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79R1163 KCR-D

By:  Nelson                                                       S.B. No. 49 



A BILL TO BE ENTITLED

AN ACT

relating to the electronic submission of certain health care 
transactions.  
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 2, Article 21.52Z, Insurance Code, is 
amended to read as follows:
	Sec. 2.  ELECTRONIC SUBMISSION OF CLAIMS.  (a) Before 
September 1, 2007, the [The] issuer of a health benefit plan by 
contract may require that a health care professional licensed or 
registered under the Occupations Code or a health care facility 
licensed under the Health and Safety Code submit a health care claim 
or equivalent encounter information, a referral certification, or 
an authorization or eligibility transaction electronically.  This 
subsection expires September 1, 2007.
	(b)  On or after September 1, 2007, the issuer of a health 
benefit plan by contract shall require that a health care 
professional licensed or registered under the Occupations Code or a 
health care facility licensed under the Health and Safety Code 
submit a health care claim or equivalent encounter information, a 
referral certification, or an authorization or eligibility 
transaction electronically.
	(c)  A [The] health benefit plan issuer shall comply with the 
standards for electronic transactions required by this section and 
established by the commissioner by rule.
	(d)  A [(b)  The issuer of a] health benefit plan by contract 
shall establish a default method to submit claims in a 
nonelectronic format if [there is] a system failure or failures 
exist or a catastrophic event substantially interferes with the 
normal business operations of the physician, provider, or health 
benefit plan or its agents.  The health benefit plan issuer shall 
comply with the standards for nonelectronic transactions 
established by the commissioner by rule.
	SECTION 2.  The change in law made by this Act applies only 
to a health benefit plan that is delivered, issued for delivery, or 
renewed on or after the effective date of this Act.  A health 
benefit plan that is delivered, issued for delivery, or renewed 
before the effective date of this Act is governed by the law in 
effect on the date that the health benefit plan was delivered, 
issued for delivery, or renewed, and that law is continued in effect 
for that purpose.
	SECTION 3.  This Act takes effect September 1, 2005.