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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for certain nonemergency |
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ambulance transportation services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1451, Insurance Code, is amended by |
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adding Subchapter J to read as follows: |
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SUBCHAPTER J. ACCESS TO TRANSPORTATION SERVICES |
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Sec. 1451.451. APPLICABILITY. This subchapter applies only |
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to a health benefit plan that provides benefits for nonemergency |
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ambulance transportation services and that: |
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(1) provides 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: |
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(A) an individual, group, blanket, or franchise |
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insurance policy or insurance agreement, a group hospital service |
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contract, or an individual or group evidence of coverage or similar |
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coverage document 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; or |
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(v) a health maintenance organization |
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operating under Chapter 843; and |
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(B) to the extent permitted by the Employee |
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Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et |
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seq.), a health benefit plan that is offered by: |
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(i) a multiple employer welfare arrangement |
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as defined by Section 3 of that Act; or |
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(ii) another analogous benefit |
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arrangement; |
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(2) is offered by: |
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(A) an approved nonprofit health corporation |
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that holds a certificate of authority under Chapter 844; or |
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(B) an entity that is 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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(3) provides health and accident coverage through a |
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risk pool created under Chapter 172, Local Government Code, |
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notwithstanding Section 172.014, Local Government Code, or any |
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other law. |
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Sec. 1451.452. EXCEPTION. This subchapter does not apply |
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to: |
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(1) a plan that provides coverage: |
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(A) only for a specified disease; |
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(B) only for accidental death or dismemberment; |
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(C) for wages or payments instead of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; or |
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(D) as a supplement to a liability insurance |
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policy; |
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(2) a small employer health benefit plan under Chapter |
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1501; |
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(3) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
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(4) a workers' compensation insurance policy; |
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(5) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; or |
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(6) a long-term care insurance policy, including a |
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nursing home fixed indemnity policy, unless the commissioner |
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determines that the policy provides benefit coverage so |
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comprehensive that the policy is a health benefit plan described by |
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Section 1451.451. |
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Sec. 1451.453. RULES. The commissioner shall adopt rules |
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necessary to implement this subchapter. |
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Sec. 1451.454. LIMITS ON NONEMERGENCY AMBULANCE |
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TRANSPORTATION PROVIDERS. (a) The issuer of a health benefit plan |
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that provides coverage for nonemergency ambulance transportation |
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services may not contract with a nonemergency ambulance |
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transportation service provider who has a direct or indirect |
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ownership interest in a transportation brokerage service that |
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contracts with the plan and provides for the establishment of a |
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nonemergency ambulance transportation network. |
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(b) Subsection (a) does not apply to nonemergency ambulance |
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transportation services provided in an area of the state in which |
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there is only one nonemergency ambulance transportation service |
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provider available to provide the transportation service needed. A |
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health benefit plan that provides coverage for nonemergency |
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ambulance transportation services under this subsection shall |
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maintain documentation evidencing that no other provider is |
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available to provide the service in the area. |
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Sec. 1451.455. LIMITS ON PAYMENTS. A transportation |
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service provider may not offer or make any payment or other form of |
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remuneration, including any kickback, rebate, cash, gift, or |
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service in kind, to the issuer of a health benefit plan for |
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referrals to the provider, or for contracting with the provider, to |
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provide nonemergency ambulance transportation services. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan delivered, issued for delivery, or renewed |
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on or after January 1, 2014. A plan delivered, issued for delivery, |
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or renewed before January 1, 2014, is governed by the law in effect |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2013. |