By: Harris, Chris S.B. No. 206
73R2135 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to claims, review of claims, and fraudulent claims for
1-3 benefits for certain health care and mental health care services
1-4 covered by insurance; imposing civil penalties.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subchapter C, Chapter 21, Insurance Code, is
1-7 amended by adding Article 21.24-2 to read as follows:
1-8 Art. 21.24-2. SETTLEMENT OF CLAIMS FOR HEALTH CARE SERVICES
1-9 Sec. 1. DEFINITIONS. In this article:
1-10 (1) "Health care provider" means a person providing
1-11 health care services who is eligible for reimbursement for those
1-12 services from an insurer.
1-13 (2) "Insured" means the policyholder in the case of an
1-14 individual policy of insurance and the certificate holder in the
1-15 case of a group policy of insurance.
1-16 (3) "Insurer" means a person who writes an individual
1-17 or group policy of insurance that is delivered, issued for
1-18 delivery, or renewed in this state and that provides coverage for
1-19 medical or surgical expenses incurred as a result of accident or
1-20 sickness, including a company subject to Chapter 20 of this code.
1-21 Sec. 2. NOTICE OF AMOUNT PAID. An insurer shall notify the
1-22 insured in writing of the amount actually paid by the insurer for
1-23 health care services provided under the insured's coverage.
1-24 Sec. 3. ADJUSTMENT OF DEDUCTIBLE OR COPAYMENT. If an
2-1 insured pays a deductible or copayment for health care services and
2-2 the amount actually paid by the insurer for those services is
2-3 adjusted, the insurer shall refund to the insured any amount of the
2-4 deductible or copayment paid by the insured in excess of the amount
2-5 required to be paid under the policy for those services.
2-6 SECTION 2. Article 21.58A, Insurance Code, is amended by
2-7 adding Section 8A to read as follows:
2-8 Sec. 8A. AUDIT OF HOSPITAL. (a) If a utilization review
2-9 agent conducts an audit of hospital billings in conjunction with a
2-10 utilization review, the agent shall report any adverse results of
2-11 the audit to the state agency that licenses the hospital.
2-12 (b) The department shall adopt criteria for reports made
2-13 under this section, including criteria to determine whether a
2-14 report of adverse results of an audit must be made, in consultation
2-15 with the Texas Department of Health, the Texas Department of Mental
2-16 Health and Mental Retardation, and the Texas Commission on Alcohol
2-17 and Drug Abuse.
2-18 SECTION 3. Section 9, Article 21.58A, Insurance Code, is
2-19 amended to read as follows:
2-20 Sec. 9. VIOLATIONS. <(a) If the commissioner believes that
2-21 a utilization review agent has violated or is violating this
2-22 article, the commissioner shall notify the utilization review agent
2-23 of the alleged violation and may compel the production of any and
2-24 all documents or other information as provided by this code.>
2-25 <(b) The commissioner may initiate the proceedings under
2-26 this section after the 30th day after the date the commissioner
2-27 notifies the agent as required by Subsection (a) of this section.>
3-1 <(c) Proceedings under this article are a contested case for
3-2 the purposes of the administrative procedure act.>
3-3 <(d)> If a <after notice and hearing the commissioner
3-4 determines that the> utilization review agent has violated or is
3-5 violating any provision of this article, the commissioner may<:>
3-6 <(1)> impose sanctions under Section 7, Article 1.10
3-7 of this code<;> or
3-8 <(2) issue a cease and desist order> under Article
3-9 1.10A of this code.
3-10 SECTION 4. Section 11, Article 21.58A, Insurance Code, is
3-11 amended by adding Subsection (c) to read as follows:
3-12 (c) The board shall adopt rules governing the review, after
3-13 a health care service has been provided to an enrollee, of the
3-14 necessity and appropriateness of that service.
