S.B. No. 1330 introduces new regulations regarding billing and reimbursement for certain medical equipment, devices, and supplies provided to Medicare enrollees in Texas. The bill adds Chapter 566 to the Insurance Code, which includes definitions for key terms such as "durable medical equipment," "enrollee," and "nonparticipating supplier." It establishes that nonparticipating suppliers cannot charge enrollees more than 115% of the Medicare-approved amount for covered items unless specific conditions are met, including written agreement from the enrollee and prior payment arrangements. Additionally, the bill mandates that nonparticipating suppliers inform enrollees about Medicare's reimbursement policies.

The bill also creates a criminal offense for nonparticipating suppliers who intentionally violate these regulations, classifying such violations as misdemeanors punishable by fines. Furthermore, it amends existing laws to clarify that Medicare supplement benefit plan issuers are not required to reimburse for charges exceeding the 115% threshold. The provisions of this act will apply only to durable medical equipment or related devices sold after its effective date of September 1, 2025.

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