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A BILL TO BE ENTITLED
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AN ACT
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relating to the distribution and use of certain penalties paid by |
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health maintenance organizations and insurers for violating |
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certain provisions governing prompt payment of 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. Section 843.342, Insurance Code, is amended by |
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amending Subsection (m) and adding Subsection (m-1) to read as |
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follows: |
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(m) Notwithstanding any other provision of this section, |
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this subsection governs the payment of a penalty under this |
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section. For a penalty under this section relating to a clean |
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claim submitted by a physician or provider other than an |
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institutional provider, the health maintenance organization shall |
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pay the entire penalty to the physician or provider, except for any |
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interest computed under Subsection (c), which shall be paid to the |
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department to be distributed to the fund established under |
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Subchapter F, Chapter 1508, to be used for any purpose authorized by |
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the commissioner by rule to improve access to health benefit |
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coverage for individuals without coverage [Texas Health Insurance
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Risk Pool]. For a penalty under this section relating to a clean |
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claim submitted by an institutional provider, the health |
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maintenance organization shall pay 50 percent of the total penalty |
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amount computed under this section, including interest, to the |
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institutional provider and the remaining 50 percent of that amount |
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to the department to be distributed to the fund established under |
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Subchapter F, Chapter 1508, to be used as provided by Subsection |
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(m-1). |
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(m-1) Money in the fund established under Subchapter F, |
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Chapter 1508, that is derived from penalties under this section |
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relating to clean claims submitted by institutional providers may |
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only be appropriated as follows: |
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(1) the first $5 million may be appropriated only to |
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the Health and Human Services Commission to be used only to fund the |
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commission's consumer assistance for Medicaid program; |
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(2) the next $20 million collected may be appropriated |
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only to the Health and Human Services Commission to be used only to |
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provide postpartum coverage through the child health plan program |
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operated under Chapter 62, Health and Safety Code, and Medicaid; |
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and |
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(3) amounts in excess of the amounts described by |
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Subdivisions (1) and (2) may be appropriated only to the Health and |
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Human Services Commission to be used only to increase reimbursement |
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rates to health care providers who provide services through the |
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Texas Women's Health Program [the Texas Health Insurance Risk
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Pool]. |
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SECTION 2. Section 1301.137, Insurance Code, is amended by |
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amending Subsection (l) and adding Subsection (l-1) to read as |
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follows: |
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(l) Notwithstanding any other provision of this section, |
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this subsection governs the payment of a penalty under this |
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section. For a penalty under this section relating to a clean |
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claim submitted by a preferred provider other than an institutional |
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provider, the insurer shall pay the entire penalty to the preferred |
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provider, except for any interest computed under Subsection (c), |
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which shall be paid to the department to be distributed to the fund |
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established under Subchapter F, Chapter 1508, to be used for any |
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purpose authorized by the commissioner by rule to improve access to |
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health benefit coverage for individuals without coverage [Texas
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Health Insurance Risk Pool]. For a penalty under this section |
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relating to a clean claim submitted by an institutional provider, |
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the insurer shall pay 50 percent of the penalty amount computed |
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under this section, including interest, to the institutional |
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provider and the remaining 50 percent of that amount to the |
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department to be distributed to the fund established under |
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Subchapter F, Chapter 1508, to be used as provided by Subsection |
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(l-1). |
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(l-1) Money in the fund established under Subchapter F, |
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Chapter 1508, that is derived from penalties under this section |
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relating to clean claims submitted by institutional providers may |
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only be appropriated as follows: |
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(1) the first $5 million may be appropriated only to |
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|
the Health and Human Services Commission to be used only to fund the |
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commission's consumer assistance for Medicaid program; |
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(2) the next $20 million collected may be appropriated |
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only to the Health and Human Services Commission to be used only to |
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provide postpartum coverage through the child health plan program |
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operated under Chapter 62, Health and Safety Code, and Medicaid; |
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and |
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(3) amounts in excess of the amounts described by |
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Subdivisions (1) and (2) may be appropriated only to the Health and |
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Human Services Commission to be used only to increase reimbursement |
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rates to health care providers who provide services through the |
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Texas Women's Health Program [Texas Health Insurance Risk Pool]. |
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SECTION 3. (a) Notwithstanding Section 6(e), Chapter 615 |
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(S.B. 1367), Acts of the 83rd Legislature, Regular Session, 2013, |
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any penalties relating to clean claims submitted by institutional |
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providers that were paid under Section 843.342(m) or 1301.137(l), |
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Insurance Code, before the effective date of this Act, and that |
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remain unexpended and unobligated on the effective date of this |
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Act, shall be used to provide grants to hospitals in this state to |
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upgrade the hospitals' emergency rooms and trauma facilities. |
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(b) The commissioner of insurance shall adopt rules |
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governing the distribution of grants to hospitals under this |
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section and the contracts under which the grants are awarded. |
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(c) The commissioner of insurance shall distribute all |
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money that is subject to this section not later than September 1, |
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2017. |
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SECTION 4. (a) The changes in law made by this Act to |
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Sections 843.342 and 1301.137, Insurance Code, apply only to |
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penalties paid under those sections on or after the effective date |
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of this Act. |
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(b) Except as provided by this Act, penalties paid before |
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the effective date of this Act are governed by the law applicable to |
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the penalties immediately before the effective date of this Act, |
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and that law is continued in effect for that purpose. |
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SECTION 5. 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, 2015. |