By:  Nelson                                                       S.B. No. 50 
	(In the Senate - Filed November 8, 2004; January 31, 2005, 
read first time and referred to Committee on State Affairs; 
March 15, 2005, reported adversely, with favorable Committee 
Substitute by the following vote:  Yeas 9, Nays 0; March 15, 2005, 
sent to printer.)


COMMITTEE SUBSTITUTE FOR S.B. No. 50                                     By:  Armbrister


A BILL TO BE ENTITLED

AN ACT


relating to contracts between health care providers and certain 
health benefit plan issuers.
	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 REJECTION OF 
BATCHED CLAIMS.  (a)  If requested by a participating physician or 
provider, a health maintenance organization shall include a 
provision in the physician's or provider's contract providing that 
the health maintenance organization or the health maintenance 
organization's clearinghouse may not refuse to process or pay an 
electronically submitted clean claim, as defined by Subchapter J, 
because the claim is submitted together with or in a batch 
submission with a claim that is not a clean claim.
	(b)  In accordance with Chapters 82 and 84, the commissioner 
may issue a cease and desist order against or impose sanctions on a 
health maintenance organization that violates this section or a 
contract provision adopted under this section.
	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 REJECTION 
OF BATCHED CLAIMS.  (a)  If requested by a preferred provider, an 
insurer shall include a provision in the preferred provider's 
contract providing that the insurer or the insurer's clearinghouse 
may not refuse to process or pay an electronically submitted clean 
claim, as defined by Subchapter C, because the claim is submitted 
together with or in a batch submission with a claim that is not a 
clean claim.
	(b)  In accordance with Chapters 82 and 84, the commissioner 
may issue a cease and desist order against or impose sanctions on an 
insurer that violates this section or a contract provision adopted 
under this section.
	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 or renewed 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.                           



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