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A BILL TO BE ENTITLED
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AN ACT
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relating to prohibited practices relating to health benefit plan |
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coverage for emergency care. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 533.005, Government Code, is amended by |
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adding Subsection (e) to read as follows: |
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(e) In addition to the requirements under Subsection (a), a |
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contract described by that subsection must require the managed care |
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organization to comply with Section 541.062, Insurance Code. |
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SECTION 2. Subchapter B, Chapter 541, Insurance Code, is |
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amended by adding Section 541.062 to read as follows: |
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Sec. 541.062. EMERGENCY CARE. (a) In this section, |
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"emergency care" and "utilization review" have the meanings |
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assigned by Section 4201.002. |
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(b) It is an unfair method of competition or an unfair or |
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deceptive act or practice in the business of insurance to make |
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health benefit plan coverage for an emergency care claim dependent |
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on a utilization review determination that the patient's medical |
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condition required emergency care. |
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SECTION 3. Section 541.062, Insurance Code, as added by |
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this Act, applies only to a health benefit plan delivered, issued |
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for delivery, or renewed on or after January 1, 2020. A health |
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benefit plan delivered, issued for delivery, or renewed before |
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January 1, 2020, 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 4. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 5. This Act takes effect September 1, 2019. |