84R8631 SCL-D

By: Elkins H.B. No. 4096

A BILL TO BE ENTITLED

AN ACT

relating to the establishment of a pilot program for the electronic transmission of certain subrogation claims.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle A, Title 8, Insurance Code, is amended by adding Chapter 1222 to read as follows:

CHAPTER 1222. MOTOR VEHICLE ACCIDENTS AND AUTOMOBILE INSURANCE

SUBROGATION PILOT PROGRAM

Sec. 1222.001. DEFINITIONS. In this chapter:

(1) "Automobile insurer" means an insurer writing automobile insurance in this state, including an insurance company, corporation, reciprocal or interinsurance exchange, mutual insurance company, Lloyd's plan, county mutual insurance company, or other insurer.

(2) "Enrollee" means an individual entitled to benefits under a health benefit plan.

(3) "Health benefit plan issuer" means:

(A) a managed care organization issuing a managed care plan offered under Chapter 533, Government Code;

(B) the Health and Human Services Commission or another entity administering the state Medicaid program operated under Chapter 32, Human Resources Code, or the state child health plan or health benefits plan for children under Chapter 62 or 63, Health and Safety Code;

(C) the Employees Retirement System of Texas or another entity issuing or administering a basic coverage plan under Chapter 1551;

(D) the Teacher Retirement System of Texas or another entity issuing or administering a basic plan under Chapter 1575 or a primary care coverage plan under Chapter 1579; and

(E) The Texas A&M University System or The University of Texas System or another entity issuing or administering basic coverage under Chapter 1601.

(4) "Payor" means a health benefit plan issuer who:

(A) pays benefits to or on behalf of an enrollee as a result of personal injuries to the enrollee caused by the tortious conduct of a third party; and

(B) has a contractual or statutory right of subrogation for the benefits paid.

Sec. 1222.002. PILOT PROGRAM. (a) The department shall establish a pilot program to evaluate the benefits of using an electronic records management system to collect and transmit information related to injuries arising from motor vehicle accidents to facilitate identification of potential subrogation claims and collection of amounts owed.

(b) Subject to the availability of funds, the department shall contract with an organization to operate the pilot program. The department shall select the organization to serve as the contractor using competitive bidding.

(c) A payor shall provide the contractor with the information required by the contractor related to benefits paid for injuries arising from motor vehicle accidents in this state. Each automobile insurer shall provide the contractor with the information required by the contractor related to motor vehicle accidents in this state. The contractor shall use the information provided under this subsection to determine if the payor has a right of subrogation against an automobile insurer and, where appropriate, seek recovery of the amounts owed on behalf of the payor.

(d) The contractor shall report the results of the subrogation determination and subrogation claim to the payor and provide any funds recovered to the payor.

Sec. 1222.003. CONFIDENTIALITY. The contractor operating the pilot program shall maintain the confidentiality of all information provided to the contractor by a payor under this chapter and may use the information only for the purposes of the pilot program.

Sec. 1222.004. EVALUATION AND REPORT. Not later than December 1, 2016, the department shall submit a report to the speaker of the house of representatives, lieutenant governor, and appropriate standing committees of the legislature that includes:

(1) the cost of the pilot program operated under this chapter;

(2) the amount of money collected under the pilot program on behalf of payors; and

(3) an evaluation of the effectiveness of the pilot program.

Sec. 1222.005. EXPIRATION. This chapter expires September 1, 2017.

SECTION 2. This Act takes effect September 1, 2015.