3-15 SECTION 5. Article 21.58A, Insurance Code, is amended by
3-16 adding Sections 12A and 13A to read as follows:
3-17 Sec. 12A. PAYMENT OF UTILIZATION REVIEW AGENTS. A
3-18 utilization review agent may not accept compensation for conducting
3-19 a utilization review if the compensation is based on:
3-20 (1) payments not made or reduced as a result of a
3-21 utilization review;
3-22 (2) promises by the utilization review agent to reduce
3-23 health care costs by specified amounts or percentages; or
3-24 (3) a business or utilization plan that establishes a
3-25 target for overall cost reductions to result from utilization
3-26 reviews.
3-27 Sec. 13A. REPORTING OF INFORMATION RELATING TO PATIENT CARE;
4-1 IMMUNITY. (a) For the purpose of this section, "quality assurance
4-2 entity" means any person, committee, division, department, or other
4-3 entity responsible for quality assurance or peer review of services
4-4 provided by a health care provider.
4-5 (b) A utilization review agent may report to a quality
4-6 assurance entity information gathered by the utilization review
4-7 agent that relates to a specific patient and that is relevant to
4-8 the quality of care received by the patient. The utilization
4-9 review agent may require that the quality assurance entity ensure
4-10 compliance with confidentiality requirements imposed by law,
4-11 including the requirements of Sections 161.032 and 611.002, Health
4-12 and Safety Code, and Section 5.06, Medical Practice Act (Article
4-13 4495b, Vernon's Texas Civil Statutes).
4-14 (c) Information provided by a utilization review agent to a
4-15 peer review committee under Section 5.06, Medical Practice Act
4-16 (Article 4495b, Vernon's Texas Civil Statutes), is subject to the
4-17 confidentiality requirements of that section.
4-18 (d) Except as provided by Section 5.06, Medical Practice Act
4-19 (Article 4495b, Vernon's Texas Civil Statutes), a utilization
4-20 review agent is not subject to liability for providing information
4-21 to a quality assurance entity.
4-22 SECTION 6. Section 2, Article 1.10A, Insurance Code, is
4-23 amended to read as follows:
4-24 Sec. 2. Authority To Issue Order. The commissioner may
4-25 issue an emergency cease and desist order, ex parte, if:
4-26 (1) the commissioner believes:
4-27 (A) an authorized person engaging in the
5-1 business of insurance is committing an unfair method of competition
5-2 or an unfair or deceptive act or practice in violation of Article
5-3 21.21 or Article 21.21-2 of this code or in violation of a rule or
5-4 regulation promulgated under Article 21.21 or Article 21.21-2 of
5-5 this code;
5-6 (B) an unauthorized person is engaging in the
5-7 business of insurance in violation of Article 1.14-1 of this code
5-8 or in violation of a rule or regulation promulgated under Article
5-9 1.14-1 of this code;
5-10 (C) an unauthorized person engaged in the
5-11 business of insurance acting in violation of Article 1.14-1 of this
5-12 code is committing an unfair method of competition or an unfair or
5-13 deceptive act or practice in violation of Article 21.21 or Article
5-14 21.21-2 of this code or in violation of any rule or regulation
5-15 promulgated under Article 21.21 or Article 21.21-2 of this code;
5-16 <or>
5-17 (D) an authorized person engaging in the
5-18 business of insurance is determined by the commissioner to be in a
5-19 hazardous condition or a hazardous financial condition under
5-20 Article 1.32 or Article 20A.19 of this code; or
5-21 (E) a person is violating Article 21.58A of this
5-22 code or a rule adopted under Article 21.58A of this code; and
5-23 (2) it appears to the commissioner that the alleged
5-24 conduct is fraudulent or hazardous or creates an immediate danger
5-25 to the public safety or is causing or can be reasonably expected to
5-26 cause significant, imminent, and irreparable public injury.
5-27 SECTION 7. Subchapter E, Chapter 21, Insurance Code, is
6-1 amended by adding Articles 21.58C and 21.58D to read as follows:
6-2 Art. 21.58C. DEPARTMENT REVIEW OF MENTAL HEALTH BENEFITS
6-3 CLAIMS
6-4 Sec. 1. DEFINITIONS. In this article:
6-5 (1) "Insured" means a person who makes a mental health
6-6 benefits claim.
