By: Hancock  S.B. No. 1330          (In the Senate - Filed February 14, 2025; February 28, 2025,   read first time and referred to Committee on Health & Human   Services; March 24, 2025, reported adversely, with favorable   Committee Substitute by the following vote:  Yeas 8, Nays 0;   March 24, 2025, sent to printer.)Click here to see the committee vote     COMMITTEE SUBSTITUTE FOR S.B. No. 1330 By:  Perry     A BILL TO BE ENTITLED   AN ACT     relating to billing and reimbursement for certain medical   equipment, devices, and supplies provided to Medicare enrollees;   creating a criminal offense.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle C, Title 5, Insurance Code, is amended   by adding Chapter 566 to read as follows:   CHAPTER 566.  BILLING FOR CERTAIN MEDICAL EQUIPMENT, DEVICES, AND   SUPPLIES   SUBCHAPTER A. GENERAL PROVISIONS          Sec. 566.001.  DEFINITIONS. In this chapter:                (1)  "Assignment" means an agreement in which a   supplier agrees to accept the Medicare-approved amount as payment   for medical equipment or a medical device or supply.                (2)  "Durable medical equipment" means medical   equipment that:                      (A)  can withstand repeated use;                      (B)  is expected to last at least three years;                      (C)  is primarily and customarily used to serve a   medical purpose;                      (D)  is generally not useful in the absence of an   illness or injury; and                      (E)  is appropriate for use in the home.                (3)  "Enrollee" means an individual enrolled in   Medicare.                (4)  "Medicare" means the health benefit coverage   provided under the Health Insurance for the Aged Act (42 U.S.C.   Section 1395 et seq.).                (5)  "Nonparticipating supplier" means an entity or   person who:                      (A)  provides Medicare-covered durable medical   equipment, orthotic devices or supplies, or prosthetic devices or   supplies to Medicare enrollees; and                      (B)  is not enrolled in Medicare as a   participating supplier.                (6)  "Orthotic device or supply" means:                      (A)  a custom-fitted or custom-fabricated medical   device designed to correct a deformity, improve function, or   relieve symptoms of a disease; or                      (B)  a medical supply related to a device   described by Paragraph (A).                (7)  "Prosthetic device or supply" means:                      (A)  an artificial medical device designed to   replace all or part of a limb or internal organ; or                      (B)  a medical supply related to a device   described by Paragraph (A).   SUBCHAPTER B.  REGULATION OF CERTAIN BILLING PRACTICES          Sec. 566.051.  LIMITATIONS ON BILLING; NOTICE.  (a)  A   nonparticipating supplier may not charge an enrollee more than 115   percent of the Medicare-approved amount for durable medical   equipment, orthotic devices or supplies, or prosthetic devices or   supplies covered under Medicare for which the supplier has not   accepted written assignment unless:                (1)  before the enrollee is billed, the enrollee agrees   in writing to pay the additional amount; and                (2)  before receiving the durable medical equipment,   orthotic device or supply, or prosthetic device or supply, the   enrollee:                      (A)  enters into a rental payment plan; or                      (B)  pays the additional amount in full.          (b)  A written agreement between a nonparticipating supplier   and enrollee under this section must provide notice to the enrollee   that:                (1)  Medicare will reimburse 80 percent of the   Medicare-approved amount for durable medical equipment, orthotic   devices or supplies, or prosthetic devices or supplies covered   under Medicare; and                (2)  a Medicare supplement benefit plan issuer is not   required to reimburse the nonparticipating supplier or enrollee for   the amount by which the charge exceeds 115 percent of the   Medicare-approved amount.   SUBCHAPTER C.  ENFORCEMENT          Sec. 566.101.  APPLICATION OF DECEPTIVE TRADE PRACTICES LAW.   A nonparticipating supplier who violates this chapter engages in a   false, misleading, or deceptive act or practice under Section   17.46, Business & Commerce Code.          Sec. 566.102.  CRIMINAL OFFENSE. (a)  A nonparticipating   supplier who intentionally violates this chapter commits an   offense.          (b)  An offense under this section is a misdemeanor   punishable by a fine of not less than $500 or more than $1,000.          (c)  Notwithstanding any other law, an offense under this   section may be prosecuted in:                (1)  Travis County; or                (2)  a county in which prosecution is authorized under   the Code of Criminal Procedure.          SECTION 2.  Subchapter B, Chapter 1652, Insurance Code, is   amended by adding Section 1652.059 to read as follows:          Sec. 1652.059.  REIMBURSEMENT FOR CERTAIN MEDICAL   EQUIPMENT, DEVICES, AND SUPPLIES.  (a)  In this section, terms   defined by Section 566.001 have the meanings assigned by that   section.          (b)  A Medicare supplement benefit plan issuer is not   required to reimburse an enrollee or nonparticipating supplier for   the amount by which a charge for durable medical equipment,   orthotic devices or supplies, or prosthetic devices or supplies   exceeds 115 percent of the Medicare-allowed amount for the   equipment, device, or supply.          (c)  This section does not prohibit a Medicare supplement   benefit plan issuer and a nonparticipating supplier from   negotiating a level and type of reimbursement for durable medical   equipment or orthotic or prosthetic devices or supplies.          SECTION 3.  Chapter 566, Insurance Code, as added by this   Act, applies only to durable medical equipment or orthotic or   prosthetic devices or supplies sold on or after the effective date   of this Act.          SECTION 4.  This Act takes effect September 1, 2025.     * * * * *