SB2108 - Relating to the inclusion of direct primary care fees as qualified medical expenses applied toward insurance deductibles in certain state health benefit plans.

      By: Hughes S.B. No. 2108               A BILL TO BE ENTITLED   AN ACT   relating to the inclusion of direct primary care fees as qualified   medical expenses applied toward insurance deductibles in certain   state health benefit plans.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 1551, Insurance Code, is amended by   adding Subchapter K to read as follows:   SUBCHAPTER K. DIRECT PRIMARY CARE SERVICES           Sec. 1551.501.  DEFINITIONS. In this subchapter:                 (1)     "Direct fee" means a fee charged by a physician to   a patient or a patient's designee for primary medical care services   provided by, or to be provided by, the physician to the patient. The   term includes a fee in any form, including a:                       (A)  monthly retainer;                       (B)  membership fee;                       (C)  subscription fee;                       (D)     fee paid under a medical service agreement;   or                       (E)  fee for a service, visit, or episode of care.                 (2)     "Direct primary care" means a primary medical care   service provided by a physician to a patient in return for payment   in accordance with a direct fee. The term include telemedicine   medical services and telehealth services, as those terms are   defined by Section 111.001, Occupations Code, provided using a   technology platform.           Sec.   1551.502.     INCLUSION OF DIRECT PRIMARY CARE FEES AS   QUALIFIED MEDICAL EXPENSES. (a) Direct fees paid to a direct   primary care provider shall apply to the deductible of a   participant enrolled in the basic coverage provided under the   Employees Retirement System of Texas.           (b)     The board of trustees shall adopt rules necessary to   implement this section.          SECTION 2.  Chapter 1575, Insurance Code, is amended by   adding Subchapter L to read as follows:   SUBCHAPTER L. DIRECT PRIMARY CARE SERVICES           Sec. 1575.601.  DEFINITIONS. In this subchapter:                 (1)     "Direct fee" means a fee charged by a physician to   a patient or a patient's designee for primary medical care services   provided by, or to be provided by, the physician to the patient. The   term includes a fee in any form, including a:                       (A)  monthly retainer;                       (B)  membership fee;                       (C)  subscription fee;                       (D)     fee paid under a medical service agreement;   or                       (E)  fee for a service, visit, or episode of care.                 (2)     "Direct primary care" means a primary medical care   service provided by a physician to a patient in return for payment   in accordance with a direct fee. The term include telemedicine   medical services and telehealth services, as those terms are   defined by Section 111.001, Occupations Code, provided using a   technology platform.           Sec.   1575.602.     INCLUSION OF DIRECT PRIMARY CARE FEES AS   QUALIFIED MEDICAL EXPENSES. (a) Direct fees paid to a direct   primary care provider shall apply to the deductible of a   participant enrolled in the basic coverage provided under the   Teacher Retirement System of Texas.           (b)     The trustee shall adopt rules necessary to implement   this section.          SECTION 3.  This Act applies only to a health benefit plan   delivered, issued for delivery, or renewed on or after January 1,   2026.          SECTION 4.  This Act takes effect September 1, 2025.