6-7 (2) "Insurer" means an insurer that writes an
6-8 individual or group policy of insurance that is delivered, issued
6-9 for delivery, or renewed in this state, including a company subject
6-10 to Chapter 20, Insurance Code, and a health maintenance
6-11 organization subject to the Texas Health Maintenance Organization
6-12 Act (Chapter 20A, Vernon's Texas Insurance Code).
6-13 (3) "Mental health benefits claim" means a claim made
6-14 under an insurance policy for benefits for the treatment of a
6-15 mental or emotional disorder, including a serious mental illness as
6-16 defined by Section 3.51-14 of this code.
6-17 (4) "Mental health benefits invoice" means an invoice
6-18 for goods or services provided to an insured for the treatment of a
6-19 mental or emotional disorder, including a serious mental illness as
6-20 defined by Section 3.51-14 of this code. The term includes an
6-21 invoice that is provided to an assignee of the insured.
6-22 Sec. 2. CLAIM REVIEW. (a) On request and in accordance
6-23 with this section, the department may review a mental health
6-24 benefits invoice.
6-25 (b) Not later than the 30th day after the date an insured
6-26 notifies an insurer of a mental health benefits claim, the insurer
6-27 may request that the department conduct a review of the invoice
7-1 under this section. The department shall adopt rules establishing
7-2 criteria for when review may be requested by an insurer under this
7-3 subsection and what documentation the insurer must provide in
7-4 connection with the request to demonstrate that those criteria have
7-5 been satisfied.
7-6 (c) Not later than the 30th day after the date the insurer
7-7 notifies an insured that the insurer has denied all or part of a
7-8 mental health benefits claim, the insured may request that the
7-9 department conduct a review of the invoice under this section.
7-10 This subsection does not apply to an invoice for which the insurer
7-11 has requested a review under Subsection (b) of this section.
7-12 (d) Not later than the 30th day after the date the
7-13 department receives a request from an insured under Subsection (c)
7-14 of this section, the department shall mail a notice to the affected
7-15 insurer, advising the insurer of the request.
7-16 (e) The department may report a person to the Texas
7-17 Department of Mental Health and Mental Retardation or other
7-18 appropriate state agency if the department finds, as a result of a
7-19 review conducted under this section, that the person participated
7-20 in the issuance of a mental health benefits invoice that:
7-21 (1) does not accurately reflect the services or
7-22 products provided;
7-23 (2) includes a service or product that should not have
7-24 been provided; or
7-25 (3) includes an unreasonable charge for a service or
7-26 product.
7-27 (f) The board shall adopt rules governing hearings and
8-1 reviews conducted under this article.
8-2 (g) This section does not limit the right of an insured to
8-3 bring an action in a court to enforce the insured's rights against
8-4 an insurer. An insured is not required to request review under
8-5 this article before bringing an action in court. Regardless of
8-6 whether a review has been conducted under Subsection (c) of this
8-7 section, the insured is entitled to trial de novo with respect to
8-8 any matter that was the subject of the review.
8-9 Art. 21.58D. Insurer Investigation of Health Benefits Claims
8-10 Sec. 1. Definitions. In this article:
8-11 (1) "Health benefits claim" means a claim made under
8-12 an insurance policy for benefits for the treatment of an illness or
8-13 injury, including a serious mental illness as defined by Section
8-14 3.51-14 of this code or any other mental or emotional disorder.
8-15 (2) "Health benefits invoice" means an invoice for
8-16 goods or services provided to an insured for the treatment of an
8-17 illness or injury, including a mental or emotional disorder. The
8-18 term includes an invoice that is provided to an assignee of the
8-19 insured.
8-20 (3) "Insured" means a person making a health benefits
8-21 claim under an insurance policy.
8-22 (4) "Insurer" means an insurer that writes an
8-23 individual or group policy of insurance that is delivered, issued
8-24 for delivery, or renewed in this state, including a company subject
8-25 to Chapter 20, Insurance Code, and a health maintenance
8-26 organization subject to the Texas Health Maintenance Organization
8-27 Act (Chapter 20A, Vernon's Texas Insurance Code).
