By Eiland, Janek, Lewis of Tarrant, H.B. No. 1862
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the regulation and prompt payment of health care
1-3 providers under certain health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF STATE OF TEXAS:
1-5 SECTION 1. Section 1, Article 3.70-3C, Insurance Code, as
1-6 added by Chapter 1024, Acts of the 75th Legislature, Regular
1-7 Session, 1997, is amended by adding Subdivisions (14) and (15) to
1-8 read as follows:
1-9 (14) "Preauthorization" means a determination by the
1-10 insurer that the medical care or health care services proposed to
1-11 be provided to a patient are medically necessary and appropriate.
1-12 (15) "Verification" means a reliable representation by
1-13 an insurer to a physician or health care provider that the insurer
1-14 will pay the physician or health care provider for proposed medical
1-15 care or health care services if the physician or health care
1-16 provider renders those services to the patient for whom the
1-17 services are proposed. The term includes precertification,
1-18 certification, recertification, or any other term that would be a
1-19 reliable representation by an insurer to a physician or health care
1-20 provider.
1-21 SECTION 2. Section 3A, Article 3.70-3C, Insurance Code, as
1-22 added by Chapter 1024, Acts of the 75th Legislature, Regular
1-23 Session, 1997, is amended to read as follows:
1-24 Sec. 3A. PROMPT PAYMENT OF PREFERRED PROVIDERS. (a) In this
1-25 section, "clean claim" means a [completed] claim that complies with
2-1 Section 3B of this article[, as determined under department rules,
2-2 submitted by a preferred provider for medical care or health care
2-3 services under a health insurance policy].
2-4 (b) A physician or provider must submit a claim to an
2-5 insurer not later than the 95th day after the date the physician or
2-6 provider provides the medical care or health care services for
2-7 which the claim is made. An insurer shall accept as proof of
2-8 timely filing a claim filed in compliance with Subsection (c) of
2-9 this section or information from another insurer showing that the
2-10 physician or provider submitted the claim to the insurer in
2-11 compliance with Subsection (c) of this section. If a physician or
2-12 provider fails to submit a claim in compliance with this
2-13 subsection, the physician or provider forfeits the right to
2-14 payment. The period for submitting a claim under this subsection
2-15 may be extended by contract. A physician or provider may not
2-16 submit a duplicate claim for payment before the 46th day after the
2-17 date the original claim was submitted. The commissioner shall
2-18 adopt rules under which an insurer may determine whether a claim is
2-19 a duplicate claim [A preferred provider for medical care or health
2-20 care services under a health insurance policy may obtain
2-21 acknowledgment of receipt of a claim for medical care or health
2-22 care services under a health care plan by submitting the claim by
2-23 United States mail, return receipt requested. An insurer or the
2-24 contracted clearinghouse of an insurer that receives a claim
2-25 electronically shall acknowledge receipt of the claim by an
2-26 electronic transmission to the preferred provider and is not
2-27 required to acknowledge receipt of the claim by the insurer in
3-1 writing].
3-2 (c) A physician or provider shall, as appropriate:
3-3 (1) mail a claim by United States mail, first class,
3-4 or by overnight delivery service, and maintain a log of mailed
3-5 claims and include a copy of the log with the relevant mailed
3-6 claim;
3-7 (2) submit the claim electronically and maintain a log
3-8 of electronically submitted claims;
3-9 (3) fax the claim and maintain a log of all faxed
3-10 claims; or
3-11 (4) hand deliver the claim and maintain a log of all
3-12 hand-delivered claims.
3-13 (d) If a claim for medical care or health care services
3-14 under a health care plan is mailed, the claim is presumed to have
3-15 been received by the insurer on the third day after the date the
3-16 claim is mailed or, if the claim is mailed using overnight service
3-17 or return receipt requested, on the date the delivery receipt is
3-18 signed. If the claim is submitted electronically, the claim is
3-19 presumed to have been received on the date of the electronic
3-20 verification of receipt by the insurer or the insurer's
3-21 clearinghouse. If the insurer or the insurer's clearinghouse does
3-22 not provide a confirmation within 24 hours of submission by the
3-23 physician or provider, the physician's or provider's clearinghouse
3-24 shall provide the confirmation. The physician's or provider's
3-25 clearinghouse must be able to verify that the filing contained the
3-26 correct address of the entity to receive the filing. If the claim
3-27 is faxed, the claim is presumed to have been received on the date
4-1 of the transmission acknowledgment. If the claim is hand delivered,
4-2 the claim is presumed to have been received on the date the
4-3 delivery receipt is signed. The commissioner shall promulgate a
4-4 form to be submitted by the physician or provider that easily
4-5 identifies all claims included in each filing and that can be used
4-6 by a physician or provider as the physician's or provider's log.
4-7 (e) Not later than the 45th day after the date that the
4-8 insurer receives a clean claim from a preferred provider, the
4-9 insurer shall make a determination of whether the claim is eligible
4-10 for payment and:
4-11 (1) if the insurer determines the entire claim is
4-12 eligible for payment, pay the total amount of the claim in
4-13 accordance with the contract between the preferred provider and the
4-14 insurer;
4-15 (2) if the insurer disputes a portion of the claim,
4-16 pay the portion of the claim that is not in dispute and notify the
4-17 preferred provider in writing why the remaining portion of the
4-18 claim will not be paid; or
4-19 (3) if the insurer determines that the claim is not
4-20 eligible for payment, notify the preferred provider in writing why
4-21 the claim will not be paid.
4-22 (f) Not later than the 21st day after the date an insurer
4-23 affirmatively adjudicates a pharmacy benefit claim that is
4-24 electronically submitted, the insurer shall:
4-25 (1) pay the total amount of the claim; or
4-26 (2) notify the benefit provider of the reasons for
4-27 denying payment of the claim.
5-1 (g) An insurer that determines under Subsection (e) of this
5-2 section that a claim is eligible for payment and does not pay the
5-3 claim on or before the 45th day after the date the insurer receives
5-4 a clean claim commits an unfair claim settlement practice in
5-5 violation of Article 21.21-2 of this code and is subject to an
5-6 administrative penalty under Chapter 84 of this code. The insurer
5-7 shall pay the physician or provider making the claim the lesser of
5-8 the full amount of billed charges submitted on the claim and
5-9 interest on the billed charges at a rate of 15 percent annually or
5-10 two times the contracted rate and interest on that amount at a rate
5-11 of 15 percent annually. Billed charges shall be established under
5-12 a fee schedule provided by the preferred provider to the insurer on
5-13 or before the 30th day after the date the physician or provider
5-14 enters into a preferred provider contract with the insurer. The
5-15 preferred provider may modify the fee schedule if the provider
5-16 notifies the insurer of the modification on or before the 90th day
5-17 before the date the modification takes effect.
