By:  Bosse                                             H.B. No. 451
       73R32 DLF-D
                                 A BILL TO BE ENTITLED
    1-1                                AN ACT
    1-2  relating to overpayments made by health insurers.
    1-3        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
    1-4        SECTION 1.  Subchapter B, Chapter 21, Insurance Code, is
    1-5  amended by adding Article 21.21-6 to read as follows:
    1-6        Art. 21.21-6.  OVERPAYMENT BY HEALTH INSURER
    1-7        Sec. 1.  SCOPE.  This article applies to the payment of
    1-8  benefits under an individual or group policy of accident and
    1-9  sickness insurance that is delivered, issued for delivery, or
   1-10  renewed in this state, including insurance written by a company
   1-11  subject to Chapter 20, Insurance Code.
   1-12        Sec. 2.  DUTIES OF INSURER.  (a)  An insurer may not suspend
   1-13  or delay payment of benefits to or on behalf of an insured solely
   1-14  because the amount of benefits previously paid by the insurer for a
   1-15  particular claim exceeded the amount the insurer was required to
   1-16  pay under the policy for that claim.
   1-17        (b)  This section does not apply if the benefits previously
   1-18  paid by the insurer were paid directly to the insured.
   1-19        Sec. 3.  DUTIES OF HEALTH CARE PROVIDER.  (a)  In this
   1-20  section, "health care provider" includes a person licensed to
   1-21  practice medicine in this state and any person or organization
   1-22  licensed to provide health care or mental health care as an
   1-23  audiologist, certified social worker-advanced clinical
   1-24  practitioner, chiropractor, dentist, dietician, marriage and family
    2-1  therapist, nurse, optometrist, pharmacist, podiatrist, professional
    2-2  counselor, psychologist, speech-language pathologist, blood bank,
    2-3  hospital, kidney dialysis center, or nursing home.
    2-4        (b)  Except as provided by Subsection (c) of this section, a
    2-5  health care provider that has received a payment from an insurer
    2-6  for services rendered by the provider to an insured shall refund to
    2-7  the insurer any amount of the payment that exceeded the amount the
    2-8  insurer was required to pay under the policy for that claim.
    2-9        (c)  If the health care provider disputes that a refund is
   2-10  owed, or disputes the amount of any refund, the provider may pay
   2-11  the disputed amount to the commissioner for deposit in an
   2-12  interest-bearing escrow account.  The commissioner shall distribute
   2-13  the amount in the escrow account in accordance with a final
   2-14  judicial order regarding the dispute or, if no final judicial order
   2-15  is entered, in accordance with a written agreement between the
   2-16  provider and the insurer.
   2-17        (d)  A health care provider shall make the refund or payment
   2-18  required by Subsection (b) or (c) of this section not later than
   2-19  the 30th day after the date the insurer notifies the health care
   2-20  provider of the overpayment.
   2-21        (e)  A health care provider that violates this section is
   2-22  subject to professional discipline in accordance with the law
   2-23  governing the licensing and regulation of the provider and any
   2-24  rules adopted by the appropriate licensing agency.
   2-25        Sec. 4.  RULES.  The board may adopt rules to implement this
   2-26  article.
   2-27        SECTION 2.  (a)  This Act takes effect September 1, 1993.
    3-1        (b)  Section 2, Article 21.21-6, Insurance Code, as added by
    3-2  this Act, applies only to a claim for benefits received by an
    3-3  insurer on or after January 1, 1994.  A claim received before
    3-4  January 1, 1994, is governed by the law in effect immediately
    3-5  before the effective date of this Act, and that law is continued in
    3-6  effect for that purpose.
    3-7        (c)  Section 3, Article 21.21-6, Insurance Code, as added by
    3-8  this Act, applies only to a payment received by a health care
    3-9  provider on or after January 1, 1994.  A payment received before
   3-10  January 1, 1994, is governed by the law in effect immediately
   3-11  before the effective date of this Act, and that law is continued in
   3-12  effect for that purpose.
   3-13        SECTION 3.  The importance of this legislation and the
   3-14  crowded condition of the calendars in both houses create an
   3-15  emergency   and   an   imperative   public   necessity   that   the
   3-16  constitutional rule requiring bills to be read on three several
   3-17  days in each house be suspended, and this rule is hereby suspended.