Overview
For several legislative terms, Texas has enacted legislation to explore the desirability and feasibility of mandating an all-payer claims database (APCD), while the state ran a voluntary claims data collection effort through the University of Texas Center for Healthcare Data. The medical and pharmacy claims collected from the voluntary effort account for 65% of the Texas population. In the 2021 session, the state finally passed a law to establish a statewide APCD and require health care cost disclosures by health benefit plan issuers and third-party administrators. Texas lawmakers have also enacted some surprise billing protections for consumers, requiring a hold harmless provision and no liability notice for patients that incur a balance bill from out-of-network emergency services and a hold harmless provisions for non-emergency services.
In addition to exploring pay-for-performance models in tandem with its existing rate review processes, Texas maintains a number of consumer resources for finding and using health insurance. The Lone Star state also mandates parity in telemedicine to promote the use of telehealth services. Specifically, Texas statutes require that an insurance provider or issuer cannot exclude coverage for a service provided by a healthcare provider solely because that service is provided via telemedicine and not in person. The statutes further provide parity for reimbursement and cost-sharing of telehealth services.
In provider market competition, the state limits non-compete agreement for physicians, but does not provide statutory authority for notice or review of mergers and acquisitions involving healthcare entities. Notable antitrust cases in Texas involved federal enforcement agencies, including the DOJ action against United Regional Health Care System of Wichita Falls for contracts that improperly inhibited commercial health insurers from contracting with its competitors and the FTC post-merger investigation of King’s Daughters Hospital that was joined by the Texas AG.
Texas is also the site of the latest legal challenge against the Affordable Care Act, in which 20 state attorneys general filed suit in the Northern District of Texas against the Department of Health and Human Services and the Internal Revenue Service (Texas v. U.S.) claiming that the elimination of the tax penalty voids the constitutionality of the individual mandate and the entirety of the ACA. The case was appealed to the Fifth Circuit and granted for Supreme Court review.
See below for an overview of existing Texas state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/10/2023 - 5/29/2023 (2023 term). *Legislature convenes in odd number years only.
HB 220 – Texas
Introduced: 2019 Status: Inactive / Dead
Relating to reimbursement of health care providers under Medicaid.
HB 2222 – Texas
Introduced: 2019 Status: Inactive / Dead
Relating to the administration and oversight of the Medicaid and child health plan programs.
HB 2231 (see companion bill SB 2261) – Texas
Introduced: 2019 Status: Inactive / Dead
Relating to the practices and operation of pharmacy benefit managers; providing administrative penalties. The bill would amend the Insurance Code relating to the practices and operation of pharmacy benefit managers; providing administrative penalties. The bill …
HB 224 – Texas
Introduced: 2017 Status: Inactive / Dead
This proposes to Amend Chapter 1509 of the Texas Insurance code to prohibit health plans from denying or refusing to enroll individuals because of their pre-existing conditions. It also proposes to prohibit health plans from …
HB 2327 – Texas
Introduced: 2019 Status: Inactive / Dead
Relating to preauthorization of certain medical care and health care services by certain health benefit plan issuers and to the regulation of utilization review, independent review, and peer review for health benefit plan and workers’ …
HB 711 – Texas
Introduced: 2023 Status: Enacted
A provider may not: (1) offer to a general contracting entity a provider network contract that includes an all-or-nothing, anti-steering, anti-tiering, gag, or most favored nation clause; (2) enter into a provider network contract that …
SB 1096 (see companion bill HB 3685) – Texas
Introduced: 2019 Status: Enacted
Relating to pharmacy benefits provided through the Medicaid managed care program.
Tex. Bus. & Comm. Code § 15.40. Authority, Powers, and Duties of Attorney General: Texas Free Enterprise and Antitrust Act of 1983 – Texas
Introduced: Status: Enacted
The attorney general may bring any actions on behalf of the state pursuant to the State’s antitrust laws.
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Tex. Bus. & Comm. Code § 17.45. Definitions: Deceptive Trade Practices and Consumer Protection Act – Texas
Introduced: Status: Enacted
Includes the Definitions for the Deceptive Trade Practices and Consumer Protection Act
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Tex. Bus. & Comm. Code § 17.46. Deceptive Trade Practices Unlawful: Deceptive Trade Practices and Consumer Protection Act – Texas
Introduced: Status: Enacted
Lists what Texas considers false or misleading or deceptive trade practices, including disseminating or releasing false or misleading information.
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U.S. Anesthesia Partners of Texas, P.A. v. United Healthcare Insurance – Texas
District Court: 14th District Court, Dallas County Status: Decided
In late March, a group of doctors sued United Healthcare Insurance in Texas state court, alleging the insurance giant violated state antitrust laws. Plaintiffs U.S. …
Texas et al. v. United States of America et al. – California, Federal, Texas
District Court: Northern District of Texas Status: Decided
[Consolidated with California et al. v. Texas et al. for Supreme Court review] This case arises out of the Supreme Court’s decision in NFIB v. …
United States and the State of Texas v. United Regional Health Care System of Wichita Falls – Texas
District Court: Northern District of Texas Wichita Falls Division Status: Decided
On February 25, 2011, the Department of Justice’s Antitrust Division and the Texas Attorney General’s Office filed a complaint against, and proposed settlement with, United …
Additional Resources
STATE BUDGET
Texas’ biennium budget begins September 1 after each regular legislative session and ends August 31 of the following odd-numbered year.
REGULATION & ENFORCEMENT
- In 2020, Texas HHSC and AG approved a pair of purchases from Community Health Systems (CHS) using COPAs, over FTC’s objection. The first transaction involves Hendrick Health System’s purchase of Abilene Regional Medical Center and Brownwood Regional Medical Center, and the second transaction is Shannon Health System’s purchase of San Angelo Community Medical Center. Texas’ COPA law passed in 2019 shields healthcare transactions from federal antitrust oversight. The FTC sent a 70-page comment letter urging the state to deny the proposed transactions as they would create a monopoly in the markets and result in higher prices to consumers.
KEY RESOURCES
- Texas State Legislature
- Texas Office of the Attorney General
- Texas Department of Insurance
- Texas PricePoint
- Texas Health Options