83R8810 SCL-F
By: Eiland H.B. No. 2162
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for certain nonemergency
transportation services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1451, Insurance Code, is amended by
adding Subchapter J to read as follows:
SUBCHAPTER J. ACCESS TO TRANSPORTATION SERVICES
Sec. 1451.451. APPLICABILITY. This subchapter applies only
to a health benefit plan that provides benefits for nonemergency
transportation services and that:
(1) provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including:
(A) an individual, group, blanket, or franchise
insurance policy or insurance agreement, a group hospital service
contract, or an individual or group evidence of coverage or similar
coverage document 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; or
(v) a health maintenance organization
operating under Chapter 843; and
(B) to the extent permitted by the Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
seq.), a health benefit plan that is offered by:
(i) a multiple employer welfare arrangement
as defined by Section 3 of that Act; or
(ii) another analogous benefit
arrangement;
(2) is offered by:
(A) an approved nonprofit health corporation
that holds a certificate of authority under Chapter 844; or
(B) an entity that is 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
(3) provides health and accident coverage through a
risk pool created under Chapter 172, Local Government Code,
notwithstanding Section 172.014, Local Government Code, or any
other law.
Sec. 1451.452. EXCEPTION. This subchapter does not apply
to:
(1) a plan that provides coverage:
(A) only for a specified disease;
(B) only for accidental death or dismemberment;
(C) for wages or payments instead of wages for a
period during which an employee is absent from work because of
sickness or injury; or
(D) as a supplement to a liability insurance
policy;
(2) a small employer health benefit plan under Chapter
1501;
(3) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(6) a long-term care insurance policy, including a
nursing home fixed indemnity policy, unless the commissioner
determines that the policy provides benefit coverage so
comprehensive that the policy is a health benefit plan described by
Section 1451.451.
Sec. 1451.453. RULES. The commissioner shall adopt rules
necessary to implement this subchapter.
Sec. 1451.454. LIMITS ON NONEMERGENCY TRANSPORTATION
PROVIDERS. (a) A health benefit plan may not provide coverage for
nonemergency transportation services provided by a transportation
service provider if the issuer of the plan has a financial
relationship with the transportation service provider.
(b) Subsection (a) does not apply to transportation
services provided in an area of the state in which there is only one
transportation service provider available to provide the
transportation service needed. A health benefit plan that provides
coverage for transportation services under this subsection shall
maintain documentation evidencing that no other provider is
available to provide the service in the area.
Sec. 1451.455. LIMITS ON PAYMENTS. A transportation
service provider may not offer or make any payment or other form of
remuneration, including any kickback, rebate, cash, gift, or
service in kind, to the issuer of a health benefit plan for
referrals to the provider, or for contracting with the provider, to
provide nonemergency transportation services.
SECTION 2. The change in law made by this Act applies only
to a health benefit plan delivered, issued for delivery, or renewed
on or after January 1, 2014. A plan delivered, issued for delivery,
or renewed before January 1, 2014, is governed by the law in effect
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2013.