5-18 (h) The investigation and determination of eligibility for
5-19 payment, including any coordination of other payments, does not
5-20 extend the period for determining whether a claim is eligible for
5-21 payment under Subsection (e) of this section [(d) If a prescription
5-22 benefit claim is electronically adjudicated and electronically
5-23 paid, and the preferred provider or its designated agent authorizes
5-24 treatment, the claim must be paid not later than the 21st day after
5-25 the treatment is authorized].
5-26 (i) Except as provided by Subsection (j) of this section, if
5-27 [(e) If] the insurer acknowledges coverage of an insured under the
6-1 health insurance policy but intends to audit the preferred provider
6-2 claim, the insurer shall pay the charges submitted at 85 percent of
6-3 the contracted rate on the claim not later than the 45th day after
6-4 the date that the insurer receives the claim from the preferred
6-5 provider. The insurer must complete [Following completion of] the
6-6 audit, and any additional payment due a preferred provider or any
6-7 refund due the insurer shall be made not later than the 90th [30th]
6-8 day after the receipt of a claim or 45 days after receipt of a
6-9 completed attachment from the physician or provider, whichever is
6-10 later [of the date that:]
6-11 [(1) the preferred provider receives notice of the
6-12 audit results; or]
6-13 [(2) any appeal rights of the insured are exhausted].
6-14 (j) If an insurer needs additional information from a
6-15 treating preferred provider to determine eligibility for payment,
6-16 the insurer, not later than the 30th calendar day after the date
6-17 the insurer receives a clean claim, shall request in writing that
6-18 the preferred provider provide any attachment to the claim the
6-19 insurer desires in good faith for clarification of the claim. The
6-20 request must describe with specificity the clinical information
6-21 requested and relate only to information the insurer can
6-22 demonstrate is specific to the claim or the claim's related episode
6-23 of care. An insurer that requests an attachment under this
6-24 subsection shall determine whether the claim is eligible for
6-25 payment on or before the later of the 15th day after the date the
6-26 insurer receives the completed attachment or the latest date for
6-27 determining whether the claim is eligible for payment under
7-1 Subsection (e) of this section. An insurer may not make more than
7-2 one request under this subsection in connection with a claim.
7-3 Subsections (c) and (d) of this section apply to a request for and
7-4 submission of an attachment under this subsection.
7-5 (k) If an insurer requests an attachment or other
7-6 information from a person other than the physician or provider who
7-7 submitted the claim, the insurer shall provide a copy of the
7-8 request to the physician or provider who submitted the claim. The
7-9 insurer may not withhold payment pending receipt of an attachment
7-10 or information requested under this subsection. If on receiving an
7-11 attachment or information requested under this subsection the
7-12 insurer determines an error in payment of the claim, the insurer
7-13 may recover under Section 3C of this article.
7-14 (l) The commissioner shall adopt rules under which an
7-15 insurer can easily identify attachments or information submitted by
7-16 a physician or provider under Subsection (j) or (k) of this
7-17 section.
7-18 (m) The insurer's claims payment processes shall:
7-19 (1) use nationally recognized, generally accepted
7-20 Correct Procedural Terminology codes, including all relevant
7-21 modifiers; and
7-22 (2) be consistent with nationally recognized,
7-23 generally accepted, clinically appropriate bundling logic and edits
7-24 [(f) An insurer that violates Subsection (c) or (e) of this
7-25 section is liable to a preferred provider for the full amount of
7-26 billed charges submitted on the claim or the amount payable under
7-27 the contracted penalty rate, less any amount previously paid or any
8-1 charge for a service that is not covered by the health insurance
8-2 policy].
8-3 (n) [(g)] A preferred provider may recover reasonable
8-4 attorney's fees and court costs in an action to recover payment
8-5 under this section.
8-6 (o) [(h)] In addition to any other penalty or remedy
8-7 authorized by this code or another insurance law of this state, an
8-8 insurer that violates Subsection (e) [(c)] or (i) [(e)] of this
8-9 section is subject to an administrative penalty under Article 1.10E
8-10 of this code. The administrative penalty imposed under that
8-11 article may not exceed $1,000 for each day the claim remains unpaid
8-12 in violation of Subsection (e) [(c)] or (i) [(e)] of this section.
8-13 (p) [(i)] The insurer shall provide a preferred provider
8-14 with copies of all applicable utilization review policies and claim
8-15 processing policies or procedures[, including required data
8-16 elements and claim formats].
8-17 (q) [(j) An insurer may, by contract with a preferred
8-18 provider, add or change the data elements that must be submitted
8-19 with the preferred provider claim.]
8-20 [(k) Not later than the 60th day before the date of an
8-21 addition or change in the data elements that must be submitted with
8-22 a claim or any other change in an insurer's claim processing and
8-23 payment procedures, the insurer shall provide written notice of the
8-24 addition or change to each preferred provider.]
8-25 [(l) This section does not apply to a claim made by a
8-26 preferred provider who is a member of the legislature.]
8-27 [(m)] This section applies to a person with whom an insurer
9-1 contracts to process claims or to obtain the services of preferred
9-2 providers to provide medical care or health care to insureds under
9-3 a health insurance policy.
9-4 (r) [(n)] The commissioner of insurance may adopt rules as
9-5 necessary to implement this section.
9-6 SECTION 3. Article 3.70-3C, Insurance Code, as added by
9-7 Chapter 1024, Acts of the 75th Legislature, Regular Session, 1997,
9-8 is amended by adding Sections 3B-3I, 10, 11, and 12 to read as
9-9 follows:
9-10 Sec. 3B. ELEMENTS OF CLEAN CLAIM. (a) A claim by a
9-11 physician or provider, other than an institutional provider, is a
9-12 "clean claim" if the claim is submitted using Health Care Financing
9-13 Administration Form 1500 or a successor to that form developed by
9-14 the National Uniform Billing Committee or its successor and adopted
9-15 by the commissioner by rule for the purposes of this subsection
9-16 that is submitted to an insurer for payment and that contains the
9-17 information required by the commissioner by rule for the purposes
9-18 of this subsection entered into the appropriate fields on the form.
