By: Hancock  S.B. No. 1530
         (In the Senate - Filed March 5, 2019; March 14, 2019, read
  first time and referred to Committee on Business & Commerce;
  April 8, 2019, reported adversely, with favorable Committee
  Substitute by the following vote:  Yeas 7, Nays 2; April 8, 2019,
  sent to printer.)
Click here to see the committee vote
  relating to the applicability of mediation requirements for balance
  billing to certain health benefit plans.
         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
               (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 August 31, 2021.
         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 September 1, 2021. A managed care plan
  delivered, issued for delivery, or renewed before September 1,
  2021, 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 January 1, 2020.
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