|
|
|
A BILL TO BE ENTITLED
|
|
AN ACT
|
|
relating to the methods of payment to health care providers by |
|
certain health benefit plan issuers. |
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
SECTION 1. Subtitle F, Title 8, Insurance Code, is amended |
|
by adding Chapter 1468 to read as follows: |
|
CHAPTER 1468. METHODS OF PAYMENT OF PHYSICIANS AND HEALTH CARE |
|
PROVIDERS |
|
Sec. 1468.001. DEFINITIONS. In this chapter: |
|
(1) "Health benefit plan issuer" means an entity |
|
authorized under this code or another insurance law of this state |
|
that provides health insurance or health benefits in this state, |
|
including: |
|
(A) an insurance company; |
|
(B) a group hospital service corporation |
|
operating under Chapter 842; |
|
(C) a health maintenance organization operating |
|
under Chapter 843; and |
|
(D) a stipulated premium company operating under |
|
Chapter 884. |
|
(2) "Health care provider" means a practitioner, |
|
institutional provider, or other person or organization that |
|
furnishes health care services and that is licensed or otherwise |
|
authorized to practice in this state. The term includes a |
|
pharmacist, pharmacy, hospital, nursing home, or other medical or |
|
health-related service facility that provides care for the sick or |
|
injured or other care. The term does not include a physician. |
|
(3) "Physician" means an individual licensed to |
|
practice medicine in this state. |
|
Sec. 1468.002. METHODS OF PAYMENT. (a) Subject to |
|
Subsection (b), a health benefit plan issuer or a person with whom a |
|
health benefit plan issuer contracts to process or pay physician or |
|
health care provider claims may pay a physician or health care |
|
provider by any lawful method of payment, including: |
|
(1) an automated clearinghouse payment; |
|
(2) a wire transfer; |
|
(3) electronic funds transfer by card; |
|
(4) payment through a private card network; or |
|
(5) another form of electronic funds transfer. |
|
(b) Unless a contract between the health benefit plan issuer |
|
and the physician or health care provider specifies the method of |
|
payment, a physician or health care provider may refuse to accept a |
|
method of payment allowed under Subsection (a). |
|
(c) A physician or health care provider that refuses to |
|
accept a method of payment allowed under Subsection (a) shall give |
|
written notice of the refusal to the health benefit plan issuer or |
|
the person with whom the health benefit plan issuer contracts to |
|
process or pay physician or health care provider claims and specify |
|
an acceptable and otherwise lawful method of payment. |
|
SECTION 2. This Act takes effect September 1, 2017. |