85R8865 PMO-D
 
  By: Bonnen of Galveston H.B. No. 2077
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to data collection related to certain health benefit plan
  issuers' calculation of payments to out-of-network physicians and
  providers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 38, Insurance Code, is amended by adding
  Subchapter J to read as follows:
  SUBCHAPTER J. DATA COLLECTION RELATED TO PAYMENT OF OUT-OF-NETWORK
  PHYSICIANS AND HEALTH CARE PROVIDERS
         Sec. 38.451.  APPLICABILITY. This subchapter applies to an
  issuer of a preferred provider benefit plan as defined by Section
  1301.001 or an evidence of coverage for a health care plan that
  provides basic health care services as defined by Section 843.002.
         Sec. 38.452.  DEFINITION. In this subchapter,
  "out-of-network physicians and health care providers" means
  physicians and health care providers who are not preferred
  providers or are not otherwise included in a health benefit plan
  issuer's delivery network.
         Sec. 38.453.  COLLECTION OF INFORMATION; REPORT. (a) A
  health benefit plan issuer described by Section 38.451 shall report
  biennially to the department the information required by the
  commissioner under Subsection (b) relating to the health benefit
  plan issuer's calculation of payment rates for and payments to
  out-of-network physicians and health care providers.
         (b)  The commissioner by rule shall prescribe the form and
  required content of the report required under Subsection (a). The
  report must include payment methodologies and formulas used to
  calculate payment rates for and payments to out-of-network
  physicians and health care providers.
         (c)  On or before December 31 of each even-numbered year, the
  commissioner shall assemble and analyze the information submitted
  under this section during the preceding biennium and submit to the
  speaker of the house of representatives, the lieutenant governor,
  and the appropriate committees of each house of the legislature a
  report of the information and the commissioner's analysis.
         SECTION 2.  Not later than December 31, 2017, the
  commissioner of insurance shall adopt rules as necessary to
  implement Subchapter J, Chapter 38, Insurance Code, as added by
  this Act. The rules must require that a health benefit plan issuer
  subject to that subchapter make the initial submission of data
  under that subchapter not later than the 60th day after the
  effective date of the rules.
         SECTION 3.  This Act takes effect September 1, 2017.