| 4 | 3 | | |
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| 5 | 4 | | |
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| 6 | 5 | | A BILL TO BE ENTITLED |
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| 7 | 6 | | AN ACT |
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| 8 | 7 | | relating to prohibited practices relating to health benefit plan |
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| 9 | 8 | | coverage for emergency care. |
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| 10 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 10 | | SECTION 1. Section 533.005, Government Code, is amended by |
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| 12 | 11 | | adding Subsection (e) to read as follows: |
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| 13 | 12 | | (e) In addition to the requirements under Subsection (a), a |
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| 14 | 13 | | contract described by that subsection must require the managed care |
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| 15 | 14 | | organization to comply with Section 541.062, Insurance Code. |
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| 16 | 15 | | SECTION 2. Subchapter B, Chapter 541, Insurance Code, is |
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| 17 | 16 | | amended by adding Section 541.062 to read as follows: |
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| 18 | 17 | | Sec. 541.062. EMERGENCY CARE. (a) In this section, |
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| 19 | 18 | | "emergency care" and "utilization review" have the meanings |
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| 20 | 19 | | assigned by Section 4201.002. |
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| 21 | 20 | | (b) It is an unfair method of competition or an unfair or |
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| 22 | 21 | | deceptive act or practice in the business of insurance to make |
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| 23 | 22 | | health benefit plan coverage for an emergency care claim dependent |
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| 24 | 23 | | on a utilization review determination that the patient's medical |
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| 25 | 24 | | condition required emergency care. |
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| 26 | 25 | | SECTION 3. Section 541.062, Insurance Code, as added by |
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| 27 | 26 | | this Act, applies only to a health benefit plan delivered, issued |
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| 28 | 27 | | for delivery, or renewed on or after January 1, 2020. A health |
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| 29 | 28 | | benefit plan delivered, issued for delivery, or renewed before |
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| 30 | 29 | | January 1, 2020, is governed by the law as it existed immediately |
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| 31 | 30 | | before the effective date of this Act, and that law is continued in |
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| 32 | 31 | | effect for that purpose. |
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| 33 | 32 | | SECTION 4. If before implementing any provision of this Act |
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| 34 | 33 | | a state agency determines that a waiver or authorization from a |
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| 35 | 34 | | federal agency is necessary for implementation of that provision, |
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| 36 | 35 | | the agency affected by the provision shall request the waiver or |
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| 37 | 36 | | authorization and may delay implementing that provision until the |
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| 38 | 37 | | waiver or authorization is granted. |
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| 39 | 38 | | SECTION 5. This Act takes effect September 1, 2019. |
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