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A BILL TO BE ENTITLED
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AN ACT
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relating to prohibited steering or directing use of certain |
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facilities for emergency care under certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter F, Chapter 540, Government Code, as |
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effective April 1, 2025, is amended by adding Section 540.02611 to |
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read as follows: |
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Sec. 540.02611. COMPLIANCE WITH PROHIBITION ON STEERING TO |
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FACILITY FOR EMERGENCY CARE. A contract to which this subchapter |
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applies must require the contracting Medicaid managed care |
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organization to comply with Section 541.062, Insurance Code. |
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SECTION 2. Subchapter B, Chapter 541, Insurance Code, is |
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amended by adding Section 541.062 to read as follows: |
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Sec. 541.062. STEERING OR DIRECTING USE OF FACILITY FOR |
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EMERGENCY CARE PROHIBITED. (a) In this section, "emergency care" |
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has the meaning assigned by Section 4201.002. |
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(b) It is an unfair method of competition or an unfair or |
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deceptive act or practice in the business of insurance for an |
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insurer or health maintenance organization, or an individual or |
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entity acting on behalf of an insurer or health maintenance |
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organization, to steer or direct an enrollee to use a certain |
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facility to obtain emergency care. |
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(c) A violation of this section does not create a private |
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cause of action under Section 541.151 or 541.251. |
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SECTION 3. 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 the provision until the |
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waiver or authorization is granted. |
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SECTION 4. The changes in law made by this Act apply only to |
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a health benefit plan delivered, issued for delivery, or renewed on |
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or after January 1, 2026. A health benefit plan delivered, issued |
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for delivery, or renewed before January 1, 2026, is governed by the |
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law as it existed immediately before the effective date of this Act, |
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and that law is continued in effect for that purpose. |
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SECTION 5. This Act takes effect September 1, 2025. |