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A BILL TO BE ENTITLED
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AN ACT
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relating to payment for care provided by a chiropractor under |
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certain health benefit plans; providing administrative penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter I, Chapter 843, Insurance Code, is |
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amended by adding Section 843.3042 to read as follows: |
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Sec. 843.3042. CHIROPRACTIC SERVICES. (a) A health |
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maintenance organization offering a health care plan that covers a |
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service that is within the scope of a chiropractor's license may not |
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refuse to provide reimbursement to an in-network chiropractor for |
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the performance of the covered service solely because the service |
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is provided by a chiropractor. |
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(b) This section does not require a health maintenance |
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organization to cover a particular health care service. |
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(c) This section does not affect the right of a health |
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maintenance organization to determine whether a health care service |
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is medically necessary. |
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(d) A health maintenance organization that violates this |
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section is subject to an administrative penalty as provided by |
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Chapter 84 of not more than $1,000 for each claim that remains |
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unpaid in violation of this section. Each day the violation |
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continues constitutes a separate violation. |
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SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.0516 to read as follows: |
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Sec. 1301.0516. CHIROPRACTIC SERVICES. (a) An insurer |
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offering a preferred provider benefit plan that covers a service |
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that is within the scope of a chiropractor's license may not refuse |
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to provide reimbursement for the performance of the covered service |
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solely because the service is provided by a chiropractor. |
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(b) This section does not require an insurer to cover a |
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particular medical or health care service. |
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(c) This section does not affect the right of an insurer to |
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determine whether a medical or health care service is medically |
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necessary. |
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(d) An insurer that violates this section is subject to an |
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administrative penalty as provided by Chapter 84 of not more than |
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$1,000 for each claim that remains unpaid in violation of this |
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section. Each day a violation continues constitutes a separate |
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violation. |
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SECTION 3. Section 1451.109, Insurance Code, is amended by |
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adding Subsection (e) to read as follows: |
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(e) A health insurance policy issuer that violates this |
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section is subject to an administrative penalty as provided by |
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Chapter 84 of not more than $1,000 for each claim that remains |
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unpaid in violation of this section. Each day the violation |
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continues constitutes a separate violation. |
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SECTION 4. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2020. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2020, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 5. This Act takes effect September 1, 2019. |