9-19 (b) A claim by an institutional provider is a "clean claim"
9-20 if the claim is submitted using Health Care Financing
9-21 Administration Form UB-92 or a successor to that form developed by
9-22 the National Uniform Billing Committee or its successor and adopted
9-23 by the commissioner by rule for the purposes of this subsection
9-24 that is submitted to an insurer for payment and that contains the
9-25 information required by the commissioner by rule for the purposes
9-26 of this subsection entered into the appropriate fields on the form.
9-27 (c) An insurer may require any data element that is required
10-1 in an electronic transaction set needed to comply with federal law.
10-2 An insurer may not require a physician or provider to provide
10-3 information other than information for a data field included on the
10-4 form used for a clean claim under Subsection (a) or (b) of this
10-5 section, as applicable.
10-6 (d) A claim submitted by a physician or provider that
10-7 includes additional fields, data elements, attachments, or other
10-8 information not required under this section is considered to be a
10-9 clean claim for the purposes of this article.
10-10 Sec. 3C. OVERPAYMENT. An insurer may recover an overpayment
10-11 to a physician or provider if:
10-12 (1) not later than the 180th day after the date the
10-13 physician or provider receives the payment, the insurer provides
10-14 written notice of the overpayment to the physician or provider that
10-15 includes the basis and specific reasons for the request for
10-16 recovery of funds; and
10-17 (2) the physician or provider does not make
10-18 arrangements for repayment of the requested funds on or before the
10-19 45th day after the date the physician or provider receives the
10-20 notice.
10-21 Sec. 3D. VERIFICATION OF ELIGIBILITY FOR PAYMENT. (a) On
10-22 the request of a physician or provider for verification of the
10-23 eligibility for payment of a particular medical care or health care
10-24 service the physician or provider proposes to provide to a
10-25 particular patient, the insurer shall inform the physician or
10-26 provider whether the service, if provided to that patient, is
10-27 eligible for payment from the insurer to the physician or provider.
11-1 (b) An insurer shall provide verification under this section
11-2 between 6 a.m. and 6 p.m. central standard time each day.
11-3 (c) Verification under this section shall be made in good
11-4 faith and without delay.
11-5 (d) In this section, "verification" includes any required
11-6 preauthorization process.
11-7 (e) An insurer may establish a time certain for the validity
11-8 of verification.
11-9 (f) If an insurer has verified medical care or health care
11-10 services, the insurer may not deny or reduce payment to a physician
11-11 or health care provider for those services unless:
11-12 (1) the physician or provider has materially
11-13 misrepresented the proposed medical or health care services or has
11-14 substantially failed to perform the proposed medical or health care
11-15 services; or
11-16 (2) the insurer certifies in writing:
11-17 (A) that the patient was not a covered enrollee
11-18 of the health plan;
11-19 (B) the insurer was notified on or before the
11-20 30th day after the date the patient's enrollment ended; and
11-21 (C) the physician or provider was notified that
11-22 the patient's enrollment ended on or before the 30th day after the
11-23 date of verification under this section.
11-24 Sec. 3E. COORDINATION OF PAYMENT. (a) An insurer may
11-25 require a physician or provider to retain in the physician's or
11-26 provider's records updated information concerning other health
11-27 benefit plan coverage and to provide the information to the
12-1 insurer on the applicable form described by Section 3B of this
12-2 article. Except as provided in this subsection, an insurer may not
12-3 require a physician or provider to investigate coordination of
12-4 other health benefit plan coverage.
12-5 (b) Coordination of payment under this section does not
12-6 extend the period for determining whether a service is eligible for
12-7 payment under Section 3A(e) of this article.
12-8 (c) A physician or provider who submits a claim for
12-9 particular medical care or health care services to more than one
12-10 health maintenance organization or insurer shall provide written
12-11 notice on the claim submitted to each health maintenance
12-12 organization or insurer of the identity of each other health
12-13 maintenance organization or insurer with which the same claim is
12-14 being filed.
12-15 (d) On receipt of notice under Subsection (c) of this
12-16 section, an insurer shall coordinate and determine the appropriate
12-17 payment for each health maintenance organization or insurer to make
12-18 to the physician or provider.
12-19 (e) If an insurer is a secondary payor and pays more than
12-20 the amount for which the insurer is legally obligated, the insurer
12-21 may recover the amount of the overpayment from the health
12-22 maintenance organization or insurer that is primarily responsible
12-23 for that amount.
12-24 (f) If the portion of the claim overpaid by the secondary
12-25 insurer was also paid by the primary health maintenance
12-26 organization or insurer, the secondary insurer may recover the
12-27 amount of overpayment under Section 3C of this article from the
13-1 physician or provider who received the payment.
13-2 (g) An insurer may share information with another health
13-3 maintenance organization or insurer to the extent necessary to
13-4 coordinate appropriate payment obligations on a specific claim.
13-5 (h) The provisions of this section may not be waived,
13-6 voided, or nullified by contract.
13-7 Sec. 3F. PREAUTHORIZATION OF MEDICAL AND HEALTH CARE
13-8 SERVICES. (a) An insurer that uses a preauthorization process for
13-9 medical care and health care services shall provide to each
13-10 participating physician or health care provider, not later than the
13-11 10th working day after the date a request is made, a list of
13-12 medical care and health care services that require preauthorization
13-13 and information concerning the preauthorization process.
13-14 (b) If proposed medical care or health care services require
13-15 preauthorization as a condition of the insurer's payment to a
13-16 physician or health care provider under a health insurance policy,
13-17 the insurer shall determine whether the medical care or health care
13-18 services proposed to be provided to the insured are medically
13-19 necessary and appropriate.
13-20 (c) On receipt of a request from a physician or health care
13-21 provider for preauthorization, the insurer shall review and issue a
13-22 determination indicating whether the proposed services are
13-23 preauthorized. The determination must be mailed or otherwise
13-24 transmitted not later than the third calendar day after the date
13-25 the request is received by the insurer.
