Under current law, “plaintiff’s lawyers will conspire with health care providers who over-diagnose, over-treat, and overbill for the services provided to plaintiffs, avoiding compliance with the ‘paid or incurred’ statute and turning medical bills into a litigation profit center.” Senate Comm. on State Affairs, Bill Analysis, Tex. S.B. 30, 89th Leg., R.S. (2025). Defendants struggle to contest inflated claims and challenge unreasonable awards, which may contribute to rising costs in legal proceedings, complicating the pursuit of fair and equitable outcomes. Id.
Senate Bill 30 is intended to address enormous and unfair verdicts caused by manipulation of medical damages to present vastly inflated medical bills to juries and disproportionately large awards of noneconomic damages. On April 22, 2025, after being reported favorably by the Senate State Affairs Committee (9-1) and passing the Senate (20-11), S.B. 30 was referred to the House Judiciary & Civil Jurisprudence Committee. If it becomes law, S.B. 30 would make significant changes to the Texas Civil Practice and Remedies Code regarding damages.
I. New Disclosure Requirements
In addition to disclosures required by other law, by a new § 41.105 of the Texas Civil Practice and Remedies Code, S.B. 30 would require claimants to: (1) provide a copy of all statements or invoices showing health care services provided to the injured individual because of the event that is the basis for the action, which would be admissible at trial; (2) provide a copy of any letter of protection related to the action, which would be admissible at trial; (3) provide a copy of any written agreement where a provider would refund, rebate, or remit money to a payor, injured individual, claimant, claimant’s attorney, or the associate of any such person, which agreement would be admissible at trial; (4) identify any health care provider and provide an authorization to obtain medical records from the provider; (5) disclose any non-written agreement where a provider would refund, rebate, or remit money to a payor, injured individual, claimant, claimant’s attorney, or the associate of any such person; and (6) disclose the person who referred them to any provider and the relationship between the claimant and the referrer. S.B. 30 does not include deadlines for any of the disclosures that would be required.
If the referrer is the injured person’s attorney, there is a further requirement to provide an anonymized list of people the attorney referred to the provider in the prior two years, dates and amounts of payments made to the provider by or at the direction of the attorney in the prior two years with anonymous description of the person on whose behalf a payment was made, and other aspects of any financial relationship between the attorney and the provider, all of which would be admissible at trial. Attorney referral is defined broadly, to include referrals made by another person when the attorney knew or had reason to know the referral would be made.
II. Controverting by Notice Rather than Counteraffidavit
Under the current version of § 18.001 of the Texas Civil Practice and Remedies Code, the reasonableness of charges and the necessity of services could be established by affidavit of the person who provided the services or the person in charge of the records showing the service was provided and the charge made, unless that affidavit is controverted. To controvert, a defendant must serve a counteraffidavit that gives reasonable notice of the basis on which the claim will be controverted at trial and be made by a qualified expert. Tex. R. Civ. P. 18.001(f).
At one time, Texas intermediate appellate courts held that a party who did not controvert under § 18.001 was precluded from presenting evidence at trial to oppose reasonableness or necessity, but the Supreme Court of Texas has held otherwise. In re Allstate Indem. Co., 622 S.W.3d 870, 881 (Tex. 2021). Whether a defendant serves a valid counteraffidavit therefore determines whether the plaintiff may prove reasonableness and necessity by affidavit or instead must have expert testimony at trial. See id. at 876.
In the engrossed version of S.B. 30 (the version passed by the Senate), § 18.001 of the Texas Civil Practice and Remedies Code would change from defendants needing to serve a counteraffidavit to defendants needing to serve a notice of intent to controvert. As with a valid counteraffidavit under current law, the notice would render the initial affidavit ineffective to prove reasonableness and necessity. The bill does not include language that would set statutory requirements for the content of such notice. The subsection setting out the requirements for counteraffidavits would be wholly repealed. Perhaps similar detail would be required for notice compared to counteraffidavits, but at somewhat lower cost because an expert would not have to sign off.
