Texas 2015 - 84th Regular

Texas House Bill HB3006 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	84R26261 AJA-F
2	2	By: Coleman, Bonnen of Galveston, Zerwas, H.B. No. 3006
3	3	Davis of Harris, Sheffield
4	4	Substitute the following for H.B. No. 3006:
5	5	By: Sheets C.S.H.B. No. 3006
6	6
7	7
8	8	A BILL TO BE ENTITLED
9	9	AN ACT
10	10	relating to the distribution and use of certain penalties paid by
11	11	health maintenance organizations and insurers for violating
12	12	certain provisions governing prompt payment of physicians and
13	13	health care providers.
14	14	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
15	15	SECTION 1. Section 843.342, Insurance Code, is amended by
16	16	amending Subsection (m) and adding Subsection (m-1) to read as
17	17	follows:
18	18	(m) Notwithstanding any other provision of this section,
19	19	this subsection governs the payment of a penalty under this
20	20	section. For a penalty under this section relating to a clean
21	21	claim submitted by a physician or provider other than an
22	22	institutional provider, the health maintenance organization shall
23	23	pay the entire penalty to the physician or provider, except for any
24	24	interest computed under Subsection (c), which shall be paid to the
25	25	department to be distributed to the fund established under
26	26	Subchapter F, Chapter 1508, to be used for any purpose authorized by
27	27	the commissioner by rule to improve access to health benefit
28	28	coverage for individuals without coverage [Texas Health Insurance
29	29	Risk Pool]. For a penalty under this section relating to a clean
30	30	claim submitted by an institutional provider, the health
31	31	maintenance organization shall pay 50 percent of the total penalty
32	32	amount computed under this section, including interest, to the
33	33	institutional provider and the remaining 50 percent of that amount
34	34	to the department to be distributed to the fund established under
35	35	Subchapter F, Chapter 1508, to be used as provided by Subsection
36	36	(m-1).
37	37	(m-1) Money in the fund established under Subchapter F,
38	38	Chapter 1508, that is derived from penalties under this section
39	39	relating to clean claims submitted by institutional providers may
40	40	only be appropriated as follows:
41	41	(1) the first $5 million may be appropriated only to
42	42	the Health and Human Services Commission to be used only to fund the
43	43	commission's consumer assistance for Medicaid program;
44	44	(2) the next $20 million collected may be appropriated
45	45	only to the Health and Human Services Commission to be used only to
46	46	provide postpartum coverage through the child health plan program
47	47	operated under Chapter 62, Health and Safety Code, and Medicaid;
48	48	and
49	49	(3) amounts in excess of the amounts described by
50	50	Subdivisions (1) and (2) may be appropriated only to the Health and
51	51	Human Services Commission to be used only to increase reimbursement
52	52	rates to health care providers who provide services through the
53	53	Texas Women's Health Program [the Texas Health Insurance Risk
54	54	Pool].
55	55	SECTION 2. Section 1301.137, Insurance Code, is amended by
56	56	amending Subsection (l) and adding Subsection (l-1) to read as
57	57	follows:
58	58	(l) Notwithstanding any other provision of this section,
59	59	this subsection governs the payment of a penalty under this
60	60	section. For a penalty under this section relating to a clean
61	61	claim submitted by a preferred provider other than an institutional
62	62	provider, the insurer shall pay the entire penalty to the preferred
63	63	provider, except for any interest computed under Subsection (c),
64	64	which shall be paid to the department to be distributed to the fund
65	65	established under Subchapter F, Chapter 1508, to be used for any
66	66	purpose authorized by the commissioner by rule to improve access to
67	67	health benefit coverage for individuals without coverage [Texas
68	68	Health Insurance Risk Pool]. For a penalty under this section
69	69	relating to a clean claim submitted by an institutional provider,
70	70	the insurer shall pay 50 percent of the penalty amount computed
71	71	under this section, including interest, to the institutional
72	72	provider and the remaining 50 percent of that amount to the
73	73	department to be distributed to the fund established under
74	74	Subchapter F, Chapter 1508, to be used as provided by Subsection
75	75	(l-1).
76	76	(l-1) Money in the fund established under Subchapter F,
77	77	Chapter 1508, that is derived from penalties under this section
78	78	relating to clean claims submitted by institutional providers may
79	79	only be appropriated as follows:
80	80	(1) the first $5 million may be appropriated only to
81	81	the Health and Human Services Commission to be used only to fund the
82	82	commission's consumer assistance for Medicaid program;
83	83	(2) the next $20 million collected may be appropriated
84	84	only to the Health and Human Services Commission to be used only to
85	85	provide postpartum coverage through the child health plan program
86	86	operated under Chapter 62, Health and Safety Code, and Medicaid;
87	87	and
88	88	(3) amounts in excess of the amounts described by
89	89	Subdivisions (1) and (2) may be appropriated only to the Health and
90	90	Human Services Commission to be used only to increase reimbursement
91	91	rates to health care providers who provide services through the
92	92	Texas Women's Health Program [Texas Health Insurance Risk Pool].
93	93	SECTION 3. (a) Notwithstanding Section 6(e), Chapter 615
94	94	(S.B. 1367), Acts of the 83rd Legislature, Regular Session, 2013,
95	95	any penalties relating to clean claims submitted by institutional
96	96	providers that were paid under Section 843.342(m) or 1301.137(l),
97	97	Insurance Code, before the effective date of this Act, and that
98	98	remain unexpended and unobligated on the effective date of this
99	99	Act, shall be used to provide grants to hospitals in this state to
100	100	upgrade the hospitals' emergency rooms and trauma facilities.
101	101	(b) The commissioner of insurance shall adopt rules
102	102	governing the distribution of grants to hospitals under this
103	103	section and the contracts under which the grants are awarded.
104	104	(c) The commissioner of insurance shall distribute all
105	105	money that is subject to this section not later than September 1,
106	106	2017.
107	107	SECTION 4. (a) The changes in law made by this Act to
108	108	Sections 843.342 and 1301.137, Insurance Code, apply only to
109	109	penalties paid under those sections on or after the effective date
110	110	of this Act.
111	111	(b) Except as provided by this Act, penalties paid before
112	112	the effective date of this Act are governed by the law applicable to
113	113	the penalties immediately before the effective date of this Act,
114	114	and that law is continued in effect for that purpose.
115	115	SECTION 5. This Act takes effect immediately if it receives
116	116	a vote of two-thirds of all the members elected to each house, as
117	117	provided by Section 39, Article III, Texas Constitution. If this
118	118	Act does not receive the vote necessary for immediate effect, this
119	119	Act takes effect September 1, 2015.