85R8865 PMO-D
By: Bonnen of Galveston H.B. No. 2077
A BILL TO BE ENTITLED
AN ACT
relating to data collection related to certain health benefit plan
issuers' calculation of payments to out-of-network physicians and
providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 38, Insurance Code, is amended by adding
Subchapter J to read as follows:
SUBCHAPTER J. DATA COLLECTION RELATED TO PAYMENT OF OUT-OF-NETWORK
PHYSICIANS AND HEALTH CARE PROVIDERS
Sec. 38.451. APPLICABILITY. This subchapter applies to an
issuer of a preferred provider benefit plan as defined by Section
1301.001 or an evidence of coverage for a health care plan that
provides basic health care services as defined by Section 843.002.
Sec. 38.452. DEFINITION. In this subchapter,
"out-of-network physicians and health care providers" means
physicians and health care providers who are not preferred
providers or are not otherwise included in a health benefit plan
issuer's delivery network.
Sec. 38.453. COLLECTION OF INFORMATION; REPORT. (a) A
health benefit plan issuer described by Section 38.451 shall report
biennially to the department the information required by the
commissioner under Subsection (b) relating to the health benefit
plan issuer's calculation of payment rates for and payments to
out-of-network physicians and health care providers.
(b) The commissioner by rule shall prescribe the form and
required content of the report required under Subsection (a). The
report must include payment methodologies and formulas used to
calculate payment rates for and payments to out-of-network
physicians and health care providers.
(c) On or before December 31 of each even-numbered year, the
commissioner shall assemble and analyze the information submitted
under this section during the preceding biennium and submit to the
speaker of the house of representatives, the lieutenant governor,
and the appropriate committees of each house of the legislature a
report of the information and the commissioner's analysis.
SECTION 2. Not later than December 31, 2017, the
commissioner of insurance shall adopt rules as necessary to
implement Subchapter J, Chapter 38, Insurance Code, as added by
this Act. The rules must require that a health benefit plan issuer
subject to that subchapter make the initial submission of data
under that subchapter not later than the 60th day after the
effective date of the rules.
SECTION 3. This Act takes effect September 1, 2017.