S.B. 30 would not alter the deadlines for initial affidavits and the notice of intent to controvert from those that currently apply to initial affidavits and counteraffidavits.
While affidavits under § 18.001 are most commonly used with respect to medical expenses, they are not so limited by the current statutory language and are sometimes used for other claims, such as for attorney’s fees (where recoverable). S.B. 30 would add new language making the statute only apply for health care services.
III. New Limits on Controverting Reasonableness
Under a proposed new § 18.0011, S.B. 30 would disallow controverting the reasonableness of charges for health care services where the amount for each service is: the amount received from all sources to pay for the service; or less than three times the Medicare fee schedule for the service. Effectively, charges will be deemed reasonable whenever they have been paid or when the charge outstanding is no more than three times the Medicare rate.
The Medicare rate would be the Medicare fee schedule as it exists on May 1, 2025, adjusted for inflation by the consumer price index for prices of goods and services purchased by urban wage earners and clerical workers’ families and single workers living alone (CPI-W: Seasonally Adjusted U.S. City Average-All Items), rather than adjusting for later Medicare fee schedules. If inflation for health care services is greater than the CPI-W, there may be comparatively more ability to challenge reasonableness of charges in the future.
Where a provider’s initial affidavit meets the requirements, no party would be able to seek discovery from that provider as to reasonableness and necessity.
IV. Proof at Trial
While the rules of evidence would generally continue to apply, S.B. 30 would impose additional requirements. Under a new § 41.104 of the Texas Civil Practice and Remedies Code, evidence of health care services in the past would be limited to evidence of: (1) amounts third-party payors paid to providers for health care services for the injured individual; (2) amounts paid by the injured or others for health care services provided to the injured individual, other than to purchase an account receivable or as a loan, and if the payment was without an agreement for the provider to refund, rebate, or remit money to the payor, injured individual, claimant, claimant’s attorney, or the associate of any such person; or (3) amounts that do not exceed three times the Medicare fee schedule for the service. Between the section on admissible evidence and the section disallowing controvertion, any dispute on reasonableness of charges for health care services will end up being for incurred charges that have not been satisfied and that are more than three times the Medicare rate.
Additionally, provider statements or invoices must be presented in a form that would comply with the clean claim requirements of chapter 1301 of the Texas Insurance Code.
By amendment to § 41.001 of the Texas Civil Practice and Remedies Code, S.B. 30 would add definitions for “mental or emotional pain or anguish” and “physical pain and suffering,” which may also affect proof at trial.
“Mental or emotional pain or anguish” would be defined as “grievous and debilitating angst, distress, torment, or emotional suffering or turmoil that causes a substantial disruption in a person’s life. The term includes mental or emotional pain or anguish arising from loss of consortium, loss of companionship and society, loss of enjoyment of life, disfigurement, and physical impairment.” This differs from the Supreme Court of Texas’s approach, which required “evidence of a high degree of mental pain and distress that is more than mere worry, anxiety, vexation, embarrassment, or anger” in order to support an award of mental anguish, but left the jury to interpret the term. See Bennett v. Grant, 525 S.W.3d 642, 648 (Tex. 2017). The statutory definition also pulls an aspect out of what are typically treated as separate categories of damages. See Comm. on Pattern Jury Charges, State Bar of Tex., Texas Pattern Jury Charges: General Negligence & Intentional Personal Torts PJC 28.3 & cmt., 28.4, 29.3 (2024).
The definition of “physical pain and suffering” would be defined in terms of “a painful or distressing sensation associated with an injury or damage to a part of a person’s body.” It would further require the pain to be consciously felt and, other than in sexual assault or abuse cases, to arise from an observable injury or objectively verifiable medical evaluation or testing.
By amendment to § 41.001 and a new § 41.104 of the Texas Civil Practice and Remedies Code, S.B. 30 would inject the concept of “reasonable probability” into future loss of earning capacity and future medical expenses. It is not clear from the bill text whether this should be interpreted as something other than the usual preponderance of evidence standard.
