81R5445 PMO-D
By: Menendez H.B. No. 1342
A BILL TO BE ENTITLED
AN ACT
relating to adoption of certain information technology.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle J, Title 8, Insurance Code, is amended
by adding Chapter 1661 to read as follows:
CHAPTER 1661. INFORMATION TECHNOLOGY
Sec. 1661.001. DEFINITIONS. In this chapter:
(1) "Health benefit plan" means a plan that provides:
(A) 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 that is offered by:
(i) an insurance company;
(ii) a group hospital service corporation
operating under Chapter 842;
(iii) a fraternal benefit society operating
under Chapter 885;
(iv) a stipulated premium company operating
under Chapter 884;
(v) a Lloyd's plan operating under Chapter
941;
(vi) an exchange operating under Chapter
942;
(vii) a health maintenance organization
operating under Chapter 843;
(viii) a multiple employer welfare
arrangement that holds a certificate of authority under Chapter
846;
(ix) an approved nonprofit health
corporation that holds a certificate of authority under Chapter
844; or
(x) an entity not authorized under this
code or another insurance law of this state that contracts directly
for health care services on a risk-sharing basis, including a
capitation basis; or
(B) health and accident coverage through a risk
pool created under Chapter 172, Local Government Code,
notwithstanding Section 172.014, Local Government Code.
(2) "Health benefit plan issuer" means an entity
authorized to issue a health benefit plan in this state.
Sec. 1661.002. USE OF CERTAIN INFORMATION TECHNOLOGY
REQUIRED. (a) A health benefit plan issuer shall use information
technology that:
(1) provides an enrollee with real-time information at
the point of service concerning:
(A) any applicable deductibles;
(B) the allowable or usual and customary amount
paid for out-of-network care, as applicable; and
(C) the enrollee's potential total financial
responsibility; and
(2) provides a physician or other health care provider
with real-time information regarding physician or health care
provider network participation.
(b) A health benefit plan issuer shall use information
technology that permits real-time adjudication of health care
claims at the point of service.
Sec. 1661.003. CERTAIN FEES PROHIBITED. A health benefit
plan issuer may not directly or indirectly charge or collect from an
enrollee or a physician, or other health care provider, a fee to
cover the costs incurred by the health benefit plan issuer in
complying with this chapter.
Sec. 1661.004. RULES. The commissioner shall adopt rules
as necessary to implement this chapter, including rules that ensure
that the information technology used by a health benefit plan
issuer does not have legal or technical restrictions for encoding,
displaying, exchanging, reading, printing, transmitting, or
storing information or data in electronic form.
SECTION 2. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2009.