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.