By: Harris of Williamson  (Senate Sponsor - Hughes) H.B. No. 4500
         (In the Senate - Received from the House May 10, 2023;
  May 11, 2023, read first time and referred to Committee on Health &
  Human Services; May 21, 2023, reported adversely, with favorable
  Committee Substitute by the following vote:  Yeas 8, Nays 0;
  May 21, 2023, sent to printer.)
Click here to see the committee vote
 
  COMMITTEE SUBSTITUTE FOR H.B. No. 4500 By:  Hughes
 
 
 
  COMMITTEE VOTE
 
 
         YeaNayAbsentPNV
         KolkhorstX
         PerryX
         BlancoX
         HallX
         HancockX
         HughesX
         LaMantiaX
         MilesX
         SparksX
 
 
A BILL TO BE ENTITLED
 
AN ACT
 
  relating to electronic verification of health benefits by health
  benefit plan issuers for certain physicians and health care
  providers.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle A, Title 8, Insurance Code, is amended
  by adding Chapter 1223 to read as follows:
  CHAPTER 1223. VERIFICATION OF HEALTH BENEFITS
         Sec. 1223.001.  APPLICABILITY OF CHAPTER. (a)  This chapter
  applies only to a health benefit plan that provides benefits for
  medical or surgical expenses incurred as a result of a health
  condition, accident, or sickness, including an individual, group,
  blanket, or franchise insurance policy or insurance agreement, a
  group hospital service contract, or an individual or group evidence
  of coverage or similar coverage document that is issued by:
               (1)  an insurance company;
               (2)  a group hospital service corporation operating
  under Chapter 842;
               (3)  a health maintenance organization operating under
  Chapter 843;
               (4)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844;
               (5)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846;
               (6)  a stipulated premium company operating under
  Chapter 884;
               (7)  a Lloyd's plan operating under Chapter 941; or
               (8)  an exchange operating under Chapter 942.
         (b)  Notwithstanding any other law, this chapter applies to:
               (1)  a small employer health benefit plan subject to
  Chapter 1501, including coverage provided through a health group
  cooperative under Subchapter B of that chapter;
               (2)  a standard health benefit plan issued under
  Chapter 1507;
               (3)  a basic coverage plan under Chapter 1551;
               (4)  a basic plan under Chapter 1575;
               (5)  a primary care coverage plan under Chapter 1579;
               (6)  a plan providing basic coverage under Chapter
  1601;
               (7)  alternative health benefit coverage offered by a
  subsidiary of the Texas Mutual Insurance Company under Subchapter
  M, Chapter 2054;
               (8)  group health coverage made available by a school
  district in accordance with Section 22.004, Education Code;
               (9)  a regional or local health care program operated
  under Section 75.104, Health and Safety Code; and
               (10)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code.
         (c)  This chapter does not apply to the state Medicaid
  program, including the Medicaid managed care program operated under
  Chapter 533, Government Code, or the child health plan program
  operated under Chapter 62, Health and Safety Code.
         Sec. 1223.002.  INTERNET WEBSITE FOR VERIFICATION REQUIRED
  FOR EMERGENCY PHYSICIANS AND HEALTH CARE PROVIDERS. (a)  A health
  benefit plan issuer shall maintain and make available a secure
  system on the issuer's Internet website that allows a physician or
  health care provider for a hospital or freestanding emergency
  medical care facility to determine at any time:
               (1)  whether the physician's or provider's patient is
  covered by the issuer's health benefit plan; and
               (2)  the deductible, copayment, or coinsurance for
  which the patient is responsible.
         (b)  A health benefit plan issuer may provide the information
  described by Subsection (a) through:
               (1)  an existing Internet portal that is available at
  all times; or
               (2)  an Internet portal that is:
                     (A)  provided by a third party contracting with
  the issuer; and
                     (B)  available at all times.
         SECTION 2.  This Act takes effect January 1, 2024.
 
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