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A BILL TO BE ENTITLED
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AN ACT
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relating to prompt payment deadlines for health benefit plan |
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claims affected by a catastrophic event. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.337, Insurance Code, is amended by |
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amending Subsections (b) and (c) and adding Subsection (c-1) to |
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read as follows: |
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(b) If a physician or provider fails to submit a claim in |
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compliance with this section, the physician or provider forfeits |
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the right to payment [unless the failure to submit the claim in |
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compliance with this section is a result of a catastrophic event |
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that substantially interferes with the normal business operations |
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of the physician or provider]. |
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(c) The period for submitting a claim under this section may |
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be extended by: |
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(1) contract; |
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(2) notice published by the commissioner allowing an |
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extension of prompt payment deadlines to a later date chosen by the |
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commissioner due to a catastrophic event; or |
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(3) the department's approval of a physician's or |
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provider's request for an extension due to a catastrophic event |
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that substantially interferes with the normal business operations |
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of the physician or provider. |
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(c-1) The commissioner may adopt rules to implement |
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Subsection (c), including rules establishing requirements for a |
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request made under Subsection (c)(3). |
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SECTION 2. Section 843.342(h), Insurance Code, is amended |
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to read as follows: |
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(h) A health maintenance organization is not liable for a |
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penalty under this section: |
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(1) if the failure to pay the claim in accordance with |
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this subchapter is a result of a catastrophic event and: |
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(A) the commissioner published a notice allowing |
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an extension of the applicable prompt payment deadlines due to the |
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catastrophic event; or |
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(B) the department approved the health |
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maintenance organization's request for an extension due to the |
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substantial interference of the catastrophic event [that |
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substantially interferes] with the normal business operations of |
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the health maintenance organization; or |
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(2) if the claim was paid in accordance with this |
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subchapter, but for less than the contracted rate, and: |
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(A) the physician or provider notifies the health |
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maintenance organization of the underpayment after the 270th day |
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after the date the underpayment was received; and |
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(B) the health maintenance organization pays the |
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balance of the claim on or before the 30th day after the date the |
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health maintenance organization receives the notice. |
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SECTION 3. Section 1301.102, Insurance Code, is amended by |
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amending Subsections (d) and (e) and adding Subsection (e-1) to |
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read as follows: |
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(d) If a physician or health care provider fails to submit a |
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claim in compliance with this section, the physician or provider |
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forfeits the right to payment [unless the failure to submit the |
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claim in compliance with this section is a result of a catastrophic |
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event that substantially interferes with the normal business |
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operations of the physician or provider]. |
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(e) The period for submitting a claim under this section may |
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|
be extended by: |
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(1) contract; |
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(2) notice published by the commissioner allowing an |
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extension of prompt payment deadlines to a later date chosen by the |
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commissioner due to a catastrophic event; or |
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|
(3) the department's approval of a physician's or |
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health care provider's request for an extension due to a |
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catastrophic event that substantially interferes with the normal |
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business operations of the physician or provider. |
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(e-1) The commissioner may adopt rules to implement |
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Subsection (e), including rules establishing requirements for a |
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request made under Subsection (e)(3). |
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SECTION 4. Section 1301.137(h), Insurance Code, is amended |
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to read as follows: |
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(h) An insurer is not liable for a penalty under this |
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section: |
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(1) if the failure to pay the claim in accordance with |
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Subchapter C is a result of a catastrophic event and: |
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(A) the commissioner published a notice allowing |
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an extension of the applicable prompt payment deadlines due to the |
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catastrophic event; or |
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(B) the department approved the insurer's |
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request for an extension due to the substantial interference of the |
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catastrophic event [that substantially interferes] with the normal |
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business operations of the insurer; or |
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(2) if the claim was paid in accordance with |
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Subchapter C, but for less than the contracted rate, and: |
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(A) the preferred provider notifies the insurer |
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of the underpayment after the 270th day after the date the |
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underpayment was received; and |
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(B) the insurer pays the balance of the claim on |
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or before the 30th day after the date the insurer receives the |
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notice. |
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SECTION 5. The changes in law made by this Act apply only to |
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a claim submitted on or after the effective date of this Act. A |
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claim submitted before the effective date of this Act is governed by |
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the law as it existed immediately before the effective date of this |
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Act, and that law is continued in effect for that purpose. |
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SECTION 6. This Act takes effect September 1, 2023. |