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INTRODUCED
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HOUSE COMMITTEE
SUBSTITUTE
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SECTION 1. Section
843.342(m), Insurance Code, is amended to read as follows:
(m) Notwithstanding any
other provision of this section, this subsection governs the payment of a
penalty under this section. For a penalty under this section relating to a
clean claim submitted by a physician or provider other than an
institutional provider, the health maintenance organization shall pay the
entire penalty to the physician or provider, except for any interest
computed under Subsection (c), which shall be paid to the Texas Health Insurance Risk Pool. [For a
penalty under this section relating to a clean claim submitted by an
institutional provider, the health maintenance organization shall pay 50
percent of the total penalty amount computed under this section, including
interest, to the institutional provider and the remaining 50 percent of
that amount to the Texas Health Insurance Risk Pool.]
No
equivalent provision.
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SECTION 1. Section 843.342,
Insurance Code, is amended by amending Subsection (m) and adding Subsection
(m-1) to read as follows:
(m) Notwithstanding any
other provision of this section, this subsection governs the payment of a
penalty under this section. For a penalty under this section relating to a
clean claim submitted by a physician or provider other than an
institutional provider, the health maintenance organization shall pay the
entire penalty to the physician or provider, except for any interest
computed under Subsection (c), which shall be paid to the department to be distributed to the fund
established under Subchapter F, Chapter 1508, to be used for any purpose authorized
by the commissioner by rule to improve access to health benefit coverage
for individuals without coverage
[Texas Health Insurance Risk Pool]. For a penalty under this
section relating to a clean claim submitted by an institutional provider,
the health maintenance organization shall pay 50 percent of the total
penalty amount computed under this section, including interest, to the
institutional provider and the remaining 50 percent of that amount to the
department to be distributed to the fund established under Subchapter F,
Chapter 1508, to be used as provided by Subsection (m-1).
(m-1) Money in the fund
established under Subchapter F, Chapter 1508, that is derived from
penalties under this section relating to clean claims submitted by
institutional providers may only be appropriated as follows:
(1) the first $5 million
may be appropriated only to the Health and Human Services Commission to be
used only to fund the commission's consumer assistance for Medicaid
program;
(2) the next $20 million
collected may be appropriated only to the Health and Human Services
Commission to be used only to provide postpartum coverage through the child
health plan program operated under Chapter 62, Health and Safety Code, and
Medicaid; and
(3) amounts in excess of
the amounts described by Subdivisions (1) and (2) may be appropriated only
to the Health and Human Services Commission to be used only to increase
reimbursement rates to health care providers who provide services through
the Texas Women's Health Program [the Texas Health Insurance Risk
Pool].
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SECTION 2. Section
1301.137(l), Insurance Code, is amended to read as follows:
(l) Notwithstanding any
other provision of this section, this subsection governs the payment of a
penalty under this section. For a penalty under this section relating to a
clean claim submitted by a preferred provider other than an institutional
provider, the insurer shall pay the entire penalty to the preferred
provider, except for any interest computed under Subsection (c), which shall
be paid to the Texas Health Insurance Risk
Pool. [For a penalty under this section relating to a clean claim
submitted by an institutional provider, the insurer shall pay 50 percent of
the penalty amount computed under this section, including interest, to the
institutional provider and the remaining 50 percent of that amount to the
Texas Health Insurance Risk Pool.]
No
equivalent provision.
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SECTION 2. Section 1301.137,
Insurance Code, is amended by amending Subsection (l) and adding Subsection
(l-1) to read as follows:
(l) Notwithstanding any
other provision of this section, this subsection governs the payment of a
penalty under this section. For a penalty under this section relating to a
clean claim submitted by a preferred provider other than an institutional
provider, the insurer shall pay the entire penalty to the preferred
provider, except for any interest computed under Subsection (c), which
shall be paid to the department to be
distributed to the fund established under Subchapter F, Chapter 1508, to be
used for any purpose authorized by the commissioner by rule to improve
access to health benefit coverage for individuals without coverage [Texas Health Insurance Risk Pool]. For
a penalty under this section relating to a clean claim submitted by an
institutional provider, the insurer shall pay 50 percent of the penalty
amount computed under this section, including interest, to the
institutional provider and the remaining 50 percent of that amount to the department
to be distributed to the fund established under Subchapter F, Chapter 1508,
to be used as provided by Subsection (l-1).
(l-1) Money in the fund
established under Subchapter F, Chapter 1508, that is derived from
penalties under this section relating to clean claims submitted by institutional
providers may only be appropriated as follows:
(1) the first $5 million
may be appropriated only to the Health and Human Services Commission to be
used only to fund the commission's consumer assistance for Medicaid
program;
(2) the next $20 million
collected may be appropriated only to the Health and Human Services
Commission to be used only to provide postpartum coverage through the child
health plan program operated under Chapter 62, Health and Safety Code, and
Medicaid; and
(3) amounts in excess of
the amounts described by Subdivisions (1) and (2) may be appropriated only
to the Health and Human Services Commission to be used only to increase
reimbursement rates to health care providers who provide services through
the Texas Women's Health Program [Texas Health Insurance Risk Pool].
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No
equivalent provision.
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SECTION 3. (a)
Notwithstanding Section 6(e), Chapter 615 (S.B. 1367), Acts of the 83rd
Legislature, Regular Session, 2013, any penalties relating to clean claims
submitted by institutional providers that were paid under Section
843.342(m) or 1301.137(l), Insurance Code, before the effective date of
this Act, and that remain unexpended and unobligated on the effective date
of this Act, shall be used to provide grants to hospitals in this state to
upgrade the hospitals' emergency rooms and trauma facilities.
(b) The commissioner of
insurance shall adopt rules governing the distribution of grants to
hospitals under this section and the contracts under which the grants are
awarded.
(c) The commissioner of
insurance shall distribute all money that is subject to this section not
later than September 1, 2017.
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No
equivalent provision.
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SECTION 4. (a) The changes
in law made by this Act to Sections 843.342 and 1301.137, Insurance Code,
apply only to penalties paid under those sections on or after the effective
date of this Act.
(b) Except as provided by
this Act, penalties paid before the effective date of this Act are governed
by the law applicable to the penalties immediately before the effective
date of this Act, and that law is continued in effect for that purpose.
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SECTION 3. This Act takes
effect immediately if it receives a vote of two-thirds of all the members
elected to each house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate effect, this
Act takes effect on September 1, 2015.
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SECTION 5. Same as
introduced version.
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SECTION 4. The importance of
this legislation and the crowded condition of the calendars in both houses
create an emergency and an imperative public necessity that the
constitutional rule requiring bills to be read on three separate days in
each house be suspended, and this rule hereby suspended, and that this act
take effect and be in force from and after its passage, and it so enacted.
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No
equivalent provision.
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