Relating to direct payment for certain health care provided by a hospital.

Contracts

• Managed Care Agreements: Review your lowest-reimbursing commercial contract immediately. Because the statutory cap can be pegged to your "lowest contracted rate," a single low-performing contract now creates a revenue ceiling for your entire self-pay population.
• RCM & Vendor MSAs: Amend Master Services Agreements with third-party billing and collection vendors. Insert indemnification clauses holding them liable if they fail to include the statutory notice on patient statements by June 20.

Hiring/Training

• Patient Access & Billing Staff: Train staff to identify "non-enrollees" (patients without health benefit plan coverage).
• Dispute Resolution: Establish a protocol for the 60-day window. If a patient requests direct payment within 60 days of the bill date, staff must have the authority and tools to re-rate the claim immediately.

Reporting & Record-Keeping

• Mandatory Billing Notice: You must alter your final billing template to include a statement informing the patient of their right to request direct payment under Section 311.006(b).
• Audit Trail: Maintain a documented, quarterly calculation of:
• 1. Your IRS-defined "Amounts Generally Billed" (AGB).
• 2. Your lowest commercial contracted rate per service line.

You must be able to prove to regulators how you derived the final billed amount.

Fees & Costs

• Revenue Impact: Expect a mandatory write-down of Accounts Receivable (AR) for self-pay patients who exercise this right.
• System Costs: Budget for immediate IT spend to reprogram billing logic to handle the "Greater of AGB+25% OR Lowest Contract+50%" calculation.