{"data":{"id":"us-tx/tex.-health-and-safety-code-311.006","jurisdiction":"us-tx","citation":"Tex. Health and Safety Code § 311.006","heading":"DIRECT PAYMENT TO HOSPITAL.","body":"(a) In this section:\n(1) \"Enrollee\" means an individual who is enrolled in a health benefit plan or otherwise entitled to coverage under a health benefit plan.\n(2) \"Health benefit plan\" means any individual or group arrangement with a public or private entity under which the entity will pay for, reimburse expenses for, or otherwise contract with a health care provider for the provision of health care services, supplies, or devices to a patient. The term includes an arrangement with:\n(A) an insurance company;\n(B) the sponsor or administrator of a self-insured health benefit plan;\n(C) a group hospital service corporation operating under Chapter 842, Insurance Code;\n(D) a health maintenance organization operating under Chapter 843, Insurance Code;\n(E) the state Medicaid program, including the Medicaid managed care program operating under Chapter 540, Government Code;\n(F) a health benefit plan offered or administered by or on behalf of this state or a political subdivision of this state or an agency or instrumentality of the state or a political subdivision of this state, including:\n(i) a basic coverage plan under Chapter 1551, Insurance Code;\n(ii) a basic plan under Chapter 1575, Insurance Code;\n(iii) a primary care coverage plan under Chapter 1579, Insurance Code; and\n(iv) a plan providing basic coverage under Chapter 1601, Insurance Code; or\n(G) any other entity providing a health insurance or health benefit plan subject to regulation by the Texas Department of Insurance.\n(3) \"Health care service\" means a service to diagnose, prevent, alleviate, cure, or heal a human illness or injury that is provided to an individual by a physician or other health care provider.\n(4) \"Hospital\" means a public or private institution licensed under Chapter 241. The term does not include an ambulatory surgical center licensed under Chapter 243.\n(b) At the request of a patient who is not an enrollee, and subject to Subsection (c), a hospital must accept directly from the patient full payment for a health care service provided by the hospital.\n(c) A request under Subsection (b) must be made not later than the 60th day after the date on which the patient receives a bill for or other final accounting of the health care service provided. The bill or other final accounting must notify the patient of the ability to make a request under Subsection (b).\n(d) Notwithstanding Section 552.003, Insurance Code, or any other law, in accepting payments as described by Subsection (b) for health care services provided by the hospital, a hospital may charge patients amounts that are either:\n(1) not more than 25 percent greater than the amounts generally billed, as defined by 26 C.F.R. Section 1.501(r)-1, for a health care service; or\n(2) not more than 50 percent greater than the lowest contracted rate for a health care service that the hospital has agreed to accept as payment in full as a contracted, preferred, or participating provider of a health benefit plan other than:\n(A) the state Medicaid program, including the Medicaid managed care program operated under Chapter 540, Government Code;\n(B) the child health plan program operated under Chapter 62; or\n(C) Medicare benefits.\n(e) Nothing in this section precludes a patient from receiving from a hospital charity care that the patient would otherwise qualify for or be entitled to.\nAdded by Acts 2025, 89th Leg., R.S., Ch. 565 (H.B. 1612), Sec. 1, eff. September 1, 2025.","path":["HEALTH AND SAFETY CODE","TITLE 4. HEALTH FACILITIES","SUBTITLE F. POWERS AND DUTIES OF HOSPITALS","CHAPTER 311. POWERS AND DUTIES OF HOSPITALS","SUBCHAPTER A. GENERAL PROVISIONS"],"source_url":"https://statutes.capitol.texas.gov/Docs/HS/htm/HS.311.htm#311.006","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:17Z","sha256":"0466ef43d0db8fdfe713426d68caa24107a0bdddb5cc9e735556a94c095e74fe","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-health-and-safety-code-311.005","next":"us-tx/tex.-health-and-safety-code-311.021"},"notice":"GroundRules: Original legal text. Not legal advice."}