83R984 KKR-D
By: Kuempel H.B. No. 522
A BILL TO BE ENTITLED
AN ACT
relating to direct payment by a health insurer to physicians and
health care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Subchapter B, Chapter 1204,
Insurance Code, is amended to read as follows:
SUBCHAPTER B. ASSIGNMENT OF BENEFIT PAYMENTS; DIRECT PAYMENT OF
BENEFITS
SECTION 2. Section 1204.051(3), Insurance Code, is amended
to read as follows:
(3) "Health care provider" means a person who provides
health care services or ambulance services under a license,
certificate, registration, or other similar evidence of regulation
issued by this or another state of the United States.
SECTION 3. Subchapter B, Chapter 1204, Insurance Code, is
amended by adding Sections 1204.056, 1204.057, and 1204.058 to read
as follows:
Sec. 1204.056. ASSIGNMENT OF BENEFITS OPTION REQUIRED.
(a) A health insurance policy claim form must provide an option
for the claimant to assign benefits to a physician or health care
provider who provided covered services.
(b) The health insurer may require a written attestation of
assignment of benefits.
Sec. 1204.057. AMOUNT OF PAYMENT UNDER ASSIGNMENT OF
BENEFITS. A payment to a physician or health care provider under an
assignment of benefits may not be more than the amount the insurer
would have paid in the absence of an assignment of benefits.
Sec. 1204.058. DIRECT PAYMENT PROVISION AUTHORIZED. A
health insurance policy may provide for payment of benefits
directly to a physician or health care provider who provides
covered services to a covered person, even in the absence of an
assignment of benefits.
SECTION 4. Subchapter B, Chapter 1301, Insurance Code, is
amended by adding Section 1301.0561 to read as follows:
Sec. 1301.0561. DIRECT PAYMENT TO PREFERRED PROVIDERS
REQUIRED. An insurer that issues a preferred provider benefit plan
shall pay a preferred provider directly for covered services
provided to a person insured under the plan, in accordance with this
chapter, without requiring an assignment of benefits.
SECTION 5. The changes in law made by this Act apply only to
an insurance policy delivered, issued for delivery, or renewed on
or after January 1, 2014. An insurance policy 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 6. This Act takes effect September 1, 2013.