85R6793 PMO-F
By: Flynn H.B. No. 1675
A BILL TO BE ENTITLED
AN ACT
relating to the methods of payment to health care providers by
certain health benefit plan issuers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
by adding Chapter 1468 to read as follows:
CHAPTER 1468. METHODS OF PAYMENT OF PHYSICIANS AND HEALTH CARE
PROVIDERS
Sec. 1468.001. DEFINITIONS. In this chapter:
(1) "Health benefit plan issuer" means an entity
authorized under this code or another insurance law of this state
that provides health insurance or health benefits in this state,
including:
(A) an insurance company;
(B) a group hospital service corporation
operating under Chapter 842;
(C) a health maintenance organization operating
under Chapter 843; and
(D) a stipulated premium company operating under
Chapter 884.
(2) "Health care provider" means a practitioner,
institutional provider, or other person or organization that
furnishes health care services and that is licensed or otherwise
authorized to practice in this state. The term includes a
pharmacist, pharmacy, hospital, nursing home, or other medical or
health-related service facility that provides care for the sick or
injured or other care. The term does not include a physician.
(3) "Physician" means an individual licensed to
practice medicine in this state.
Sec. 1468.002. METHODS OF PAYMENT. (a) Subject to
Subsection (b), a health benefit plan issuer or a person with whom a
health benefit plan issuer contracts to process or pay physician or
health care provider claims may pay a physician or health care
provider by any lawful method of payment, including:
(1) an automated clearinghouse payment;
(2) a wire transfer;
(3) electronic funds transfer by card;
(4) payment through a private card network; or
(5) another form of electronic funds transfer.
(b) Unless a contract between the health benefit plan issuer
and the physician or health care provider specifies the method of
payment, a physician or health care provider may refuse to accept a
method of payment allowed under Subsection (a).
(c) A physician or health care provider that refuses to
accept a method of payment allowed under Subsection (a) shall give
written notice of the refusal to the health benefit plan issuer or
the person with whom the health benefit plan issuer contracts to
process or pay physician or health care provider claims and specify
an acceptable and otherwise lawful method of payment.
SECTION 2. This Act takes effect September 1, 2017.