9-1 Sec. 2. Investigation. (a) An insurer shall investigate a
9-2 claim submitted to the insurer if the insured requests an
9-3 investigation under this section.
9-4 (b) An insured may request that the insurer investigate
9-5 whether the health benefits invoice on which the claim is based:
9-6 (1) accurately reflects the services or products
9-7 provided;
9-8 (2) includes a service or product that should not have
9-9 been provided; or
9-10 (3) includes an unreasonable charge for a service or
9-11 product.
9-12 (c) The insured must make the request for investigation not
9-13 later than the 30th day after the date on which the insured mailed
9-14 or delivered the claim to the insurer.
9-15 (d) The insurer shall report the results of the
9-16 investigation to the insured, the department, and to the Texas
9-17 Department of Health, Texas Department of Mental Health and Mental
9-18 Retardation, or other appropriate state agency.
9-19 Sec. 3. NOTIFICATION OF RIGHT TO INVESTIGATION. (a) Each
9-20 individual policy of insurance, certificate evidencing coverage
9-21 under a group policy of insurance, and evidence of coverage issued
9-22 by a health maintenance organization that is delivered, issued for
9-23 delivery, or renewed by an insurer in this state must include a
9-24 statement of an insured's right to an investigation under this
9-25 article.
9-26 (b) The board shall adopt rules governing the form and
9-27 content of the statement included in the policy, certificate, or
10-1 evidence of coverage under this article.
10-2 SECTION 8. Subchapter E, Chapter 21, Insurance Code, is
10-3 amended by adding Articles 21.79, 21.79A, 21.79A-1, and 21.79A-2 to
10-4 read as follows:
10-5 Art. 21.79. CIVIL ACTIONS FOR INSURANCE CLAIM FRAUD
10-6 Sec. 1. DEFINITION. For purposes of this article, "health
10-7 care practitioner" means a person who renders or causes to be
10-8 rendered health care or mental health care services and who is
10-9 entitled to payment under a health insurance policy and includes
10-10 any person who may be selected by an insured or beneficiary under
10-11 Article 21.52 of this code. The term also includes a person who is
10-12 an officer, employee, or agent of an organization that renders
10-13 health care or mental health care services.
10-14 Sec. 2. CAUSES OF ACTION. (a) A person who is injured by
10-15 an act of fraud in connection with an insurance claim may bring an
10-16 action in a court of competent jurisdiction for damages and may
10-17 petition the court to restrain further attempts to make an improper
10-18 claim for payment.
10-19 (b) A person who has received medical treatment wrongfully
10-20 or unnecessarily at the direction of a health care practitioner may
10-21 bring an action in a court of competent jurisdiction for damages or
10-22 to enjoin further wrongful acts.
10-23 Sec. 3. DAMAGES. (a) In an action filed under this
10-24 article, the court may grant a successful claimant:
10-25 (1) compensatory damages, plus all reasonable
10-26 investigation and litigation expenses, including attorney's fees;
10-27 (2) an order restraining the respondent from engaging
11-1 in further attempts to make an improper claim for payment;
11-2 (3) damages in accordance with Subsection (b) of this
11-3 section; and
11-4 (4) any other relief the court finds proper.
11-5 (b) If the court finds that the respondent has engaged in a
11-6 pattern of committing fraud in connection with insurance claims,
11-7 the court may award the claimant two times the amount of
11-8 compensatory damages awarded under Subsection (a)(1) of this
11-9 section. An award of damages under this subsection is in addition
11-10 to an award of damages under Subsection (a)(1) of this section.
11-11 Sec. 4. LIMITATIONS. (a) Notwithstanding Section 16.003,
11-12 Civil Practice and Remedies Code, a person must bring suit under
11-13 this article on or before the later of:
11-14 (1) four years after the date the fraud occurred; or
11-15 (2) four years after the date the person, in the
11-16 exercise of reasonable diligence, should have discovered the
11-17 occurrence of the fraud.
