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79R493 AJA-D

By:  Nelson                                                       S.B. No. 50 



A BILL TO BE ENTITLED

AN ACT

relating to contracts between health care providers and certain 
health benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter I, Chapter 843, Insurance Code, is 
amended by adding Section 843.323 to read as follows:
	Sec. 843.323.  CONTRACT PROVISIONS PROHIBITING BUNDLING OF 
CLAIMS.  A health maintenance organization may not refuse to 
include a provision in a contract with a participating physician or 
provider under which the health maintenance organization may not 
refuse to pay an individual clean claim, as that term is defined 
under Subchapter J, submitted by the physician or provider if 
payment is refused because another claim submitted by the physician 
or provider is not a clean claim, regardless of whether the claims 
are submitted or processed together.
	SECTION 2.  Subchapter B, Chapter 1301, Insurance Code, as 
effective April 1, 2005, is amended by adding Section 1301.0641 to 
read as follows:
	Sec. 1301.0641.  CONTRACT PROVISIONS PROHIBITING BUNDLING 
OF CLAIMS.  An insurer may not refuse to include a provision in a 
contract with a preferred provider under which the insurer may not 
refuse to pay an individual clean claim, as that term is defined 
under Subchapter C, submitted by the provider if payment is refused 
because another claim submitted by the provider is not a clean 
claim, regardless of whether the claims are submitted or processed 
together.
	SECTION 3.  The change in law made by this Act applies only 
to a contract between an insurer and a preferred provider or a 
health maintenance organization and a physician or provider that is 
entered into on or after January 1, 2006.  A contract entered into 
before January 1, 2006, is governed by the law in effect immediately 
before the effective date of this Act, and that law is continued in 
effect for that purpose.
	SECTION 4.  This Act takes effect September 1, 2005.