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A BILL TO BE ENTITLED
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AN ACT
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relating to prompt payment of physicians and health care providers |
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under contract with certain self-insured health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter C, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.1091 to read as follows: |
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Sec. 1301.1091. APPLICABILITY TO CERTAIN SELF-INSURED |
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PLANS. (a) This section applies only with respect to a |
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self-insured plan that: |
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(1) provides medical or health care benefits to plan |
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enrollees in the manner of a preferred provider benefit plan; and |
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(2) is administered by an insurer acting as a |
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third-party administrator. |
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(b) The payment of a claim submitted to an insurer acting as |
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a third-party administrator for a plan described by Subsection (a) |
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by a physician or health care provider who is under contract to |
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provide medical care or health care to plan enrollees is subject to |
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this subchapter and Section 1301.137 as if the claim were made by a |
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preferred provider under a preferred provider benefit plan issued |
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by the insurer, except to the extent that the insurer asserts that |
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the claim is not payable because the medical care or health care |
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services for which the claim is made are not covered under the plan. |
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SECTION 2. (a) The change in law made by this Act applies |
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only to payment for services under: |
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(1) a contract between an insurer and a self-insured |
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plan sponsor entered into or renewed on or after January 1, 2016; |
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and |
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(2) a contract between a physician or health care |
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provider and the insurer or plan sponsor entered into on or after |
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that date in connection with the plan. |
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(b) Payment for services under a contract between an insurer |
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and a self-insured plan sponsor entered into or renewed before |
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January 1, 2016, or a contract between a physician or health care |
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provider and the insurer or plan sponsor entered into or renewed |
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before that date is governed by the law as it existed immediately |
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before the effective date of this Act, and that law is continued in |
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effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2015. |