The bill, S.B. No. 1330, introduces new regulations regarding billing and reimbursement practices for certain medical equipment, devices, and supplies provided to Medicare enrollees in Texas. It establishes Chapter 566 in the Insurance Code, which includes definitions for key terms such as "durable medical equipment," "enrollee," and "nonparticipating supplier." The bill stipulates 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 to pay the additional amount. Additionally, it mandates that any written agreement must inform the enrollee about Medicare's reimbursement policies.

Furthermore, the bill creates a criminal offense for nonparticipating suppliers who intentionally violate these regulations, classifying such violations as misdemeanors punishable by fines ranging from $500 to $1,000. It also clarifies that Medicare supplement benefit plan issuers are not required to reimburse for charges exceeding the specified limits. The provisions of this bill will apply only to transactions involving durable medical equipment or related devices sold on or after the effective date of September 1, 2025.

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