Texas 2009 - 81st Regular

Texas Senate Bill SB863 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R5445 PMO-D
2	2	By: Harris S.B. No. 863
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to adoption of certain information technology.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle J, Title 8, Insurance Code, is amended
10	10	by adding Chapter 1661 to read as follows:
11	11	CHAPTER 1661. INFORMATION TECHNOLOGY
12	12	Sec. 1661.001. DEFINITIONS. In this chapter:
13	13	(1) "Health benefit plan" means a plan that provides:
14	14	(A) benefits for medical or surgical expenses
15	15	incurred as a result of a health condition, accident, or sickness,
16	16	including an individual, group, blanket, or franchise insurance
17	17	policy or insurance agreement, a group hospital service contract,
18	18	or an individual or group evidence of coverage that is offered by:
19	19	(i) an insurance company;
20	20	(ii) a group hospital service corporation
21	21	operating under Chapter 842;
22	22	(iii) a fraternal benefit society operating
23	23	under Chapter 885;
24	24	(iv) a stipulated premium company operating
25	25	under Chapter 884;
26	26	(v) a Lloyd's plan operating under Chapter
27	27	941;
28	28	(vi) an exchange operating under Chapter
29	29	942;
30	30	(vii) a health maintenance organization
31	31	operating under Chapter 843;
32	32	(viii) a multiple employer welfare
33	33	arrangement that holds a certificate of authority under Chapter
34	34	846;
35	35	(ix) an approved nonprofit health
36	36	corporation that holds a certificate of authority under Chapter
37	37	844; or
38	38	(x) an entity not authorized under this
39	39	code or another insurance law of this state that contracts directly
40	40	for health care services on a risk-sharing basis, including a
41	41	capitation basis; or
42	42	(B) health and accident coverage through a risk
43	43	pool created under Chapter 172, Local Government Code,
44	44	notwithstanding Section 172.014, Local Government Code.
45	45	(2) "Health benefit plan issuer" means an entity
46	46	authorized to issue a health benefit plan in this state.
47	47	Sec. 1661.002. USE OF CERTAIN INFORMATION TECHNOLOGY
48	48	REQUIRED. (a) A health benefit plan issuer shall use information
49	49	technology that:
50	50	(1) provides an enrollee with real-time information at
51	51	the point of service concerning:
52	52	(A) any applicable deductibles;
53	53	(B) the allowable or usual and customary amount
54	54	paid for out-of-network care, as applicable; and
55	55	(C) the enrollee's potential total financial
56	56	responsibility; and
57	57	(2) provides a physician or other health care provider
58	58	with real-time information regarding physician or health care
59	59	provider network participation.
60	60	(b) A health benefit plan issuer shall use information
61	61	technology that permits real-time adjudication of health care
62	62	claims at the point of service.
63	63	Sec. 1661.003. CERTAIN FEES PROHIBITED. A health benefit
64	64	plan issuer may not directly or indirectly charge or collect from an
65	65	enrollee or a physician, or other health care provider, a fee to
66	66	cover the costs incurred by the health benefit plan issuer in
67	67	complying with this chapter.
68	68	Sec. 1661.004. RULES. The commissioner shall adopt rules
69	69	as necessary to implement this chapter, including rules that ensure
70	70	that the information technology used by a health benefit plan
71	71	issuer does not have legal or technical restrictions for encoding,
72	72	displaying, exchanging, reading, printing, transmitting, or
73	73	storing information or data in electronic form.
74	74	SECTION 2. This Act takes effect immediately if it receives
75	75	a vote of two-thirds of all the members elected to each house, as
76	76	provided by Section 39, Article III, Texas Constitution. If this
77	77	Act does not receive the vote necessary for immediate effect, this
78	78	Act takes effect September 1, 2009.