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A BILL TO BE ENTITLED
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AN ACT
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relating to adoption of certain information technology. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle J, Title 8, Insurance Code, is amended |
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by adding Chapter 1661 to read as follows: |
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CHAPTER 1661. INFORMATION TECHNOLOGY |
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Sec. 1661.001. DEFINITIONS. In this chapter: |
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(1) "Health benefit plan" means a plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage that is offered by: |
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(A) an insurance company; |
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(B) a group hospital service corporation |
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operating under Chapter 842; |
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(C) a fraternal benefit society operating under |
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Chapter 885; |
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(D) a stipulated premium company operating under |
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Chapter 884; |
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(E) a Lloyd's plan operating under Chapter 941; |
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(F) an exchange operating under Chapter 942; |
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(G) a health maintenance organization operating |
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under Chapter 843; |
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(H) a multiple employer welfare arrangement that |
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holds a certificate of authority under Chapter 846; |
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(I) an approved nonprofit health corporation |
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that holds a certificate of authority under Chapter 844; or |
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(J) an entity not authorized under this code or |
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another insurance law of this state that contracts directly for |
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health care services on a risk-sharing basis, including a |
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capitation basis. |
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(2) "Health benefit plan issuer" means an entity |
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authorized to issue a health benefit plan in this state. |
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Sec. 1661.002. USE OF CERTAIN INFORMATION TECHNOLOGY |
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REQUIRED. (a) A health benefit plan issuer shall use information |
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technology that provides a physician, hospital, or other health |
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care provider with real-time information at the point of care |
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concerning: |
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(1) the enrollee's: |
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(A) copayment and coinsurance; |
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(B) applicable deductibles; and |
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(C) covered benefits and services; and |
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(2) the enrollee's estimated total financial |
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responsibility for the care. |
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(b) A health benefit plan issuer shall use information |
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technology that provides an enrollee with information concerning |
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the enrollee's: |
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(1) copayment and coinsurance; |
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(2) applicable deductibles; |
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(3) covered benefits and services; and |
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(4) estimated financial responsibility for the health |
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care provided to the enrollee. |
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(c) Nothing in this section may be interpreted as a |
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guarantee of payment for health care services. |
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Sec. 1661.003. REQUIRED USE OF TECHNOLOGY BY PROVIDERS. A |
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physician, hospital, or other health care provider shall use |
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information technology as required under this chapter beginning not |
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later than September 1, 2013. |
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Sec. 1661.004. REFUND OF OVERPAYMENT. A physician, |
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hospital, or other health care provider that receives an |
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overpayment from an enrollee must refund the amount of the |
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overpayment to the enrollee not later than the 30th day after the |
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date the physician, hospital, or health care provider determines |
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that an overpayment has been made. This section does not apply to an |
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overpayment subject to Section 843.350 or 1301.132. |
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Sec. 1661.005. HEALTH BENEFIT PLAN ISSUER CONDUCT. A |
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contract between a health benefit plan issuer and a physician, |
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hospital, or other health care provider may not prohibit the |
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physician, hospital, or health care provider from collecting, at |
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the time of care, the estimated amount for which the enrollee may be |
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financially responsible. |
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Sec. 1661.006. CERTAIN FEES PROHIBITED. A health benefit |
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plan issuer may not directly charge or collect from an enrollee or a |
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physician, or other health care provider, a fee to cover the costs |
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incurred by the health benefit plan issuer in complying with this |
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chapter. |
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Sec. 1661.007. WAIVER. (a) A health benefit plan issuer |
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may apply to the commissioner for a waiver of the requirement under |
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this chapter to use information technology. |
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(b) The commissioner by rule shall identify circumstances |
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that justify a waiver, including: |
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(1) undue hardship, including financial or |
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operational hardship; |
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(2) the geographical area in which the health benefit |
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plan issuer operates; |
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(3) the number of enrollees covered by a health |
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benefit plan issuer; and |
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(4) other special circumstances. |
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(c) The commissioner shall approve or deny a waiver |
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application under this section not later than the 60th day after the |
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date of receipt of the application. |
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(d) This section expires January 1, 2012. |
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Sec. 1661.008. RULES. The commissioner shall adopt rules |
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as necessary to implement this chapter, including rules that ensure |
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that the information technology used by a health benefit plan |
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issuer does not have legal or technical restrictions for encoding, |
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displaying, exchanging, reading, printing, transmitting, or |
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storing information or data in electronic form. |
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SECTION 2. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect January 1, 2010. |