BILL ANALYSIS

C.S.H.B. 4500

By: Harris, Caroline

Insurance

Committee Report (Substituted)

BACKGROUND AND PURPOSE

Physicians and health care providers frequently face difficulties in verifying patients' insurance information. Some of the information that is currently challenging to verify is whether a patient is insured and the patient's responsibility with respect to the deductible, copayment, or coinsurance. C.S.H.B. 4500 seeks to increase transparency between all parties and give physicians and health care providers greater predictability by requiring certain health benefit plan issuers to maintain and make available a secure online system through which certain physicians and health care providers may access certain insurance coverage information for a patient.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

C.S.H.B. 4500 amends the Insurance Code to require a health benefit plan issuer to maintain and make available on the issuer's website a secure system that allows a physician or health care provider for a hospital or freestanding emergency medical care facility to determine at any time whether the physician's or provider's patient is covered by the issuer's health benefit plan and the deductible, copayment, or coinsurance for which the patient is responsible. The bill authorizes a health benefit plan issuer to provide such information through an existing Internet portal that is available at all times or through an Internet portal that is provided by a third party contracting with the issuer and available at all times. The bill specifies the types of plans to which its provisions apply and establishes that the bill does not apply to Medicaid, including the Medicaid managed care program, or CHIP.

EFFECTIVE DATE

January 1, 2024.

COMPARISON OF INTRODUCED AND SUBSTITUTE

While C.S.H.B. 4500 may differ from the introduced in minor or nonsubstantive ways, the following summarizes the substantial differences between the introduced and committee substitute versions of the bill.

The substitute changes the applicability of the bill's provisions as follows:

· omits from the applicability a health benefit plan issued by a fraternal benefit society, health benefits provided by or through a church benefits board, county employee group health benefits, and health and accident coverage provided by a risk pool, which were included in the applicability in the introduced; and

· whereas the introduced applied to Medicaid, including the Medicaid managed care program, and CHIP, the substitute establishes that the bill does not apply to those programs.

While both the introduced and the substitute require a health benefit plan issuer to maintain and make available on its website a secure system that allows a physician or health care provider for a hospital or freestanding emergency medical care facility to make certain determinations, the substitute omits a determination from the introduced of whether the issuer will pay the physician or provider for the proposed health care service or supply the physician or provider intends to provide to the patient.

The substitute includes provisions that were not in the introduced authorizing a health benefit plan issuer to provide the information required by the bill on an existing Internet portal that is available at all times or an Internet portal that is provided by a third party contracting with the issuer and available at all times.

The substitute omits a provision from the introduced that provided for the delayed implementation of any provision for which an applicable state agency determines a federal waiver or authorization is necessary for implementation until the waiver or authorization is requested and granted.