Texas 2013 - 83rd Regular

Texas House Bill HB2162 Compare Versions

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Old	New	Differences
1	1	83R17036 SCL-F
2	2	By: Eiland H.B. No. 2162
3	3	Substitute the following for H.B. No. 2162:
4	4	By: Eiland C.S.H.B. No. 2162
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to health benefit plan coverage for certain nonemergency
10	10	ambulance transportation services.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 1451, Insurance Code, is amended by
13	13	adding Subchapter J to read as follows:
14	14	SUBCHAPTER J. ACCESS TO TRANSPORTATION SERVICES
15	15	Sec. 1451.451. APPLICABILITY. This subchapter applies only
16	16	to a health benefit plan that provides benefits for nonemergency
17	17	ambulance transportation services and that:
18	18	(1) provides benefits for medical or surgical expenses
19	19	incurred as a result of a health condition, accident, or sickness,
20	20	including:
21	21	(A) an individual, group, blanket, or franchise
22	22	insurance policy or insurance agreement, a group hospital service
23	23	contract, or an individual or group evidence of coverage or similar
24	24	coverage document that is offered by:
25	25	(i) an insurance company;
26	26	(ii) a group hospital service corporation
27	27	operating under Chapter 842;
28	28	(iii) a fraternal benefit society operating
29	29	under Chapter 885;
30	30	(iv) a stipulated premium company operating
31	31	under Chapter 884; or
32	32	(v) a health maintenance organization
33	33	operating under Chapter 843; and
34	34	(B) to the extent permitted by the Employee
35	35	Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
36	36	seq.), a health benefit plan that is offered by:
37	37	(i) a multiple employer welfare arrangement
38	38	as defined by Section 3 of that Act; or
39	39	(ii) another analogous benefit
40	40	arrangement;
41	41	(2) is offered by:
42	42	(A) an approved nonprofit health corporation
43	43	that holds a certificate of authority under Chapter 844; or
44	44	(B) an entity that is not authorized under this
45	45	code or another insurance law of this state that contracts directly
46	46	for health care services on a risk-sharing basis, including a
47	47	capitation basis; or
48	48	(3) provides health and accident coverage through a
49	49	risk pool created under Chapter 172, Local Government Code,
50	50	notwithstanding Section 172.014, Local Government Code, or any
51	51	other law.
52	52	Sec. 1451.452. EXCEPTION. This subchapter does not apply
53	53	to:
54	54	(1) a plan that provides coverage:
55	55	(A) only for a specified disease;
56	56	(B) only for accidental death or dismemberment;
57	57	(C) for wages or payments instead of wages for a
58	58	period during which an employee is absent from work because of
59	59	sickness or injury; or
60	60	(D) as a supplement to a liability insurance
61	61	policy;
62	62	(2) a small employer health benefit plan under Chapter
63	63	1501;
64	64	(3) a Medicare supplemental policy as defined by
65	65	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
66	66	(4) a workers' compensation insurance policy;
67	67	(5) medical payment insurance coverage provided under
68	68	a motor vehicle insurance policy; or
69	69	(6) a long-term care insurance policy, including a
70	70	nursing home fixed indemnity policy, unless the commissioner
71	71	determines that the policy provides benefit coverage so
72	72	comprehensive that the policy is a health benefit plan described by
73	73	Section 1451.451.
74	74	Sec. 1451.453. RULES. The commissioner shall adopt rules
75	75	necessary to implement this subchapter.
76	76	Sec. 1451.454. LIMITS ON NONEMERGENCY AMBULANCE
77	77	TRANSPORTATION PROVIDERS. (a) The issuer of a health benefit plan
78	78	that provides coverage for nonemergency ambulance transportation
79	79	services may not contract with a nonemergency ambulance
80	80	transportation service provider who has a direct or indirect
81	81	ownership interest in a transportation brokerage service that
82	82	contracts with the plan and provides for the establishment of a
83	83	nonemergency ambulance transportation network.
84	84	(b) Subsection (a) does not apply to nonemergency ambulance
85	85	transportation services provided in an area of the state in which
86	86	there is only one nonemergency ambulance transportation service
87	87	provider available to provide the transportation service needed. A
88	88	health benefit plan that provides coverage for nonemergency
89	89	ambulance transportation services under this subsection shall
90	90	maintain documentation evidencing that no other provider is
91	91	available to provide the service in the area.
92	92	Sec. 1451.455. LIMITS ON PAYMENTS. A transportation
93	93	service provider may not offer or make any payment or other form of
94	94	remuneration, including any kickback, rebate, cash, gift, or
95	95	service in kind, to the issuer of a health benefit plan for
96	96	referrals to the provider, or for contracting with the provider, to
97	97	provide nonemergency ambulance transportation services.
98	98	SECTION 2. The change in law made by this Act applies only
99	99	to a health benefit plan delivered, issued for delivery, or renewed
100	100	on or after January 1, 2014. A plan delivered, issued for delivery,
101	101	or renewed before January 1, 2014, is governed by the law in effect
102	102	immediately before the effective date of this Act, and that law is
103	103	continued in effect for that purpose.
104	104	SECTION 3. This Act takes effect September 1, 2013.