V. Codification of Common Law on Noneconomic Damages
By a new § 41.151 of the Texas Civil Practice and Remedies Code, S.B. 30 would impose requirements and restrict noneconomic damages awards. The bill would essentially codify an aspect of Gregory v. Chohan, 670 S.W.3d 546 (Tex. 2023) (plurality op.) by requiring awards be fair and reasonable compensation for the period (or expected period) of pain and anguish; be based on evidence of the nature, duration, and severity of the injury with a rational connection between the injury suffered and the dollar amount of the award; not be used to penalize or punish a defendant, make an example, or serve a social good; and not include economic losses. In making it reversible error for a court to allow anyone to state or suggest the jury should determine the amount of a physical pain or mental anguish award to be based on objects, values, units of time, or other matters having no rational connection to the facts of the case, S.B. 30 would codify another aspect of Gregory. Arguably, the statute would provide more clarity on these points than the plurality opinion where the justices split on their views. By specifying the error would be reversible, appealing defendants’ burden would be somewhat reduced because they would not need to address the harmless error rule, and there might be a corresponding increased incentive to plaintiffs’ counsel to stay away from improper jury argument.
VI. Restriction on Prejudgment Interest
By a new § 41.152 of the Texas Civil Practice and Remedies Code, S.B. 30 would require prejudgment interest on amounts awarded for economic damages to be calculated from the date health care expenses are actually paid or other economic losses are actually suffered. The language does not expressly negate other law requiring prejudgment interest in personal injury actions, but as the newest and most specific statute, it might nevertheless be interpreted to control over other law.
VII. Prospects for Enactment
In terms of timing, there is a realistic chance for the remaining legislative steps to occur before the end of the session. Having already been reported out of the Senate committee and passed by the Senate, to become law, S.B. 30 still must be reported favorably out of the House committee, pass the House, have any differences between House and Senate versions reconciled, and not be vetoed by the governor. The end of the legislative session is June 2, 2025. The bill is subject to revision in the House Judiciary & Civil Jurisprudence Committee, on the floor of the House during debate, and by any conference committee.
There is no obvious political obstacle to passage and enactment. Unlike prior reforms that have been accomplished as a grand bargain involving prominent plaintiff and defense groups, the Texas Trial Lawyer’s Association and certain plaintiffs’ lawyers oppose the bill, as reflected in the witness list for the Senate State Affairs Committee. Nevertheless, the Republican-controlled legislature has the votes to pass S.B. 30, making the question more likely to be whether the bill is a sufficiently high priority in the House relative to other matters. Passage in the Senate was along party lines, and the favorable report out of the Senate committee was almost certainly along party lines as well. If this continues in the House, S.B. 30 would be reported favorably out of committee on a 6-5 vote and pass the House 88-62.
S.B. 30 does not specify its effective date for most purposes. Failing two-thirds supermajorities in both chambers, which S.B. 30 would not get on party-line votes, bills generally become effective on the 91st day after final adjournment of the session in which it was enacted, which is September 1 following the regular session. The new law would be effective with new actions commenced on or after that date. The new version of chapter 41 of the Texas Civil Practice and Remedies Code would also be effective in a trial, new trial, or retrial following a motion, appeal, or otherwise, which begins on or after January 1, 2026.
III. Conclusion
If passed, S.B. 30 would make it easier for defendants to obtain evidence of bias on the part of plaintiffs’ medical providers and use that evidence at trial, make it easier for defendants to require plaintiffs to prove reasonableness and necessity of medical care and expenses with expert testimony, would change recovery of physical pain to require an observable or otherwise objectively verifiable condition, and may well reduce prejudgment interest on economic damages. On the other hand, the bill would eliminate the option of challenging the reasonableness of charges when they are less than three times the Medicare rate, which the legislature would deem sufficiently reasonable.
