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  S.B. No. 1286
 
 
 
 
AN ACT
  relating to prompt payment deadlines for health benefit plan
  claims affected by a catastrophic event.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 843.337, Insurance Code, is amended by
  amending Subsections (b) and (c) and adding Subsection (c-1) to
  read as follows:
         (b)  If a physician or provider fails to submit a claim in
  compliance with this section, the physician or provider forfeits
  the right to payment [unless the failure to submit the claim in
  compliance with this section is a result of a catastrophic event
  that substantially interferes with the normal business operations
  of the physician or provider].
         (c)  The period for submitting a claim under this section may
  be extended by:
               (1)  contract;
               (2)  notice published by the commissioner allowing an
  extension of prompt payment deadlines to a later date chosen by the
  commissioner due to a catastrophic event; or
               (3)  the department's approval of a physician's or
  provider's request for an extension due to a catastrophic event
  that substantially interferes with the normal business operations
  of the physician or provider.
         (c-1)  The commissioner may adopt rules to implement
  Subsection (c), including rules establishing requirements for a
  request made under Subsection (c)(3).
         SECTION 2.  Section 843.342(h), Insurance Code, is amended
  to read as follows:
         (h)  A health maintenance organization is not liable for a
  penalty under this section:
               (1)  if the failure to pay the claim in accordance with
  this subchapter is a result of a catastrophic event and:
                     (A)  the commissioner published a notice allowing
  an extension of the applicable prompt payment deadlines due to the
  catastrophic event; or
                     (B)  the department approved the health
  maintenance organization's request for an extension due to the
  substantial interference of the catastrophic event [that
  substantially interferes] with the normal business operations of
  the health maintenance organization; or
               (2)  if the claim was paid in accordance with this
  subchapter, but for less than the contracted rate, and:
                     (A)  the physician or provider notifies the health
  maintenance organization of the underpayment after the 270th day
  after the date the underpayment was received; and
                     (B)  the health maintenance organization pays the
  balance of the claim on or before the 30th day after the date the
  health maintenance organization receives the notice.
         SECTION 3.  Section 1301.102, Insurance Code, is amended by
  amending Subsections (d) and (e) and adding Subsection (e-1) to
  read as follows:
         (d)  If a physician or health care provider fails to submit a
  claim in compliance with this section, the physician or provider
  forfeits the right to payment [unless the failure to submit the
  claim in compliance with this section is a result of a catastrophic
  event that substantially interferes with the normal business
  operations of the physician or provider].
         (e)  The period for submitting a claim under this section may
  be extended by:
               (1)  contract;
               (2)  notice published by the commissioner allowing an
  extension of prompt payment deadlines to a later date chosen by the
  commissioner due to a catastrophic event; or
               (3)  the department's approval of a physician's or
  health care provider's request for an extension due to a
  catastrophic event that substantially interferes with the normal
  business operations of the physician or provider.
         (e-1)  The commissioner may adopt rules to implement
  Subsection (e), including rules establishing requirements for a
  request made under Subsection (e)(3).
         SECTION 4.  Section 1301.137(h), Insurance Code, is amended
  to read as follows:
         (h)  An insurer is not liable for a penalty under this
  section:
               (1)  if the failure to pay the claim in accordance with
  Subchapter C is a result of a catastrophic event and:
                     (A)  the commissioner published a notice allowing
  an extension of the applicable prompt payment deadlines due to the
  catastrophic event; or
                     (B)  the department approved the insurer's
  request for an extension due to the substantial interference of the
  catastrophic event [that substantially interferes] with the normal
  business operations of the insurer; or
               (2)  if the claim was paid in accordance with
  Subchapter C, but for less than the contracted rate, and:
                     (A)  the preferred provider notifies the insurer
  of the underpayment after the 270th day after the date the
  underpayment was received; and
                     (B)  the insurer pays the balance of the claim on
  or before the 30th day after the date the insurer receives the
  notice.
         SECTION 5.  The changes in law made by this Act apply only to
  a claim submitted on or after the effective date of this Act. A
  claim submitted before the effective date of this Act is governed by
  the law as it existed immediately before the effective date of this
  Act, and that law is continued in effect for that purpose.
         SECTION 6.  This Act takes effect September 1, 2023.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 1286 passed the Senate on
  April 20, 2023, by the following vote:  Yeas 31, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 1286 passed the House on
  May 5, 2023, by the following vote:  Yeas 142, Nays 2, three
  present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor