86R9910 PMO-F
By: Moody H.B. No. 1914
A BILL TO BE ENTITLED
AN ACT
relating to prompt payment of claims to certain physicians and
health care providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.351, Insurance Code, is amended to
read as follows:
Sec. 843.351. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND
PROVIDERS. (a) The provisions of this subchapter relating to prompt
payment by a health maintenance organization of a physician or
provider, including Section 843.342, and to verification of health
care services apply to a physician or provider who:
(1) is not included in the health maintenance
organization delivery network; and
(2) provides to an enrollee:
(A) care related to an emergency or its attendant
episode of care as required by state or federal law; or
(B) specialty or other health care services at
the request of the health maintenance organization or a physician
or provider who is included in the health maintenance organization
delivery network because the services are not reasonably available
within the network.
(b) For purposes of calculating a penalty under Section
843.342 related to a claim by a physician or provider described by
Subsection (a), the contracted rate for the health care service
provided by the physician or provider is the usual and customary
rate for the service in the geographic area in which the service is
provided.
SECTION 2. Section 1301.069, Insurance Code, is amended to
read as follows:
Sec. 1301.069. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND
HEALTH CARE PROVIDERS. (a) The provisions of this chapter relating
to prompt payment by an insurer of a physician or health care
provider, including Section 1301.137, and to verification of
medical care or health care services apply to a physician or
provider who:
(1) is not a preferred provider included in the
preferred provider network; and
(2) provides to an insured:
(A) care related to an emergency or its attendant
episode of care as required by state or federal law; or
(B) specialty or other medical care or health
care services at the request of the insurer or a preferred provider
because the services are not reasonably available from a preferred
provider who is included in the preferred delivery network.
(b) For purposes of calculating a penalty under Section
1301.137 related to a claim by a physician or health care provider
described by Subsection (a) or Section 1301.0053, the contracted
rate for the health care service provided by the physician or
provider is the usual and customary rate for the service in the
geographic area in which the service is provided.
SECTION 3. Sections 843.351 and 1301.069, Insurance Code,
as amended by this Act, apply only to a claim filed on or after the
effective date of this Act.
SECTION 4. This Act takes effect September 1, 2019.