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 establishes Chapter 566 in the Insurance Code, which includes definitions for key terms such as "durable medical equipment," "enrollee," and "nonparticipating supplier." It sets limitations on how much nonparticipating suppliers can charge enrollees, capping the charge at 115 percent of the Medicare-approved amount unless specific conditions are met, such as obtaining written consent from the enrollee. 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 ranging from $500 to $1,000. Furthermore, it clarifies that Medicare supplement benefit plan issuers are not required to reimburse for amounts exceeding the 115 percent cap. The provisions of this bill will apply only to durable medical equipment or related devices sold on or after its effective date of September 1, 2025.

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