11-18 (b) The limitations period in this section does not include
11-19 any period during which the person bringing the action reasonably
11-20 believes that the department or another authorized governmental
11-21 agency is conducting a criminal investigation or prosecution of the
11-22 defendant for fraud.
11-23 Sec. 5. NOTICE TO APPROPRIATE AGENCY. (a) Not later than
11-24 the 31st day after a verdict is entered holding a health care
11-25 practitioner liable for damages under this article, the clerk of
11-26 the court in which the verdict is rendered shall prepare and send
11-27 to the licensing authority with jurisdiction over the practitioner
12-1 a certified abstract of the court's record regarding the case.
12-2 (b) On receipt of the abstract of the record, the licensing
12-3 authority shall consider disciplinary action against the health
12-4 care practitioner in accordance with the procedures used by that
12-5 licensing authority.
12-6 Art. 21.79A. HEALTH CARE INSURANCE CLAIM FRAUD; NOTIFICATION
12-7 OF LICENSING AUTHORITY. (a) For purposes of this article, "health
12-8 care practitioner" means a person who renders or causes to be
12-9 rendered health care or mental health care services and who is
12-10 entitled to payment under a health insurance policy. The term
12-11 includes:
12-12 (1) any person who may be selected by an insured or
12-13 beneficiary under Article 21.52 of this code; and
12-14 (2) an officer, employee, or agent of an organization
12-15 that renders health care or mental health care services.
12-16 (b) If the department knows that a health care practitioner
12-17 has been convicted of fraud in connection with an insurance claim,
12-18 the department shall notify the licensing authority with
12-19 jurisdiction over the practitioner of the conviction.
12-20 (c) On receipt of notification under Subsection (b) of this
12-21 article, the licensing authority shall consider disciplinary action
12-22 against the health care practitioner in accordance with the
12-23 procedures used by that licensing authority.
12-24 (d) The department shall cooperate with the licensing
12-25 authority and shall provide any necessary and relevant testimony,
12-26 documents, or other evidence in the possession of the department.
12-27 Art. 21.79A-1. HEALTH CARE INSURANCE CLAIM FRAUD; REPORT OF
13-1 OUT-OF-STATE CONVICTION. (a) For purposes of this article,
13-2 "health care practitioner" means a person who renders or causes to
13-3 be rendered health care or mental health care services and who is
13-4 entitled to payment under a health insurance policy. The term
13-5 includes:
13-6 (1) any person who may be selected by an insured or
13-7 beneficiary under Article 21.52 of this code; and
13-8 (2) an officer, employee, or agent of an organization
13-9 that renders health care or mental health care services.
13-10 (b) If a health care practitioner rendering health care or
13-11 mental health care services in this state is convicted of fraud on
13-12 an insurer in another state, the practitioner shall report the
13-13 conviction in writing to the commissioner.
13-14 (c) A health care practitioner who does not report a
13-15 conviction in accordance with Subsection (b) of this article may be
13-16 disciplined in accordance with the procedures of the licensing
13-17 authority with jurisdiction over the practitioner.
13-18 Art. 21.79A-2. HEALTH CARE INSURANCE CLAIM FRAUD; HEALTH
13-19 CARE PRACTITIONER COOPERATION IN INVESTIGATION. (a) In this
13-20 article:
13-21 (1) "Health benefits claim" means a claim made under
13-22 an insurance policy for benefits for the treatment of an illness or
13-23 injury, including a mental or emotional disorder.
13-24 (2) "Health benefits claim investigation" means an
13-25 investigation of a health benefits claim conducted by:
13-26 (A) a law enforcement agency of this state;
13-27 (B) an insurer;
14-1 (C) the insurance fraud unit created under
14-2 Article 1.10D of this code; or
14-3 (D) a state or federal governmental agency or a
14-4 nongovernmental agency established to detect and prevent fraudulent
14-5 insurance acts or to regulate the business of insurance.
