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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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(A) benefits for medical or surgical expenses |
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incurred as a result of a health condition, accident, or sickness, |
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including an individual, group, blanket, or franchise insurance |
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policy or insurance agreement, a group hospital service contract, |
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or an individual or group evidence of coverage that is offered by: |
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(i) an insurance company; |
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(ii) a group hospital service corporation |
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operating under Chapter 842; |
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(iii) a fraternal benefit society operating |
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under Chapter 885; |
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(iv) a stipulated premium company operating |
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under Chapter 884; |
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(v) a Lloyd's plan operating under Chapter |
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941; |
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(vi) an exchange operating under Chapter |
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942; |
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(vii) a health maintenance organization |
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operating under Chapter 843; |
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(viii) a multiple employer welfare |
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arrangement that holds a certificate of authority under Chapter |
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846; |
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(ix) an approved nonprofit health |
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corporation that holds a certificate of authority under Chapter |
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844; or |
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(x) an entity not authorized under this |
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code or another insurance law of this state that contracts directly |
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for health care services on a risk-sharing basis, including a |
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capitation basis; or |
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(B) health and accident coverage through a risk |
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pool created under Chapter 172, Local Government Code, |
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notwithstanding Section 172.014, Local Government Code. |
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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: |
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(1) provides an enrollee with real-time information at |
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the point of service concerning: |
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(A) any applicable deductibles; |
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(B) the allowable or usual and customary amount |
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paid for out-of-network care, as applicable; and |
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(C) the enrollee's potential total financial |
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responsibility; and |
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(2) provides a physician or other health care provider |
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with real-time information regarding physician or health care |
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provider network participation. |
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(b) A health benefit plan issuer shall use information |
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technology that permits real-time adjudication of health care |
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claims at the point of service. |
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Sec. 1661.003. CERTAIN FEES PROHIBITED. A health benefit |
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plan issuer may not directly or indirectly charge or collect from an |
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enrollee or a physician, or other health care provider, a fee to |
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cover the costs incurred by the health benefit plan issuer in |
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complying with this chapter. |
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Sec. 1661.004. 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 September 1, 2009. |