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By:  Nelson                                                       S.B. No. 49 
	(In the Senate - Filed November 8, 2004; January 31, 2005, 
read first time and referred to Committee on State Affairs; 
April 25, 2005, reported adversely, with favorable Committee 
Substitute by the following vote:  Yeas 8, Nays 0; April 25, 2005, 
sent to printer.)


COMMITTEE SUBSTITUTE FOR S.B. No. 49                                     By:  Madla


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)  The issuer of 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) [(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 issuer of a health benefit plan 
[issuer] shall comply with the standards for nonelectronic 
transactions established by the commissioner by rule.
	SECTION 2.  Article 21.52Z, Insurance Code, is amended by 
adding Section 1A to read as follows:
	Sec. 1A.  APPLICABILITY.  This article does not apply to:               
		(1)  a health benefit plan that provides coverage:                     
			(A)  only for a specified disease or for another 
limited benefit;   
			(B)  only for accidental death or dismemberment;                      
			(C)  for wages or payments in lieu of wages for a 
period during which an employee is absent from work because of 
sickness or injury;
			(D)  as a supplement to a liability insurance 
policy;               
			(E)  for credit insurance;                                            
			(F)  only for hospital expenses;                                      
			(G)  only for indemnity for hospital confinement; 
or                
			(H)  in accordance with Title XXI of the Social 
Security Act (42 U.S.C. Section 1397aa et seq.);
		(2)  a Medicare supplemental policy as defined by 
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
		(3)  a workers' compensation insurance policy;                         
		(4)  medical payment insurance coverage provided under 
an automobile insurance policy; or
		(5)  a long-term care insurance policy, including a 
nursing home fixed indemnity policy, unless the commissioner 
determines that the policy provides benefit coverage so 
comprehensive that the policy is a health benefit plan as described 
by Section 1 of this article.
	SECTION 3.  The change in law made by this Act applies only 
to a contract between the issuer of a health benefit plan and a 
health care professional licensed or registered under the 
Occupations Code or a health care facility licensed under the 
Health and Safety Code that is delivered, issued for delivery, or 
renewed on or after the effective date of this Act.  A contract 
between the issuer of a health benefit plan and a health care 
professional licensed or registered under the Occupations Code or a 
health care facility licensed under the Health and Safety Code 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 contract was delivered, issued for delivery, or renewed, and 
that law is continued in effect for that purpose.
	SECTION 4.  This Act takes effect September 1, 2005.                           



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