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subject to regulation by the Texas Department of Insurance. |
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(c) A physician is not required to obtain a certificate of |
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authority under the Insurance Code to market, sell, or offer a |
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medical service agreement or provide direct primary care. |
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(d) A physician providing direct primary care does not |
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violate Section 1204.055, Insurance Code. |
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Sec. 162.253. INTERFERENCE PROHIBITED. (a) The board or |
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another state agency may not prohibit, interfere with, initiate a |
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legal or administrative proceeding against, or impose a fine or |
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penalty against: |
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(1) a physician solely because the physician provides |
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direct primary care; or |
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(2) a person solely because the person pays a direct |
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fee for direct primary care. |
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(b) A health insurer, health maintenance organization, or |
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health care provider as that term is defined by Section 105.001 may |
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not prohibit, interfere with, or initiate a legal proceeding |
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against: |
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(1) a physician solely because the physician provides |
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direct primary care; or |
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(2) a person solely because the person pays a direct |
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fee for direct primary care. |
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SECTION 2. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2015. |