| 1 | 1 | | 85R6793 PMO-F |
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| 2 | 2 | | By: Flynn H.B. No. 1675 |
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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 the methods of payment to health care providers by |
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| 8 | 8 | | certain health benefit plan issuers. |
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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. Subtitle F, Title 8, Insurance Code, is amended |
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| 11 | 11 | | by adding Chapter 1468 to read as follows: |
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| 12 | 12 | | CHAPTER 1468. METHODS OF PAYMENT OF PHYSICIANS AND HEALTH CARE |
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| 13 | 13 | | PROVIDERS |
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| 14 | 14 | | Sec. 1468.001. DEFINITIONS. In this chapter: |
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| 15 | 15 | | (1) "Health benefit plan issuer" means an entity |
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| 16 | 16 | | authorized under this code or another insurance law of this state |
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| 17 | 17 | | that provides health insurance or health benefits in this state, |
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| 18 | 18 | | including: |
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| 19 | 19 | | (A) an insurance company; |
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| 20 | 20 | | (B) a group hospital service corporation |
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| 21 | 21 | | operating under Chapter 842; |
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| 22 | 22 | | (C) a health maintenance organization operating |
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| 23 | 23 | | under Chapter 843; and |
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| 24 | 24 | | (D) a stipulated premium company operating under |
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| 25 | 25 | | Chapter 884. |
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| 26 | 26 | | (2) "Health care provider" means a practitioner, |
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| 27 | 27 | | institutional provider, or other person or organization that |
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| 28 | 28 | | furnishes health care services and that is licensed or otherwise |
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| 29 | 29 | | authorized to practice in this state. The term includes a |
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| 30 | 30 | | pharmacist, pharmacy, hospital, nursing home, or other medical or |
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| 31 | 31 | | health-related service facility that provides care for the sick or |
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| 32 | 32 | | injured or other care. The term does not include a physician. |
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| 33 | 33 | | (3) "Physician" means an individual licensed to |
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| 34 | 34 | | practice medicine in this state. |
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| 35 | 35 | | Sec. 1468.002. METHODS OF PAYMENT. (a) Subject to |
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| 36 | 36 | | Subsection (b), a health benefit plan issuer or a person with whom a |
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| 37 | 37 | | health benefit plan issuer contracts to process or pay physician or |
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| 38 | 38 | | health care provider claims may pay a physician or health care |
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| 39 | 39 | | provider by any lawful method of payment, including: |
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| 40 | 40 | | (1) an automated clearinghouse payment; |
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| 41 | 41 | | (2) a wire transfer; |
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| 42 | 42 | | (3) electronic funds transfer by card; |
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| 43 | 43 | | (4) payment through a private card network; or |
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| 44 | 44 | | (5) another form of electronic funds transfer. |
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| 45 | 45 | | (b) Unless a contract between the health benefit plan issuer |
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| 46 | 46 | | and the physician or health care provider specifies the method of |
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| 47 | 47 | | payment, a physician or health care provider may refuse to accept a |
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| 48 | 48 | | method of payment allowed under Subsection (a). |
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| 49 | 49 | | (c) A physician or health care provider that refuses to |
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| 50 | 50 | | accept a method of payment allowed under Subsection (a) shall give |
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| 51 | 51 | | written notice of the refusal to the health benefit plan issuer or |
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| 52 | 52 | | the person with whom the health benefit plan issuer contracts to |
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| 53 | 53 | | process or pay physician or health care provider claims and specify |
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| 54 | 54 | | an acceptable and otherwise lawful method of payment. |
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| 55 | 55 | | SECTION 2. This Act takes effect September 1, 2017. |
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