13-26 (d) If the proposed medical care or health care services
13-27 involve inpatient care, the determination issued by the insurer
14-1 must be provided within one calendar day of the request by
14-2 telephone or electronic transmission to the physician or health
14-3 care provider of record and followed by written notice to the
14-4 physician or provider on or before the third day after the date of
14-5 the request and must specify an approved length of stay for
14-6 admission into a health care facility based on the recommendation
14-7 of the patient's physician or health care provider and the
14-8 insurer's written medically acceptable screening criteria and
14-9 review procedures. The criteria and procedures must be established,
14-10 periodically evaluated, and updated.
14-11 (e) If an insurer has preauthorized medical care or health
14-12 care services, the insurer may not deny or reduce payment to the
14-13 physician or health care provider for those services unless:
14-14 (1) the physician or provider has materially
14-15 misrepresented the proposed medical or health care services or has
14-16 substantially failed to perform the proposed medical or health care
14-17 services; or
14-18 (2) the insurer certifies in writing:
14-19 (A) that the patient was not a covered enrollee
14-20 of the health plan;
14-21 (B) the insurer was notified on or before the
14-22 30th day after the date the patient's enrollment ended; and
14-23 (C) the physician or provider was notified that
14-24 the patient's enrollment ended on or before the 30th day after the
14-25 date of verification under this section.
14-26 (f) This section applies to an agent or other person with
14-27 whom an insurer contracts to perform, or to whom the insurer
15-1 delegates the performance of, preauthorization of proposed medical
15-2 or health care services.
15-3 Sec. 3G. AVAILABILITY OF CODING GUIDELINES. (a) A preferred
15-4 provider contract between an insurer and a physician or provider
15-5 must provide that:
15-6 (1) the physician or provider may request a
15-7 description of the coding guidelines, including any underlying
15-8 bundling, recoding, or other payment process and fee schedules
15-9 applicable to specific procedures that the physician or provider
15-10 will receive under the contract;
15-11 (2) the insurer or the insurer's agent will provide
15-12 the guidelines not later than the 30th day after the date the
15-13 insurer receives the request;
15-14 (3) the insurer will provide notice of material
15-15 changes to the coding guidelines and fee schedules not later than
15-16 the 90th day before the date the changes take effect and will not
15-17 make retroactive revisions to the coding guidelines and fee
15-18 schedules; and
15-19 (4) the contract may be terminated by the physician or
15-20 provider on or before the 30th day after the date the physician or
15-21 provider receives information requested under this subsection
15-22 without penalty or discrimination in participation in other health
15-23 care products or plans.
15-24 (b) A physician or provider who receives information under
15-25 Subsection (a) of this section may use or disclose the information
15-26 only for the purpose of practice management, billing activities, or
15-27 other business operations. The attorney general may impose and
16-1 collect a penalty of $1,000 for each use or disclosure of the
16-2 information that violates this subsection.
16-3 (c) Nothing in this section shall be interpreted to require
16-4 an insurer to violate copyright or other law by disclosing
16-5 proprietary software that the insurer has licensed. In addition to
16-6 the above, the insurer shall, on request of a physician or
16-7 provider, provide the name, edition, and model version of the
16-8 software that the insurer uses to determine bundling and unbundling
16-9 of claims.
16-10 Sec. 3H. DISPUTE RESOLUTION. (a) An insurer may not require
16-11 by contract or otherwise the use of a dispute resolution procedure
16-12 or binding arbitration with a physician or health care provider.
16-13 This subsection does not prohibit an insurer from offering a
16-14 dispute resolution procedure or binding arbitration to resolve a
16-15 dispute if the insurer and the physician or provider consent to the
16-16 process after the dispute arises. This subsection may not be
16-17 construed to conflict with any applicable appeal mechanisms
16-18 required by law.
16-19 (b) The provisions of this section may not be waived or
16-20 nullified by contract.
16-21 Sec. 3I. AUTHORITY OF ATTORNEY GENERAL. In addition to any
16-22 other remedy available for a violation of this article, the
16-23 attorney general may take action and seek remedies available under
16-24 Section 15, Article 21.21 of this code, and Sections 17.58, 17.60,
16-25 17.61, and 17.62, Business & Commerce Code, for a violation of
16-26 Section 3A or 7 of this article.
16-27 Sec. 10. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND HEALTH
17-1 CARE PROVIDERS. The provisions of this article relating to prompt
17-2 payment by an insurer of a physician or health care provider and to
17-3 verification of medical care or health care services apply to a
17-4 physician or health care provider who:
17-5 (1) is not a preferred provider under a preferred
17-6 provider benefit plan; and
17-7 (2) provides to an insured:
17-8 (A) care related to an emergency or its
17-9 attendant episode of care as required by state or federal law; or
17-10 (B) specialty or other medical care or health
17-11 care services at the request of the insurer or a preferred provider
17-12 because the services are not reasonably available from a preferred
17-13 provider.
17-14 Sec. 11. CONFLICT WITH OTHER LAW. To the extent of any
17-15 conflict between this article and Article 21.52C of this code, this
17-16 article controls.
17-17 Sec. 12. APPLICATION OF CERTAIN PROVISIONS UNDER MEDICAID. A
17-18 provision of this article may not be interpreted as requiring an
17-19 insurer, physician, or health care provider, in providing benefits
17-20 or services under the state Medicaid program, to:
17-21 (1) use billing forms or codes that are inconsistent
17-22 with those required under the state Medicaid program; or
17-23 (2) make determinations relating to medical necessity
17-24 or appropriateness or eligibility for coverage in a manner
17-25 different than that required under the state Medicaid program.
17-26 SECTION 4. Section 2, Texas Health Maintenance Organization
17-27 Act (Article 20A.02, Vernon's Texas Insurance Code), is amended by
18-1 adding Subdivisions (ff) and (gg) to read as follows:
18-2 (ff) "Preauthorization" means a determination by the
18-3 health maintenance organization that the medical care or health
18-4 care services proposed to be provided to a patient are medically
18-5 necessary and appropriate.
18-6 (gg) "Verification" means a reliable representation by
18-7 a health maintenance organization to a physician or provider that
18-8 the health maintenance organization will pay the physician or
18-9 provider for proposed medical care or health care services if the
18-10 physician or provider renders those services to the patient for
18-11 whom the services are proposed. The term includes
18-12 precertification, certification, recertification, or any other term
18-13 that would be a reliable representation by a health maintenance
18-14 organization to a physician or provider.
