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A BILL TO BE ENTITLED
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AN ACT
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relating to the form of a claim payment to a health care provider by |
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a health maintenance organization, preferred provider benefit |
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plan, or managed care organization. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 540.0265, Government Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A contract to which this subchapter applies must |
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prohibit the contracting Medicaid managed care organization from |
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requiring a physician or provider to accept a claim payment in the |
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form of a virtual credit card or any other payment method with |
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respect to which a fee, including a processing fee, administrative |
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fee, percentage amount, or dollar amount, is assessed to receive |
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the payment. A nominal fee assessed by the physician's or provider's |
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bank to receive an electronic funds transfer is not considered to be |
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a prohibited fee for purposes of this subsection. |
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SECTION 2. Section 843.346, Insurance Code, is amended to |
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read as follows: |
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Sec. 843.346. PAYMENT OF CLAIMS. (a) Except as provided by |
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this subchapter, a health maintenance organization shall pay a |
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physician or provider for health care services and benefits |
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provided to an enrollee not later than: |
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(1) the 45th day after the date on which a claim for |
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payment is received with the documentation reasonably necessary to |
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process the claim; or |
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(2) if applicable, within the number of calendar days |
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specified by written agreement between the physician or provider |
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and the health maintenance organization. |
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(b) A health maintenance organization may not require a |
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physician or provider to accept a claim payment in the form of a |
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virtual credit card or any other payment method with respect to |
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which a fee, including a processing fee, administrative fee, |
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percentage amount, or dollar amount, is assessed to receive the |
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payment. A nominal fee assessed by the physician's or provider's |
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bank to receive an electronic funds transfer is not considered to be |
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a prohibited fee for purposes of this subsection. |
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SECTION 3. Subchapter C-1, Chapter 1301, Insurance Code, is |
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amended by adding Section 1301.141 to read as follows: |
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Sec. 1301.141. FORM OF CLAIM PAYMENTS. An insurer may not |
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require a physician or health care provider to accept a claim |
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payment in the form of a virtual credit card or any other payment |
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method with respect to which a fee, including a processing fee, |
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administrative fee, percentage amount, or dollar amount, is |
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assessed to receive the payment. A nominal fee assessed by the |
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physician's or provider's bank to receive an electronic funds |
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transfer is not considered to be a prohibited fee for purposes of |
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this subsection. |
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SECTION 4. (a) Section 540.0265(c), Government Code, as |
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added by this Act, applies only to a contract entered into on or |
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after the effective date of this Act. A contract entered into |
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before the effective date of this Act is governed by the law as it |
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existed immediately before the effective date of this Act, and that |
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law is continued in effect for that purpose. |
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(b) Sections 843.346(b) and 1301.141, Insurance Code, as |
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added by this Act, apply only to a claim submitted on or after the |
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effective date of this Act. A claim submitted before the effective |
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date of this Act is governed by the law as it existed immediately |
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before the effective date of this Act, and that law is continued in |
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effect for that purpose. |
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SECTION 5. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 6. This Act takes effect September 1, 2025. |