84R7545 AJA-D
By: Bonnen of Galveston H.B. No. 2757
A BILL TO BE ENTITLED
AN ACT
relating to prompt payment of physicians and health care providers
under contract with certain self-insured health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter C, Chapter 1301, Insurance Code, is
amended by adding Section 1301.1091 to read as follows:
Sec. 1301.1091. APPLICABILITY TO CERTAIN SELF-INSURED
PLANS. (a) This section applies only with respect to a
self-insured plan that:
(1) provides medical or health care benefits to plan
enrollees in the manner of a preferred provider benefit plan; and
(2) is administered by an insurer acting as a
third-party administrator.
(b) The payment of a claim submitted to an insurer acting as
a third-party administrator for a plan described by Subsection (a)
by a physician or health care provider who is under contract to
provide medical care or health care to plan enrollees is subject to
this subchapter and Section 1301.137 as if the claim were made by a
preferred provider under a preferred provider benefit plan issued
by the insurer, except to the extent that the insurer asserts that
the claim is not payable because the medical care or health care
services for which the claim is made are not covered under the plan.
SECTION 2. (a) The change in law made by this Act applies
only to payment for services under:
(1) a contract between an insurer and a self-insured
plan sponsor entered into or renewed on or after January 1, 2016;
and
(2) a contract between a physician or health care
provider and the insurer or plan sponsor entered into on or after
that date in connection with the plan.
(b) Payment for services under a contract between an insurer
and a self-insured plan sponsor entered into or renewed before
January 1, 2016, or a contract between a physician or health care
provider and the insurer or plan sponsor entered into or renewed
before that date is governed by the law as it existed 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, 2015.