18-15 SECTION 5. Section 18B, Texas Health Maintenance
18-16 Organization Act (Section 20A.18B, Vernon's Texas Insurance Code),
18-17 is amended to read as follows:
18-18 Sec. 18B. PROMPT PAYMENT OF PHYSICIAN AND PROVIDERS. (a) In
18-19 this section, "clean claim" means a [completed] claim that complies
18-20 with Section 18D of this Act[, as determined under Texas Department
18-21 of Insurance rules, submitted by a physician or provider for
18-22 medical care or health care services under a health care plan].
18-23 (b) A physician or provider must submit a claim under this
18-24 section to a health maintenance organization not later than the
18-25 95th day after the date the physician or provider provides the
18-26 medical care or health care services for which the claim is made.
18-27 A health maintenance organization shall accept as proof of timely
19-1 filing a claim filed in compliance with Subsection (c) of this
19-2 section or information from another health maintenance organization
19-3 showing that the physician or provider submitted the claim to the
19-4 health maintenance organization in compliance with Subsection (c)
19-5 of this section. If a physician or provider fails to submit a
19-6 claim in compliance with this subsection, the physician or provider
19-7 forfeits the right to payment. The period for submitting a claim
19-8 under this subsection may be extended by contract. A physician or
19-9 provider may not submit a duplicate claim for payment before the
19-10 46th day after the date the original claim was submitted. The
19-11 commissioner shall adopt rules under which a health maintenance
19-12 organization may determine whether a claim is a duplicate claim [A
19-13 physician or provider for medical care or health care services
19-14 under a health care plan may obtain acknowledgment of receipt of a
19-15 claim for medical care or health care services under a health care
19-16 plan by submitting the claim by United States mail, return receipt
19-17 requested. A health maintenance organization or the contracted
19-18 clearinghouse of the health maintenance organization that receives
19-19 a claim electronically shall acknowledge receipt of the claim by an
19-20 electronic transmission to the physician or provider and is not
19-21 required to acknowledge receipt of the claim by the health
19-22 maintenance organization in writing].
19-23 (c) A physician or provider shall, as appropriate:
19-24 (1) mail a claim by United States mail, first class,
19-25 or by overnight delivery service, and maintain a log of mailed
19-26 claims and include a copy of the log with the claim;
19-27 (2) submit the claim electronically and maintain a log
20-1 of electronically submitted claims;
20-2 (3) fax the claim and maintain a log of all faxed
20-3 claims; or
20-4 (4) hand deliver the claim and maintain a log of all
20-5 hand-delivered claims.
20-6 (d) If a claim for medical care or health care services
20-7 under a health care plan is mailed, the claim is presumed to have
20-8 been received by the health maintenance organization on the third
20-9 day after the date the claim is mailed or, if the claim is mailed
20-10 using overnight service or return receipt requested, on the date
20-11 the delivery receipt is signed. If the claim is submitted
20-12 electronically, the claim is presumed to have been received on the
20-13 date of the electronic verification of receipt by the health
20-14 maintenance organization or the health maintenance organization's
20-15 clearinghouse. If the health maintenance organization or the
20-16 health maintenance organization's clearinghouse does not provide a
20-17 confirmation within 24 hours of submission by the physician or
20-18 provider, the physician's or provider's clearinghouse shall provide
20-19 the confirmation. The physician's or provider's clearinghouse must
20-20 be able to verify that the filing contained the correct address of
20-21 the entity to receive the filing. If the claim is faxed, the claim
20-22 is presumed to have been received on the date of the transmission
20-23 acknowledgment. If the claim is hand delivered, the claim is
20-24 presumed to have been received on the date the delivery receipt is
20-25 signed. The commissioner shall promulgate a form to be submitted
20-26 by the physician or provider which easily identifies all claims
20-27 included in each filing which can be utilized by the physician or
21-1 provider as their log.
21-2 (e) Not later than the 45th day after the date that the
21-3 health maintenance organization receives a clean claim from a
21-4 physician or provider, the health maintenance organization shall
21-5 make a determination of whether the claim is eligible for payment
21-6 and:
21-7 (1) if the health maintenance organization determines
21-8 the entire claim is eligible for payment, pay the total amount of
21-9 the claim in accordance with the contract between the physician or
21-10 provider and the health maintenance organization;
21-11 (2) if the health maintenance organization disputes a
21-12 portion of the claim, pay the portion of the claim that is not in
21-13 dispute and notify the physician or provider in writing why the
21-14 remaining portion of the claim will not be paid; or
21-15 (3) if the health maintenance organization determines
21-16 that the claim is not eligible for payment, notify the physician or
21-17 provider in writing why the claim will not be paid.
21-18 (f) Not later than the 21st day after the date a health
21-19 maintenance organization or the health maintenance organization's
21-20 designated agent affirmatively adjudicates a pharmacy benefit claim
21-21 that is electronically submitted, the health maintenance
21-22 organization shall:
21-23 (1) pay the total amount of the claim; or
21-24 (2) notify the benefit provider of the reasons for
21-25 denying payment of the claim.
21-26 (g) A health maintenance organization that determines under
21-27 Subsection (e) of this section that a claim is eligible for payment
22-1 and does not pay the claim on or before the 45th day after the date
22-2 the health maintenance organization receives a clean claim commits
22-3 an unfair claim settlement practice in violation of Article
22-4 21.21-2, Insurance Code, and is subject to an administrative
22-5 penalty under Chapter 84, Insurance Code. The health maintenance
22-6 organization shall pay the physician or provider making the claim
22-7 the full amount of billed charges submitted on the claim and
22-8 interest on the billed charges at a rate of 15 percent annually,
22-9 except that the health maintenance organization is not required to
22-10 pay a physician or provider with whom the health maintenance
22-11 organization has a contract an amount of billed charges that
22-12 exceeds the amount billable under a fee schedule provided by the
22-13 physician or provider to the health maintenance organization on or
22-14 before the 30th day after the date the physician or provider enters
22-15 into the contract with the health maintenance organization. The
22-16 physician or provider may modify the fee schedule if the physician
22-17 or provider notifies the health maintenance organization of the
22-18 modification on or before the 90th day before the date the
22-19 modification takes effect.
22-20 (h) The investigation and determination of eligibility for
22-21 payment, including any coordination of other payments, does not
22-22 extend the period for determining whether a claim is eligible for
22-23 payment under Subsection (e) of this section [(d) If a
22-24 prescription benefit claim is electronically adjudicated and
22-25 electronically paid, and the health maintenance organization or its
22-26 designated agent authorizes treatment, the claim must be paid not
22-27 later than the 21st day after the treatment is authorized].
