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A BILL TO BE ENTITLED
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AN ACT
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relating to direct payment by a health insurer to physicians and |
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health care providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Subchapter B, Chapter 1204, |
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Insurance Code, is amended to read as follows: |
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SUBCHAPTER B. ASSIGNMENT OF BENEFIT PAYMENTS; DIRECT PAYMENT OF |
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BENEFITS |
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SECTION 2. Section 1204.051(3), Insurance Code, is amended |
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to read as follows: |
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(3) "Health care provider" means a person who provides |
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health care services or ambulance services under a license, |
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certificate, registration, or other similar evidence of regulation |
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issued by this or another state of the United States. |
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SECTION 3. Subchapter B, Chapter 1204, Insurance Code, is |
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amended by adding Sections 1204.056, 1204.057, and 1204.058 to read |
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as follows: |
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Sec. 1204.056. ASSIGNMENT OF BENEFITS OPTION REQUIRED. |
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(a) A health insurance policy claim form must provide an option |
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for the claimant to assign benefits to a physician or health care |
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provider who provided covered services. |
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(b) The health insurer may require a written attestation of |
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assignment of benefits. |
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Sec. 1204.057. AMOUNT OF PAYMENT UNDER ASSIGNMENT OF |
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BENEFITS. A payment to a physician or health care provider under an |
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assignment of benefits may not be more than the amount the insurer |
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would have paid in the absence of an assignment of benefits. |
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Sec. 1204.058. DIRECT PAYMENT PROVISION AUTHORIZED. A |
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health insurance policy may provide for payment of benefits |
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directly to a physician or health care provider who provides |
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covered services to a covered person, even in the absence of an |
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assignment of benefits. |
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SECTION 4. Subchapter B, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.0561 to read as follows: |
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Sec. 1301.0561. DIRECT PAYMENT TO PREFERRED PROVIDERS |
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REQUIRED. An insurer that issues a preferred provider benefit plan |
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shall pay a preferred provider directly for covered services |
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provided to a person insured under the plan, in accordance with this |
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chapter, without requiring an assignment of benefits. |
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SECTION 5. The changes in law made by this Act apply only to |
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an insurance policy delivered, issued for delivery, or renewed on |
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or after January 1, 2014. An insurance policy delivered, issued for |
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delivery, or renewed before January 1, 2014, is governed by the law |
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in effect immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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SECTION 6. This Act takes effect September 1, 2013. |