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A BILL TO BE ENTITLED
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AN ACT
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relating to provider reimbursement for certain emergency health |
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care services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1271.155, Insurance Code, is amended by |
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adding Subsection (g-1) to read as follows: |
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(g-1) A health maintenance organization may not, based on a |
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patient's final diagnosis, deny or reduce payment on a claim for the |
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following services provided in a hospital emergency facility, |
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freestanding emergency medical care facility, or comparable |
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emergency facility: |
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(1) a medical screening examination or related health |
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care service that is within the capability of the facility and the |
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facility's staff and performed to evaluate the patient's condition; |
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and |
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(2) further medical treatment: |
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(A) necessary to stabilize the patient and to |
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ensure, with reasonable medical probability, that no material |
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deterioration of the condition is likely to result from or occur |
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during the transfer of the patient from the facility; or |
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(B) provided with respect to emergency care. |
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SECTION 2. Section 1301.0053, Insurance Code, is amended by |
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adding Subsection (b-1) to read as follows: |
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(b-1) An insurer may not, based on a patient's final |
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diagnosis, deny or reduce payment on a claim for the following |
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|
services provided in a hospital emergency facility, freestanding |
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|
emergency medical care facility, or comparable emergency facility: |
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|
(1) a medical screening examination or related health |
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care service that is within the capability of the facility and the |
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facility's staff and performed to evaluate the patient's condition; |
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and |
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(2) further medical treatment: |
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(A) necessary to stabilize the patient and to |
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ensure, with reasonable medical probability, that no material |
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deterioration of the condition is likely to result from or occur |
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during the transfer of the patient from the facility; or |
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(B) provided with respect to emergency care. |
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SECTION 3. Section 1301.155, Insurance Code, is amended by |
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|
adding Subsection (d-1) to read as follows: |
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(d-1) An insurer may not, based on a patient's final |
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|
diagnosis, deny or reduce payment on a claim for the following |
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|
services provided in a hospital emergency facility, freestanding |
|
|
emergency medical care facility, or comparable emergency facility: |
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|
(1) a medical screening examination or related health |
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|
care service that is within the capability of the facility and the |
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|
facility's staff and performed to evaluate the patient's condition; |
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|
and |
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|
(2) further medical treatment: |
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|
(A) necessary to stabilize the patient and to |
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|
assure, with reasonable medical probability, that no material |
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|
deterioration of the condition is likely to result from or occur |
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|
during the transfer of the patient from the facility; or |
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(B) provided with respect to emergency care. |
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SECTION 4. The changes in law made by this Act apply only to |
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a health benefit plan delivered, issued for delivery, or renewed on |
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or after January 1, 2022. A health benefit plan delivered, issued |
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for delivery, or renewed before January 1, 2022, is governed by the |
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law as it existed immediately before the effective date of this Act, |
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and that law is continued in effect for that purpose. |
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SECTION 5. This Act takes effect September 1, 2021. |