23-1 (i) Except as provided by Subsection (j) of this section, if
23-2 [(e) If] the health maintenance organization acknowledges coverage
23-3 of an enrollee under the health care plan but intends to audit the
23-4 physician or provider claim, the health maintenance organization
23-5 shall pay the charges submitted at 85 percent of the contracted
23-6 rate on the claim not later than the 45th day after the date that
23-7 the health maintenance organization receives the claim from the
23-8 physician or provider. The health maintenance organization shall
23-9 complete [Following completion of] the audit, and any additional
23-10 payment due a physician or provider or any refund due the health
23-11 maintenance organization shall be made not later than the 90th
23-12 [30th] day after the receipt of a claim or 45 days after receipt of
23-13 a completed attachment from the physician or provider, whichever is
23-14 later [later of the date that:]
23-15 [(1) the physician or provider receives notice of the
23-16 audit results; or]
23-17 [(2) any appeal rights of the enrollee are exhausted].
23-18 (j) If a health maintenance organization needs additional
23-19 information from a treating physician or provider to determine
23-20 eligibility for payment, the health maintenance organization, not
23-21 later than the 30th calendar day after the date the health
23-22 maintenance organization receives a clean claim, shall request in
23-23 writing that the physician or provider provide any attachment to
23-24 the claim the health maintenance organization desires in good faith
23-25 for clarification of the claim. The request must describe with
23-26 specificity the clinical information requested and relate only to
23-27 information the health maintenance organization can demonstrate is
24-1 specific to the claim or the claim's related episode of care. A
24-2 health maintenance organization that requests an attachment under
24-3 this subsection shall determine whether the claim is eligible for
24-4 payment on or before the later of the 15th day after the date the
24-5 health maintenance organization receives the completed attachment
24-6 or the latest date for determining whether the claim is eligible
24-7 for payment under Subsection (e) of this section. A health
24-8 maintenance organization may not make more than one request under
24-9 this subsection in connection with a claim. Subsections (c) and (d)
24-10 of this section apply to a request for and submission of an
24-11 attachment under this subsection.
24-12 (k) If a health maintenance organization requests an
24-13 attachment or other information from a person other than the
24-14 physician or provider who submitted the claim, the health
24-15 maintenance organization shall provide a copy of the request to the
24-16 physician or provider who submitted the claim. The health
24-17 maintenance organization may not withhold payment pending receipt
24-18 of an attachment or information requested under this subsection.
24-19 If on receiving an attachment or information requested under this
24-20 subsection the health maintenance organization determines an error
24-21 in payment of the claim, the health maintenance organization may
24-22 recover under Section 18E of this Act.
24-23 (l) The commissioner shall adopt rules under which a health
24-24 maintenance organization can easily identify attachments or
24-25 information submitted by a physician or provider.
24-26 (m) A health maintenance organization's claims payment
24-27 processes must:
25-1 (1) use nationally recognized, generally accepted
25-2 Correct Procedural Terminology codes, including all relevant
25-3 modifiers; and
25-4 (2) be consistent with nationally recognized,
25-5 generally accepted, clinically appropriate bundling logic and edits
25-6 [(f) A health maintenance organization that violates Subsection
25-7 (c) or (e) of this section is liable to a physician or provider for
25-8 the full amount of billed charges submitted on the claim or the
25-9 amount payable under the contracted penalty rate, less any amount
25-10 previously paid or any charge for a service that is not covered by
25-11 the health care plan].
25-12 (n) [(g)] A physician or provider may recover reasonable
25-13 attorney's fees and court costs in an action to recover payment
25-14 under this section.
25-15 (o) [(h)] In addition to any other penalty or remedy
25-16 authorized by the Insurance Code or another insurance law of this
25-17 state, a health maintenance organization that violates Subsection
25-18 (e) [(c)] or (i) [(e)] of this section is subject to an
25-19 administrative penalty under Article 1.10E, Insurance Code. The
25-20 administrative penalty imposed under that article may not exceed
25-21 $1,000 for each day the claim remains unpaid in violation of
25-22 Subsection (e) [(c)] or (i) [(e)] of this section.
25-23 (p) [(i)] The health maintenance organization shall provide
25-24 a participating physician or provider with copies of all applicable
25-25 utilization review policies and claim processing policies or
25-26 procedures[, including required data elements and claim formats].
25-27 (q) [(j) A health maintenance organization may, by contract
26-1 with a physician or provider, add or change the data elements that
26-2 must be submitted with the physician or provider claim.]
26-3 [(k) Not later than the 60th day before the date of an
26-4 addition or change in the data elements that must be submitted with
26-5 a claim or any other change in a health maintenance organization's
26-6 claim processing and payment procedures, the health maintenance
26-7 organization shall provide written notice of the addition or change
26-8 to each participating physician or provider.]
26-9 [(l) This section does not apply to a claim made by a
26-10 physician or provider who is a member of the legislature.]
26-11 [(m)] This section does not apply to a capitation payment
26-12 required to be made to a physician or provider under an agreement
26-13 to provide medical care or health care services under a health care
26-14 plan.
26-15 (r) [(n)] This section applies to a person with whom a
26-16 health maintenance organization contracts to process claims or to
26-17 obtain the services of physicians and providers to provide health
26-18 care services to health care plan enrollees.
26-19 (s) [(o)] The commissioner may adopt rules as necessary to
26-20 implement this section.
26-21 SECTION 6. The Texas Health Maintenance Organization Act
26-22 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
26-23 Sections 18D-18L, 40, and 41 to read as follows:
26-24 Sec. 18D. ELEMENTS OF CLEAN CLAIM. (a) A claim by a
26-25 physician or provider, other than an institutional provider, is a
26-26 "clean claim" if the claim is submitted using Health Care Financing
26-27 Administration Form 1500 or a successor to that form developed by
27-1 the National Uniform Billing Committee or its successor and adopted
27-2 by the commissioner by rule for the purposes of this subsection
27-3 that is submitted to a health maintenance organization for payment
27-4 and that contains the information required by the commissioner by
27-5 rule for the purposes of this subsection entered into the
27-6 appropriate fields on the form.
