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A BILL TO BE ENTITLED
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AN ACT
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relating to the calculation of penalties for violating certain laws |
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governing the prompt payment of claims submitted by a physician or |
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health care provider to certain health benefit plan issuers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.342, Insurance Code, is amended by |
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adding Subsection (o) to read as follows: |
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(o) For the purposes of calculating a penalty under this |
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section related to a claim by a physician or provider described by |
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Section 843.351, the contracted rate for health care services |
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provided by the physician or provider is the usual and customary |
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rate for the service in the geographic area in which the service is |
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provided. |
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SECTION 2. Section 1301.137, Insurance Code, is amended by |
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adding Subsection (m) to read as follows: |
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(m) For the purposes of calculating a penalty under this |
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section related to a claim by a physician or health care provider |
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described by Section 1301.069, the contracted rate for health care |
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services provided by the physician or provider is the usual and |
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customary rate for the service in the geographic area in which the |
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service is provided. |
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SECTION 3. The changes in law made by this Act apply only to |
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a penalty or interest on a penalty owed with respect to a claim |
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submitted on or after the effective date of this Act. |
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SECTION 4. This Act takes effect September 1, 2025. |