Texas 2017 - 85th Regular

Texas House Bill HB1649 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		85R21751 MEW-D
2	2		By: Muñoz, Jr. H.B. No. 1649
3		-	Substitute the following for H.B. No. 1649:
4		-	By: Phillips C.S.H.B. No. 1649
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to the use of extrapolation by a health maintenance
10	8		organization or an insurer to audit claims.
11	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	10		SECTION 1. Section 843.010, Insurance Code, is amended to
13	11		read as follows:
14	12		Sec. 843.010. APPLICABILITY OF CERTAIN PROVISIONS TO
15	13		GOVERNMENTAL HEALTH BENEFIT PLANS. Sections 843.306(f), 843.322,
16	14		and 843.363(a)(4) do not apply to coverage under:
17	15		(1) the child health plan program under Chapter 62,
18	16		Health and Safety Code, or the health benefits plan for children
19	17		under Chapter 63, Health and Safety Code; or
20	18		(2) a Medicaid program, including a Medicaid managed
21	19		care program operated under Chapter 533, Government Code.
22	20		SECTION 2. Subchapter I, Chapter 843, Insurance Code, is
23	21		amended by adding Section 843.322 to read as follows:
24	22		Sec. 843.322. USE OF EXTRAPOLATION PROHIBITED. (a) In this
25	23		section, "extrapolation" means a mathematical process or technique
26	24		used by a health maintenance organization in the audit of a
27	25		participating physician or provider to estimate audit results or
28	26		findings for a larger batch or group of claims not reviewed by the
29	27		health maintenance organization.
30	28		(b) A health maintenance organization may not use
31	29		extrapolation to complete an audit of a participating physician or
32	30		provider. Any additional payment due a participating physician or
33	31		provider or any refund due the health maintenance organization must
34	32		be based on the actual overpayment or underpayment and may not be
35	33		based on an extrapolation.
36	34		SECTION 3. Subchapter B, Chapter 1301, Insurance Code, is
37	35		amended by adding Section 1301.0642 to read as follows:
38	36		Sec. 1301.0642. USE OF EXTRAPOLATION PROHIBITED. (a) In
39	37		this section, "extrapolation" means a mathematical process or
40	38		technique used by an insurer in the audit of a preferred provider to
41	39		estimate audit results or findings for a larger batch or group of
42	40		claims not reviewed by the insurer.
43	41		(b) An insurer may not use extrapolation to complete an
44	42		audit of a preferred provider. Any additional payment due a
45	43		preferred provider or any refund due the insurer must be based on
46	44		the actual overpayment or underpayment and may not be based on an
47	45		extrapolation.
48	46		SECTION 4. The change in law made by this Act applies only
49	47		to the audit of a physician or provider under a contract with an
50	48		insurer or health maintenance organization entered into or renewed
51	49		on or after the effective date of this Act.
52	50		SECTION 5. This Act takes effect September 1, 2017.