27-7 (b) A claim by an institutional provider is a "clean claim"
27-8 if the claim is submitted using Health Care Financing
27-9 Administration Form UB-92 or a successor to that form developed by
27-10 the National Uniform Billing Committee or its successor and adopted
27-11 by the commissioner by rule for the purposes of this subsection
27-12 that is submitted to a health maintenance organization for payment
27-13 and that contains the information required by the commissioner by
27-14 rule for the purposes of this subsection entered into the
27-15 appropriate fields on the form.
27-16 (c) A health maintenance organization may require any data
27-17 element that is required in an electronic transaction set needed to
27-18 comply with federal law. A health maintenance organization may not
27-19 require a physician or provider to provide information other than
27-20 information for a data field included on the form used for a clean
27-21 claim under Subsection (a) or (b) of this section, as applicable.
27-22 (d) A claim submitted by a physician or provider that
27-23 includes additional fields, data elements, attachments, or other
27-24 information not required under this section is considered to be a
27-25 clean claim for the purposes of this section.
27-26 Sec. 18E. OVERPAYMENT. A health maintenance organization
27-27 may recover an overpayment to a physician or provider if:
28-1 (1) not later than the 180th day after the date the
28-2 physician or provider receives the payment, the health maintenance
28-3 organization provides written notice of the overpayment to the
28-4 physician or provider that includes the basis and specific reasons
28-5 for the request for recovery of funds; and
28-6 (2) the physician or provider does not make
28-7 arrangements for repayment of the requested funds on or before the
28-8 45th day after the date the physician or provider receives the
28-9 notice.
28-10 Sec. 18F. VERIFICATION OF ELIGIBILITY FOR PAYMENT. (a) On
28-11 the request of a physician or provider for verification of the
28-12 payment eligibility of a particular medical care or health care
28-13 service the physician or provider proposes to provide to a
28-14 particular patient, the health maintenance organization shall
28-15 inform the physician or provider whether the service, if provided
28-16 to that patient, is eligible for payment from the health
28-17 maintenance organization to the physician or provider.
28-18 (b) A health maintenance organization shall provide
28-19 verification under this section between 6 a.m. and 6 p.m. central
28-20 standard time each day.
28-21 (c) Verification under this section shall be made in good
28-22 faith and without delay.
28-23 (d) In this section, "verification" includes any required
28-24 preauthorization process.
28-25 (e) A health maintenance organization may establish a time
28-26 certain for the validity of verification.
28-27 (f) If a health maintenance organization has verified
29-1 medical care or health care services, the health maintenance
29-2 organization may not deny or reduce payment to a physician or
29-3 health care provider for those services unless:
29-4 (1) the physician or provider has materially
29-5 misrepresented the proposed medical or health care services or has
29-6 substantially failed to perform the proposed medical or health care
29-7 services; or
29-8 (2) the health maintenance organization certifies in
29-9 writing:
29-10 (A) that the patient was not a covered enrollee
29-11 of the health plan;
29-12 (B) the health maintenance organization was
29-13 notified on or before the 30th day after the date the patient's
29-14 enrollment ended; and
29-15 (C) the physician or provider was notified that
29-16 the patient's enrollment ended on or before the 30th day after the
29-17 date of verification under this section.
29-18 Sec. 18G. COORDINATION OF PAYMENT BENEFITS. (a) A health
29-19 maintenance organization may require a physician or provider to
29-20 retain in the physician's or provider's records updated information
29-21 concerning other health benefit plan coverage and to provide the
29-22 information to the health maintenance organization on the
29-23 applicable form described by Section 18D of this Act. Except as
29-24 provided by this subsection, a health maintenance organization may
29-25 not require a physician or provider to investigate coordination of
29-26 other health benefit plan coverage.
29-27 (b) Coordination of other payment under this section does
30-1 not extend the period for determining whether a service is eligible
30-2 for payment under Section 18B(e) of this Act.
30-3 (c) A physician or provider who submits a claim for
30-4 particular medical care or health care services to more than one
30-5 health maintenance organization or insurer shall provide written
30-6 notice on the claim submitted to each health maintenance
30-7 organization or insurer of the identity of each other health
30-8 maintenance organization or insurer with which the same claim is
30-9 being filed.
30-10 (d) On receipt of notice under Subsection (c) of this
30-11 section, a health maintenance organization shall coordinate and
30-12 determine the appropriate payment for each health maintenance
30-13 organization or insurer to make to the physician or provider.
30-14 (e) If a health maintenance organization is a secondary
30-15 payor and pays more than the amount for which the health
30-16 maintenance organization is legally obligated, the overpayment may
30-17 be recovered from the health maintenance organization or insurer
30-18 that is primarily responsible for that amount.
30-19 (f) If the portion of the claim overpaid by the secondary
30-20 health maintenance organization was also paid by the primary health
30-21 maintenance organization or insurer, the secondary health
30-22 maintenance organization may recover the amount of the overpayment
30-23 under Section 18E of this Act from the physician or provider who
30-24 received the payment.
30-25 (g) A health maintenance organization may share information
30-26 with another health maintenance organization or insurer to the
30-27 extent necessary to coordinate appropriate payment obligations on a
31-1 specific claim.
31-2 (h) The provisions of this section may not be waived,
31-3 voided, or nullified by contract.
31-4 Sec. 18H. PREAUTHORIZATION OF MEDICAL AND HEALTH CARE
31-5 SERVICES. (a) A health maintenance organization that uses a
31-6 preauthorization process for medical care and health care services
31-7 shall provide each participating physician or provider, not later
31-8 than the 10th working day after the date a request is made, a list
31-9 of the medical care and health care services that do not require
31-10 preauthorization and information concerning the preauthorization
31-11 process.
31-12 (b) If proposed medical care or health care services require
31-13 preauthorization by a health maintenance organization as a
31-14 condition of the health maintenance organization's payment to a
31-15 physician or provider, the health maintenance organization shall
31-16 determine whether the medical care or health care services proposed
31-17 to be provided to the enrollee are medically necessary and
31-18 appropriate.
31-19 (c) On receipt of a request from a physician or provider for
31-20 preauthorization, the health maintenance organization shall review
31-21 and issue a determination indicating whether the services are
31-22 preauthorized. The determination must be mailed or otherwise
31-23 transmitted not later than the third calendar day after the date
31-24 the request is received by the insurer.