14-6 (3) "Health care practitioner" means a person who
14-7 renders or causes to be rendered health care or mental health care
14-8 services and who is entitled to payment under a health insurance
14-9 policy. The term includes:
14-10 (A) any person who may be selected by an insured
14-11 or beneficiary under Article 21.52 of this code; and
14-12 (B) an officer, employee, or agent of an
14-13 organization that renders health care or mental health care
14-14 services.
14-15 (4) "Investigating agency" means the person conducting
14-16 the health benefits claim investigation.
14-17 (b) Not later than the 31st day after the date on which a
14-18 health care practitioner receives a request for information from an
14-19 investigating agency that relates to a health benefits claim
14-20 investigation, the health care practitioner shall provide the
14-21 information to the agency.
14-22 (c) If the health care practitioner does not provide the
14-23 requested information within the time specified by Subsection (b)
14-24 of this article, a court of this state, on the petition of the
14-25 investigating agency, shall order the health care practitioner to
14-26 provide the information unless the health care practitioner
14-27 demonstrates that the information is not available or that the
15-1 information may not be released under state or federal law.
15-2 (d) A court issuing an order under Subsection (c) of this
15-3 article also shall order the health care practitioner to pay
15-4 reasonable attorney's fees and costs incurred by the investigating
15-5 agency in obtaining the order. The order may include appropriate
15-6 limits on the distribution of confidential communications.
15-7 (e) If the health benefits claim is the subject of a
15-8 criminal or civil court proceeding at the time a court order is
15-9 sought under Subsection (c) of this article, the petition for an
15-10 order under Subsection (c) of this article must be made in the
15-11 court in which the claim is pending.
15-12 SECTION 9. Section 2(e), Article 1.10D, Insurance Code, is
15-13 amended to read as follows:
15-14 (e) This section does not prohibit or limit the authority
15-15 of an insurer to conduct its own independent investigation into a
15-16 suspected case of insurance claim fraud. Before an insurer may
15-17 request the commissioner to conduct an investigation of suspected
15-18 claim fraud, the insurer must have completed its investigation and
15-19 drafted a report of its findings. The insurer shall submit the
15-20 report and the related investigation file to the commissioner as
15-21 part of the insurer's request for investigation by the
15-22 commissioner. The commissioner may undertake an investigation
15-23 against a policyholder or claimant only if:
15-24 (1) <In regard to an insurer's request for
15-25 investigation under this subsection, the commissioner's authority
15-26 to undertake an investigation against a policyholder or claimant is
15-27 limited to those instances in which> the insurer's investigation
16-1 reports show a pattern of fraudulent activity; or
16-2 (2) the total amount of allegedly fraudulent claims is
16-3 at least $25,000.
16-4 SECTION 10. Section 5, Article 1.10D, Insurance Code, is
16-5 amended by adding Subsection (d) to read as follows:
16-6 (d) The insurance fraud unit may provide information or
16-7 material that is relevant to an inquiry into claim fraud to an
16-8 insurance industry-sponsored fraud investigation unit if the
16-9 commissioner determines that providing the information or material
16-10 would prevent further fraud or otherwise serve the public interest
16-11 and that the interests of the department and of the insurance
16-12 industry-sponsored fraud investigation unit are substantially
16-13 similar with respect to the subject of the investigation. An
16-14 insurance industry-sponsored fraud investigation unit that has
16-15 received information or material under this subsection may not
16-16 release the information or material to a person other than an
16-17 authorized governmental entity. Providing information or material
16-18 under this subsection is not a waiver of confidentiality by the
16-19 department under any part of this code. The department is not
16-20 subject to liability for providing information or material to an
16-21 insurance industry-sponsored fraud investigation unit.
16-22 SECTION 11. Section 6(a), Article 1.10D, Insurance Code, is
16-23 amended to read as follows:
16-24 (a) A person acting without malice, fraudulent intent, or
16-25 bad faith is not subject to liability based on filing reports or
16-26 furnishing, orally or in writing, other information concerning
16-27 suspected, anticipated, or completed fraudulent insurance acts if
17-1 the reports or information are provided to:
17-2 (1) a law enforcement officer or an agent or employee
17-3 of a law enforcement officer;
17-4 (2) the National Association of Insurance
17-5 Commissioners, a state or federal governmental agency or
17-6 nongovernmental agency or association established to detect and
17-7 prevent fraudulent insurance acts or to regulate the business of
17-8 insurance, or an employee of that association or <governmental>
17-9 agency; <or>
17-10 (3) an insurer or an agent or an employee of an
17-11 insurer; or
17-12 (4) an authorized governmental agency or the
17-13 department.
