Relating to billing and reimbursement for certain medical equipment, devices, and supplies provided to Medicare enrollees; creating a criminal offense.
Summary
SB 1330 creates a new chapter in the Texas Insurance Code regulating billing practices for certain durable medical equipment, orthotic devices or supplies, and prosthetic devices or supplies provided to Medicare enrollees. The bill applies to nonparticipating suppliers—those not enrolled as Medicare participating suppliers—and generally prohibits them from charging more than 115% of the Medicare-approved amount unless the enrollee agrees in writing before billing and either enters a rental payment plan or pays the extra amount in full before receiving the item.
The bill also requires the written agreement to disclose that Medicare typically reimburses 80% of the Medicare-approved amount and that Medicare supplement benefit plan issuers are not required to cover charges above 115% of the Medicare-approved amount. In addition, it makes a violation of the chapter a false, misleading, or deceptive act under the Texas Deceptive Trade Practices Act and creates a misdemeanor offense for intentional violations, punishable by a fine of $500 to $1,000. Venue is specifically authorized in Travis County or any other county permitted by criminal procedure law.
Impact
SB 1330 changes Texas law by adding billing limits and disclosure requirements for certain Medicare-related medical equipment and supply transactions, and by tying violations to both civil consumer-protection remedies and criminal penalties. It also amends the Insurance Code to clarify that Medicare supplement benefit plan issuers are not obligated to reimburse amounts above the 115% cap, while still allowing negotiated reimbursement arrangements between issuers and suppliers. The bill applies prospectively to items sold on or after its effective date, September 1, 2025, and affects nonparticipating suppliers, Medicare enrollees, and Medicare supplement insurers.
Sentiment
The bill appears to have broad bipartisan support and little visible opposition. It passed the Senate unanimously and the House by a wide margin, 133-0, with two members present not voting. The absence of recorded committee testimony in the provided materials suggests the measure was not especially controversial in the legislative process.
Contention
The main policy issue in the bill is the regulation of what nonparticipating suppliers may charge Medicare enrollees for durable medical equipment, orthotics, and prosthetics, especially where suppliers do not accept assignment. Potential points of contention include the 115% billing cap, the requirement for written notice and advance payment or rental arrangements, and the decision to impose criminal penalties for intentional violations. However, the vote totals indicate these concerns did not generate significant opposition among legislators.
Identical
Relating to billing and reimbursement for certain medical equipment, devices, and supplies provided to Medicare enrollees; creating a criminal offense.
Relating to billing and reimbursement for certain medical equipment, devices, and supplies provided to Medicare enrollees; creating a criminal offense.
Establishes program for certain individuals to become certified homemaker-home health aides and provide services to certain Medicaid and Medicaid-Medicare dually eligible enrollees under increased reimbursement rates.
Establishes program for certain individuals to become certified homemaker-home health aides and provide services to certain Medicaid and Medicaid-Medicare dually eligible enrollees under increased reimbursement rates.
Payment methodologies for enteral nutrition equipment and supplies modified, and processes for establishing payment rates for medical equipment and supplies modified.