31-25 (d) If the proposed medical care or health care services
31-26 involve inpatient care, the determination issued by the health
31-27 maintenance organization must be provided within one calendar day
32-1 of the request by telephone or electronic transmission to the
32-2 physician or provider of record and followed by written notice to
32-3 the physician or provider on or before the third day after the date
32-4 of the request and must specify an approved length of stay for
32-5 admission into a health care facility based on the recommendation
32-6 of the patient's physician or provider and the health maintenance
32-7 organization's written medically acceptable screening criteria and
32-8 review procedures. The criteria and procedures must be established,
32-9 periodically evaluated, and updated.
32-10 (e) If the health maintenance organization has preauthorized
32-11 medical care or health care services, the health maintenance
32-12 organization may not deny or reduce payment to the physician or
32-13 provider for those services unless:
32-14 (1) the physician or provider has materially
32-15 misrepresented the proposed medical or health care services or has
32-16 substantially failed to perform the proposed medical or health care
32-17 services; or
32-18 (2) the health maintenance organization certifies in
32-19 writing:
32-20 (A) that the patient was not a covered enrollee
32-21 of the health plan;
32-22 (B) the health maintenance organization was
32-23 notified on or before the 30th day after the date the patient's
32-24 enrollment ended; and
32-25 (C) the physician or provider was notified that
32-26 the patient's enrollment ended on or before the 30th day after the
32-27 date of verification under this section.
33-1 (f) This section applies to an agent or other person with
33-2 whom a health maintenance organization contracts to perform, or to
33-3 whom the health maintenance organization delegates the performance
33-4 of, preauthorization of proposed medical care or health care
33-5 services.
33-6 Sec. 18I. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND
33-7 PROVIDERS. The provisions of this Act relating to prompt payment by
33-8 a health maintenance organization of a physician or provider and to
33-9 preauthorization of medical care or health care services apply to a
33-10 physician or provider who:
33-11 (1) is not included in the health maintenance
33-12 organization delivery network; and
33-13 (2) provides to an enrollee:
33-14 (A) care related to an emergency or its
33-15 attendant episode of care as required by state or federal law; or
33-16 (B) specialty or other medical care or health
33-17 care services at the request of the health maintenance organization
33-18 or a physician or provider who is included in the health
33-19 maintenance organization delivery network because the services are
33-20 not reasonably available within the network.
33-21 Sec. 18J. AVAILABILITY OF CODING GUIDELINES. (a) A contract
33-22 between a health maintenance organization and a physician or
33-23 provider must provide that:
33-24 (1) the physician or provider may request a
33-25 description of the coding guidelines, including any underlying
33-26 bundling, recoding, or other payment process and fee schedules
33-27 applicable to specific procedures that the physician or provider
34-1 will receive under the contract;
34-2 (2) the health maintenance organization will provide
34-3 the guidelines not later than the 30th day after the date the
34-4 health maintenance organization receives the request;
34-5 (3) the health maintenance organization will provide
34-6 notice of material changes to the coding guidelines and fee
34-7 schedules not later than the 90th day before the date the changes
34-8 take effect and will not make retroactive revisions to the coding
34-9 guidelines and fee schedules; and
34-10 (4) the contract may be terminated by the physician or
34-11 provider on or before the 30th day after the date the physician or
34-12 provider receives information requested under this subsection
34-13 without penalty or discrimination in participation in other health
34-14 care products or plans.
34-15 (b) A physician or provider who receives information under
34-16 Subsection (a) of this section may use or disclose the information
34-17 only for the purpose of practice management, billing activities, or
34-18 other business operations. The attorney general may impose and
34-19 collect a penalty of $1,000 for each use or disclosure of the
34-20 information that violates this subsection.
34-21 (c) Nothing in this section shall be interpreted to require
34-22 a health maintenance organization to violate copyright or other law
34-23 by disclosing proprietary software that the health maintenance
34-24 organization has licensed. In addition to the above, the health
34-25 maintenance organization shall, on request of the physician or
34-26 provider, provide the name, edition, and model version of the
34-27 software that the health maintenance organization uses to determine
35-1 bundling and unbundling of claims.
35-2 Sec. 18K. DISPUTE RESOLUTION. (a) A health maintenance
35-3 organization may not require by contract or otherwise the use of a
35-4 dispute resolution procedure or binding arbitration with a
35-5 physician or provider. This subsection does not prohibit a health
35-6 maintenance organization from offering a dispute resolution
35-7 procedure or binding arbitration to resolve a dispute if the health
35-8 maintenance organization and the physician or provider consent to
35-9 the process after the dispute arises. This subsection may not be
35-10 construed to conflict with any applicable appeal mechanisms
35-11 required by law.
35-12 (b) The provisions of this section may not be waived or
35-13 nullified by contract.
35-14 Sec. 18L. AUTHORITY OF ATTORNEY GENERAL. In addition to any
35-15 other remedy available for a violation of this Act, the attorney
35-16 general may take action and seek remedies available under Section
35-17 15, Article 21.21, Insurance Code, and Sections 17.58, 17.60,
35-18 17.61, and 17.62, Business & Commerce Code, for a violation of
35-19 Section 14 or 18B of this Act.
35-20 Sec. 40. CONFLICT WITH OTHER LAW. To the extent of any
35-21 conflict between this Act and Article 21.52C, Insurance Code, this
35-22 Act controls.
35-23 Sec. 41. APPLICATION OF CERTAIN PROVISIONS UNDER MEDICAID.
35-24 A provision of this Act may not be interpreted as requiring a
35-25 health maintenance organization, physician, or provider, in
35-26 providing benefits or services under the state Medicaid program,
35-27 to:
36-1 (1) use billing forms or codes that are inconsistent
36-2 with those required under the state Medicaid program;
36-3 (2) make determinations relating to medical necessity
36-4 or appropriateness or eligibility for coverage in a manner
36-5 different than that required under the state Medicaid program; or
36-6 (3) reimburse physicians or providers for services
36-7 rendered to a person who was not eligible to receive benefits for
36-8 such services under the state Medicaid program.
36-9 SECTION 7. (a) The changes in law made by this Act relating
36-10 to payment of a physician or health care provider for medical or
36-11 health care services apply only to payment for services provided on
36-12 or after the effective date of this Act.
36-13 (b) The changes in law made by this Act relating to a
36-14 contract between a physician or health care provider and an insurer
36-15 or health maintenance organization apply only to a contract entered
36-16 into or renewed on or after the effective date of this Act.
36-17 SECTION 8. This Act takes effect September 1, 2001.