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A BILL TO BE ENTITLED
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AN ACT
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relating to electronic verification of health benefits by health |
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benefit plan issuers for certain physicians and health care |
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providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle A, Title 8, Insurance Code, is amended |
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by adding Chapter 1223 to read as follows: |
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CHAPTER 1223. VERIFICATION OF HEALTH BENEFITS |
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Sec. 1223.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is issued by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) nonprofit agricultural organization health |
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benefits offered by a nonprofit agricultural organization under |
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Chapter 1682; |
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(8) alternative health benefit coverage offered by a |
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subsidiary of the Texas Mutual Insurance Company under Subchapter |
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M, Chapter 2054; |
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(9) health benefits provided by or through a church |
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benefits board under Subchapter I, Chapter 22, Business |
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Organizations Code; |
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(10) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(11) the state Medicaid program, including the |
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Medicaid managed care program operated under Chapter 533, |
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Government Code; |
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(12) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(13) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; |
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(14) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code; |
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(15) county employee group health benefits provided |
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under Chapter 157, Local Government Code; and |
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(16) health and accident coverage provided by a risk |
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pool created under Chapter 172, Local Government Code. |
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Sec. 1223.002. INTERNET WEBSITE FOR VERIFICATION REQUIRED |
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FOR EMERGENCY PHYSICIANS AND HEALTH CARE PROVIDERS. A health |
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benefit plan issuer shall maintain and make available a secure |
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system on the issuer's Internet website that allows a physician or |
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health care provider for a hospital or freestanding emergency |
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medical care facility to determine at any time: |
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(1) whether the physician's or provider's patient is |
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covered by the issuer's health benefit plan; |
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(2) whether the issuer will pay the physician or |
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provider for the proposed health care service or supply the |
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physician or provider intends to provide to the patient; and |
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(3) the deductible, copayment, or coinsurance for |
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which the patient is responsible. |
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SECTION 2. If before implementing any provision of Chapter |
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1223, Insurance Code, as added by this Act, a state agency |
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determines that a waiver or authorization from a federal agency is |
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necessary for implementation of that provision, the agency affected |
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by the provision shall request the waiver or authorization and may |
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delay implementing that provision until the waiver or authorization |
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is granted. |
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SECTION 3. This Act takes effect January 1, 2024. |