| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to the applicability of mediation requirements for balance |
|
|
billing to certain health benefit plans. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 1467.001, Insurance Code, is amended by |
|
|
amending Subdivisions (1), (2-a), (2-b), and (3) and adding |
|
|
Subdivision (2-c) to read as follows: |
|
|
(1) "Administrator" means: |
|
|
(A) an administering firm for a health benefit |
|
|
plan providing coverage under Chapter 1551, 1575, or 1579; [and] |
|
|
(B) if applicable, the claims administrator for |
|
|
the health benefit plan; and |
|
|
(C) if applicable, an administrating firm for an |
|
|
eligible plan for which an election is made under Section |
|
|
1467.0021. |
|
|
(2-a) "Eligible plan" means a managed care plan that |
|
|
is a self-funded or self-insured employee welfare benefit plan that |
|
|
provides health benefits and is established in accordance with the |
|
|
Employee Retirement Income Security Act of 1974 (29 U.S.C. Section |
|
|
1001 et seq.). |
|
|
(2-b) "Emergency care" has the meaning assigned by |
|
|
Section 1301.155. |
|
|
(2-c) [(2-b)] "Emergency care provider" means a |
|
|
physician, health care practitioner, facility, or other health care |
|
|
provider who provides and bills an enrollee, administrator, or |
|
|
health benefit plan for emergency care. |
|
|
(3) "Enrollee" means an individual who is eligible to |
|
|
receive benefits through a [preferred provider benefit plan or a] |
|
|
health benefit plan subject to this chapter [under Chapter 1551,
|
|
|
1575, or 1579]. |
|
|
SECTION 2. Section 1467.002, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1467.002. APPLICABILITY OF CHAPTER. This chapter |
|
|
applies to: |
|
|
(1) a preferred provider benefit plan offered by an |
|
|
insurer under Chapter 1301; [and] |
|
|
(2) an administrator of a health benefit plan, other |
|
|
than a health maintenance organization plan, under Chapter 1551, |
|
|
1575, or 1579; and |
|
|
(3) an eligible plan for which the plan sponsor makes |
|
|
an election under Section 1467.0021. |
|
|
SECTION 3. Subchapter A, Chapter 1467, Insurance Code, is |
|
|
amended by adding Section 1467.0021 to read as follows: |
|
|
Sec. 1467.0021. ELECTIVE APPLICABILITY. (a) A plan |
|
|
sponsor of an eligible plan may elect on an annual basis for this |
|
|
chapter to apply to the plan. A sponsor making an election shall |
|
|
provide written notice of the election to the department in the form |
|
|
and manner required by department rule. |
|
|
(b) An administrator of an eligible plan for which an |
|
|
election is made under Subsection (a) shall ensure that the plan and |
|
|
any evidence of coverage complies with this chapter. |
|
|
SECTION 4. The Texas Department of Insurance shall adopt |
|
|
rules necessary to implement Section 1467.0021, Insurance Code, as |
|
|
added by this Act, not later than December 31, 2019. |
|
|
SECTION 5. The changes in law made by this Act apply only to |
|
|
a managed care plan that is delivered, issued for delivery, or |
|
|
renewed on or after January 1, 2020. A managed care plan delivered, |
|
|
issued for delivery, or renewed before January 1, 2020, is governed |
|
|
by the law as it existed immediately before the effective date of |
|
|
this Act, and that law is continued in effect for that purpose. |
|
|
SECTION 6. This Act takes effect September 1, 2019. |