HB 1945

84(R) - 2015
House Public Health
House Public Health

Vote Recommendation

  • Positive
  • Neutral
  • Neutral
  • Positive
  • Neutral


Greg Bonnen


Bill Zedler

Bill Caption

Relating to the provisions of direct primary care.

Fiscal Notes

No significant fiscal implication to the State is anticipated.

No fiscal implication to units of local government is anticipated.

Bill Analysis

5/6/15 Update:

This bill is substantively the same as when we reported on it in its original chamber. We continue to support the bill.

First chamber analysis below:

Direct primary care (DPC), also known as retainer medicine or concierge medicine, is an emerging model for delivering health care services without third-party payment systems. Two sections of the Affordable Care Act (ACA) acknowledge direct primary care. Section 10104 exempts patients enrolled in DPC from the individual mandate for primary care if they have supplementary coverage for other services. Section 1301 of the ACA authorizes DPC on the exchanges if a plan combines a qualified high-deductible plan with a qualified direct primary care medical home plan.

The interpretation and administration of these direct primary care clauses in the ACA has been left up to states' discretion. For example, Utah enacted a law in 2012 that exempts direct primary care practices from state insurance regulations; Michigan passed a similar law in 2014. On the other hand, some states have limited the number of patients a direct primary care practice can contract with or required written disclosures from prospective patients.

HB 1945 would establish legal protection for direct primary care provision in Texas by adding Subchapter F to Chapter 162 of the Occupational Code. The bill would prohibit physicians who provide direct primary care to be subject to regulation by the Texas Department of Insurance (TDI). The bill would define direct primary care as a primary medical care service provided by a physician to a patient in return for payment in accordance with a direct fee. This direct fee would include a fee in any form, including a: monthly retainer; membership fee; subscription fee; fee paid under a medical service agreement; or fee for a service, visit, or episode of care.

This legislation would also prohibit a physician from billing an insurer or health maintenance organization for direct primary care that is paid under a medical service agreement.

Vote Recommendation Notes

By removing third-party involvement - specifically insurance companies and government programs - in the delivery of health care, direct primary care fosters a direct financial relationship between a patient and physician. HB 1945 would revive a market-based approach to health care. It would also protect direct primary care physicians from Texas Department of Insurance regulatory oversight.

Direct primary care is an innovative health care alternative designed to restore and empower the personal aspect of doctor-patient relationships. We support HB 1945 because it promotes our limited government and free market principles.

For an extensive and in-depth analysis on this bill, interested parties may wish to read a report provided by the Texas Public Policy Foundation which testified in favor of this legislation. Interested parties can also read The Heritage Foundation's policy report on direct primary care.

Organizations Supporting

Texas Public Policy Foundation