17-14 SECTION 12. Section 6, Article 1.10D, Insurance Code, is
17-15 amended by adding Subsection (e) to read as follows:
17-16 (e) In an action brought against a person for filing a
17-17 report or furnishing other information concerning a fraudulent
17-18 insurance act, the party bringing the action must specifically
17-19 plead any allegation that Subsection (a) of this section is
17-20 inapplicable because the person that filed the report or furnished
17-21 the information acted with malice, fraudulent intent, or bad faith.
17-22 SECTION 13. (a) Article 21.24-2, Insurance Code, as added
17-23 by this Act, applies only to amounts paid by an insurer for health
17-24 care services rendered on or after the effective date of this Act.
17-25 Amounts paid by the insurer for health care services rendered
17-26 before the effective date of this Act are governed by the law in
17-27 effect at the time the amounts were paid, and that law is continued
18-1 in effect for that purpose.
18-2 (b) Section 9, Article 21.58A, Insurance Code, as amended by
18-3 this Act, applies only to a violation of Article 21.58A that occurs
18-4 on or after the effective date of this Act. A violation of Article
18-5 21.58A, Insurance Code, that occurs before the effective date of
18-6 this Act is governed by the law in effect at the time the violation
18-7 occurs, and that law is continued in effect for that purpose.
18-8 (c) The State Board of Insurance may not adopt rules under
18-9 Section 11(c), Article 21.58A, Insurance Code, as added by this
18-10 Act, until the board has reported to the 73rd Legislature the
18-11 findings and recommendations of the study conducted by the board in
18-12 accordance with Section 11.03(b), Chapter 242, Acts of the 72nd
18-13 Legislature, Regular Session, 1991.
18-14 (d) Article 21.58C, Insurance Code, as added by this Act,
18-15 applies only to a mental health benefits claim received by an
18-16 insurer on or after the effective date of this Act. A mental
18-17 health benefits claim received before the effective date of this
18-18 Act is governed by the law in effect at the time the claim was
18-19 received, and that law is continued in effect for that purpose.
18-20 (e) Article 21.58D, Insurance Code, as added by this Act,
18-21 applies only to a health benefits claim received by an insurer on
18-22 or after the effective date of this Act. A health benefits claim
18-23 received before the effective date of this Act is governed by the
18-24 law in effect at the time the claim was received, and that law is
18-25 continued in effect for that purpose.
18-26 (f) Article 21.79, Insurance Code, as added by this Act,
18-27 applies only to a cause of action that accrues on or after the
19-1 effective date of this Act. An action that accrued before the
19-2 effective date of this Act is governed by the law in effect at the
19-3 time the action accrued, and the former law is continued in effect
19-4 for that purpose.
19-5 (g) Article 21.79A-1, Insurance Code, as added by this Act,
19-6 applies to a conviction for fraud on an insurer in another state
19-7 that occurred before, on, or after the effective date of this Act.
19-8 (h) Section 6(e), Article 1.10D, Insurance Code, as added by
19-9 this Act, applies only to a pleading filed on or after the
19-10 effective date of this Act. A pleading filed before the effective
19-11 date of this Act is governed by the law in effect at the time the
19-12 pleading was filed, and that law is continued in effect for that
19-13 purpose.
19-14 SECTION 14. This Act takes effect September 1, 1993.
19-15 SECTION 15. The importance of this legislation and the
19-16 crowded condition of the calendars in both houses create an
19-17 emergency and an imperative public necessity that the
19-18 constitutional rule requiring bills to be read on three several
19-19 days in each house be suspended, and this rule is hereby suspended.