84R26261 AJA-F
By: Coleman, Bonnen of Galveston, Zerwas, H.B. No. 3006
Davis of Harris, Sheffield
Substitute the following for H.B. No. 3006:
By: Sheets C.S.H.B. No. 3006
A BILL TO BE ENTITLED
AN ACT
relating to the distribution and use of certain penalties paid by
health maintenance organizations and insurers for violating
certain provisions governing prompt payment of physicians and
health care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.342, Insurance Code, is amended by
amending Subsection (m) and adding Subsection (m-1) to read as
follows:
(m) Notwithstanding any other provision of this section,
this subsection governs the payment of a penalty under this
section. For a penalty under this section relating to a clean
claim submitted by a physician or provider other than an
institutional provider, the health maintenance organization shall
pay the entire penalty to the physician or provider, except for any
interest computed under Subsection (c), which shall be paid to the
department to be distributed to the fund established under
Subchapter F, Chapter 1508, to be used for any purpose authorized by
the commissioner by rule to improve access to health benefit
coverage for individuals without coverage [Texas Health Insurance
Risk Pool]. For a penalty under this section relating to a clean
claim submitted by an institutional provider, the health
maintenance organization shall pay 50 percent of the total penalty
amount computed under this section, including interest, to the
institutional provider and the remaining 50 percent of that amount
to the department to be distributed to the fund established under
Subchapter F, Chapter 1508, to be used as provided by Subsection
(m-1).
(m-1) Money in the fund established under Subchapter F,
Chapter 1508, that is derived from penalties under this section
relating to clean claims submitted by institutional providers may
only be appropriated as follows:
(1) the first $5 million may be appropriated only to
the Health and Human Services Commission to be used only to fund the
commission's consumer assistance for Medicaid program;
(2) the next $20 million collected may be appropriated
only to the Health and Human Services Commission to be used only to
provide postpartum coverage through the child health plan program
operated under Chapter 62, Health and Safety Code, and Medicaid;
and
(3) amounts in excess of the amounts described by
Subdivisions (1) and (2) may be appropriated only to the Health and
Human Services Commission to be used only to increase reimbursement
rates to health care providers who provide services through the
Texas Women's Health Program [the Texas Health Insurance Risk
Pool].
SECTION 2. Section 1301.137, Insurance Code, is amended by
amending Subsection (l) and adding Subsection (l-1) to read as
follows:
(l) Notwithstanding any other provision of this section,
this subsection governs the payment of a penalty under this
section. For a penalty under this section relating to a clean
claim submitted by a preferred provider other than an institutional
provider, the insurer shall pay the entire penalty to the preferred
provider, except for any interest computed under Subsection (c),
which shall be paid to the department to be distributed to the fund
established under Subchapter F, Chapter 1508, to be used for any
purpose authorized by the commissioner by rule to improve access to
health benefit coverage for individuals without coverage [Texas
Health Insurance Risk Pool]. For a penalty under this section
relating to a clean claim submitted by an institutional provider,
the insurer shall pay 50 percent of the penalty amount computed
under this section, including interest, to the institutional
provider and the remaining 50 percent of that amount to the
department to be distributed to the fund established under
Subchapter F, Chapter 1508, to be used as provided by Subsection
(l-1).
(l-1) Money in the fund established under Subchapter F,
Chapter 1508, that is derived from penalties under this section
relating to clean claims submitted by institutional providers may
only be appropriated as follows:
(1) the first $5 million may be appropriated only to
the Health and Human Services Commission to be used only to fund the
commission's consumer assistance for Medicaid program;
(2) the next $20 million collected may be appropriated
only to the Health and Human Services Commission to be used only to
provide postpartum coverage through the child health plan program
operated under Chapter 62, Health and Safety Code, and Medicaid;
and
(3) amounts in excess of the amounts described by
Subdivisions (1) and (2) may be appropriated only to the Health and
Human Services Commission to be used only to increase reimbursement
rates to health care providers who provide services through the
Texas Women's Health Program [Texas Health Insurance Risk Pool].
SECTION 3. (a) Notwithstanding Section 6(e), Chapter 615
(S.B. 1367), Acts of the 83rd Legislature, Regular Session, 2013,
any penalties relating to clean claims submitted by institutional
providers that were paid under Section 843.342(m) or 1301.137(l),
Insurance Code, before the effective date of this Act, and that
remain unexpended and unobligated on the effective date of this
Act, shall be used to provide grants to hospitals in this state to
upgrade the hospitals' emergency rooms and trauma facilities.
(b) The commissioner of insurance shall adopt rules
governing the distribution of grants to hospitals under this
section and the contracts under which the grants are awarded.
(c) The commissioner of insurance shall distribute all
money that is subject to this section not later than September 1,
2017.
SECTION 4. (a) The changes in law made by this Act to
Sections 843.342 and 1301.137, Insurance Code, apply only to
penalties paid under those sections on or after the effective date
of this Act.
(b) Except as provided by this Act, penalties paid before
the effective date of this Act are governed by the law applicable to
the penalties immediately before the effective date of this Act,
and that law is continued in effect for that purpose.
SECTION 5. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2015.