All Roll Calls
Yes: 297 • No: 5
TexasHB 54189th Legislature Regular SessionHouse
Relating to the provision of direct patient care by physicians and health care practitioners.
Sponsored By: Matt Shaheen, Judith Zaffirini (Democratic)
Signed by Governor
Health Care ProvidersInsurance--Health & AccidentOccupational Regulation--Health OccupationsPHYSICIANSMEDICAL BOARD, TEXAS
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Direct care patients get billing safeguards
Before entering a direct patient care agreement, providers must give patients written or electronic notice that it is not insurance. Providers cannot bill an insurer or health maintenance organization for care paid for under that agreement. Both safeguards apply only to agreements entered into on or after the law’s effective date, not earlier agreements. The law takes effect immediately with a two-thirds vote of elected members in each house; otherwise, September 1, 2025.
Direct care operates outside insurance rules
Texas recognizes direct patient care, including telehealth, paid through memberships, subscriptions, retainers, or fees for individual services. Agreements must be written and signed, cover a defined period, and allow patients, legal representatives, guardians, or employers to contract. These arrangements are not insurance: Texas insurance regulation does not apply, and providers need no insurance certificate to offer them. State agencies, insurers, health maintenance organizations, and care providers cannot interfere solely because someone provides or pays for direct care. Agencies also cannot bring proceedings or impose fines solely for that reason; covered private parties cannot bring legal proceedings. The framework excludes workers’ compensation and applies only to agreements entered into on or after the law’s effective date. The law takes effect immediately with a two-thirds vote of elected members in each house; otherwise, September 1, 2025.
Sponsors & Cosponsors
Sponsors
Matt Shaheen
House
Judith Zaffirini
Democratic • Senate
Cosponsors
César Blanco
Democratic • Senate
Donna Campbell
Republican • Senate
Nathan Johnson
Democratic • Senate
Roll Call Votes
Senate vote • 5/28/2025
Record vote
Yes: 0 • No: 0
Senate vote • 5/28/2025
Record vote
Yes: 0 • No: 0
House vote • 5/8/2025
Record vote
Yes: 144 • No: 1
House vote • 5/7/2025
Record vote
Yes: 135 • No: 3
Senate vote • Unknown
Committee vote: Health & Human Services
Yes: 8 • No: 0
House vote • Unknown
Committee vote: Public Health
Yes: 10 • No: 1
Actions Timeline
Effective immediately
6/20/2025HouseSigned by the Governor
6/20/2025HouseSent to the Governor
5/31/2025HouseSigned in the Senate
5/31/2025SenateSigned in the House
5/30/2025HouseReported enrolled
5/30/2025HouseSenate passage reported
5/29/2025HouseRecord vote
5/28/2025SenatePassed
5/28/2025SenateRead 3rd time
5/28/2025SenateRecord vote
5/28/2025SenateThree day rule suspended
5/28/2025SenateVote recorded in Journal
5/28/2025SenateRead 2nd time & passed to 3rd reading
5/28/2025SenateRules suspended-Regular order of business
5/28/2025SenatePlaced on intent calendar
5/28/2025SenateCo-sponsor authorized
5/28/2025SenateCommittee report printed and distributed
5/26/2025SenateReported favorably w/o amendments
5/26/2025SenateVote taken in committee
5/26/2025SenateConsidered in public hearing
5/26/2025SenateLeft pending in committee
5/21/2025SenateTestimony taken in committee
5/21/2025SenateConsidered in public hearing
5/21/2025SenateScheduled for public hearing on . . .
5/21/2025Senate
Bill Text
Engrossed
Enrolled
House Committee Report
Introduced
Senate Committee Report
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