| 1 | 1 | | 84R6012 PMO-D |
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| 2 | 2 | | By: Guillen H.B. No. 2927 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to alternative dispute resolution of certain insurance |
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| 8 | 8 | | payment disputes with certain physicians and health care providers. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter D, Chapter 1952, Insurance Code, is |
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| 11 | 11 | | amended by adding Section 1952.1561 to read as follows: |
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| 12 | 12 | | Sec. 1952.1561. PAYMENT DISPUTES. (a) In this section: |
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| 13 | 13 | | (1) "Health care provider" means a practitioner, |
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| 14 | 14 | | institutional provider, or other person or organization that |
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| 15 | 15 | | furnishes health care services and that is licensed or otherwise |
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| 16 | 16 | | authorized to practice in this state. The term includes a |
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| 17 | 17 | | pharmacist and a pharmacy. The term does not include a physician. |
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| 18 | 18 | | (2) "Health care services" means services provided to |
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| 19 | 19 | | an individual to prevent, alleviate, cure, or heal human illness or |
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| 20 | 20 | | injury. The term includes: |
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| 21 | 21 | | (A) pharmaceutical care; |
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| 22 | 22 | | (B) medical, chiropractic, or dental care; |
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| 23 | 23 | | (C) hospitalization; and |
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| 24 | 24 | | (D) services incidental to the health care |
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| 25 | 25 | | services described by Paragraphs (A)-(C). |
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| 26 | 26 | | (3) "Pharmaceutical care," "pharmacist," "pharmacy," |
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| 27 | 27 | | and "prescription drug" have the meanings assigned by Section |
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| 28 | 28 | | 551.003, Occupations Code. |
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| 29 | 29 | | (4) "Physician" means a person licensed to practice |
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| 30 | 30 | | medicine in this state. |
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| 31 | 31 | | (b) An insurer may not bring an action against a physician |
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| 32 | 32 | | or health care provider related to a payment made under Section |
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| 33 | 33 | | 1952.156 for health care services or prescription drugs unless not |
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| 34 | 34 | | later than one year after the date of service the insurer has |
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| 35 | 35 | | offered or agreed to submit the dispute with the physician or health |
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| 36 | 36 | | care provider to an alternative dispute resolution process and the |
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| 37 | 37 | | physician or health care provider refuses to participate in the |
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| 38 | 38 | | process or the process fails to resolve the dispute. |
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| 39 | 39 | | (c) The statute of limitations applicable to a cause of |
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| 40 | 40 | | action arising out of the dispute is tolled beginning on the date |
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| 41 | 41 | | the dispute arises and ending on the earlier of the date the |
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| 42 | 42 | | alternative dispute resolution process is completed or the date the |
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| 43 | 43 | | physician or health care provider refuses to participate in the |
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| 44 | 44 | | process or the process fails. |
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| 45 | 45 | | SECTION 2. This Act applies only to an insurance policy that |
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| 46 | 46 | | is delivered, issued for delivery, or renewed on or after January 1, |
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| 47 | 47 | | 2016. A policy delivered, issued for delivery, or renewed before |
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| 48 | 48 | | January 1, 2016, is governed by the law as it existed immediately |
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| 49 | 49 | | before the effective date of this Act, and that law is continued in |
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| 50 | 50 | | effect for that purpose. |
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| 51 | 51 | | SECTION 3. This Act takes effect September 1, 2015. |
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