BILL ANALYSIS

Senate Research Center	C.S.H.B. 4500
88R30543 CJD-D	By: Harris, Caroline (Hughes)
	Health & Human Services
	5/18/2023
	Committee Report (Substituted)

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

Physicians and health care providers frequently face difficulties in verifying patients' insurance information. Some of the information that is currently challenging to verify is whether a patient is insured and the patient's responsibility with respect to the deductible, copayment, or coinsurance. H.B. 4500 seeks to increase transparency between all parties and give physicians and health care providers greater predictability by requiring certain health benefit plan issuers to maintain and make available a secure online system through which certain physicians and health care providers may access certain insurance coverage information for a patient.

(Original Author's/Sponsor's Statement of Intent)

C.S.H.B. 4500 amends current law relating to electronic verification of health benefits by health benefit plan issuers for certain physicians and health care providers.

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a state officer, institution, or agency.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Subtitle A, Title 8, Insurance Code, by adding Chapter 1223, as follows:

CHAPTER 1223. VERIFICATION OF HEALTH BENEFITS

Sec. 1223.001. APPLICABILITY OF CHAPTER. (a) Provides that this chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is issued by certain entities.

(b) Provides that this chapter, notwithstanding any other law, applies to certain health plans.

(c) Provides that this chapter does not apply to the state Medicaid program, including the Medicaid managed care program operated under Chapter 533 (Medicaid Managed Care Program), Government Code, or the child health plan program operated under Chapter 62 (Child Health Plan for Certain Low-Income Children), Health and Safety Code.

Sec. 1223.002.� INTERNET WEBSITE FOR VERIFICATION REQUIRED FOR EMERGENCY PHYSICIANS AND HEALTH CARE PROVIDERS. (a) Requires a health benefit plan issuer to maintain and make available a secure system on the issuer's Internet website that allows a physician or health care provider for a hospital or freestanding emergency medical care facility to determine at any time:

(1) whether the physician's or provider's patient is covered by the issuer's health benefit plan; and

(2) the deductible, copayment, or coinsurance for which the patient is responsible.

(b) Authorizes a health benefit plan issuer to provide the information described by Subsection (a) through:

(1) an existing Internet portal that is available at all times; or

(2) an Internet portal that is:

(A) provided by a third party contracting with the issuer; and

(B)� available at all times.

SECTION 2. Effective date: January 1, 2024. �