| 1 | 1 | | 86R12562 PMO-D |
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| 2 | 2 | | By: Bowers H.B. No. 3178 |
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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 an interim house study regarding retrospective denial |
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| 8 | 8 | | by health benefit plans of health benefit claims for emergency |
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| 9 | 9 | | care. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. HOUSE COMMITTEE. (a) A standing committee of |
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| 12 | 12 | | the house of representatives shall study and report to the speaker |
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| 13 | 13 | | and members of the house of representatives regarding the practice |
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| 14 | 14 | | of retrospective denial by health benefit plans of health benefit |
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| 15 | 15 | | claims for emergency care. |
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| 16 | 16 | | (b) Not later than the 60th day after the effective date of |
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| 17 | 17 | | this Act, the speaker of the house of representatives shall appoint |
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| 18 | 18 | | an appropriate committee from the standing committees of the house |
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| 19 | 19 | | of representatives to conduct the study and prepare the report |
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| 20 | 20 | | required by Subsection (a) of this section. |
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| 21 | 21 | | SECTION 2. STUDY. The committee selected under Section 1 of |
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| 22 | 22 | | this Act shall, with respect to the practice of retrospective |
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| 23 | 23 | | denial by health benefit plans of health benefit claims for |
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| 24 | 24 | | emergency care, study: |
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| 25 | 25 | | (1) the formal and informal policies of health benefit |
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| 26 | 26 | | plans under which claims for emergency care are denied after the |
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| 27 | 27 | | care has been provided to a covered person; |
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| 28 | 28 | | (2) the effect the retrospective denial practice has |
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| 29 | 29 | | on whether residents of this state seek emergency care; |
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| 30 | 30 | | (3) patient expectations about health benefits that |
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| 31 | 31 | | may be available when seeking emergency care; |
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| 32 | 32 | | (4) the conflict between the application of the |
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| 33 | 33 | | retrospective denial practice and the prudent layperson standard |
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| 34 | 34 | | adopted in this state with respect to emergency care; and |
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| 35 | 35 | | (5) the effect the retrospective denial practice has |
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| 36 | 36 | | on medical debt incurred by residents of this state. |
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| 37 | 37 | | SECTION 3. REPORT. Not later than January 1, 2021, the |
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| 38 | 38 | | committee selected under Section 1 of this Act shall report the |
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| 39 | 39 | | committee's findings and recommendations to the speaker and members |
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| 40 | 40 | | of the house of representatives. The committee shall include in the |
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| 41 | 41 | | recommendations specific statutory changes, including any changes |
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| 42 | 42 | | necessary to Title 8, Insurance Code, that may appear necessary or |
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| 43 | 43 | | advisable from the committee's study conducted under Section 2 of |
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| 44 | 44 | | this Act. |
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| 45 | 45 | | SECTION 4. EXPIRATION. This Act expires September 1, 2021. |
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| 46 | 46 | | SECTION 5. EFFECTIVE DATE. This Act takes effect September |
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| 47 | 47 | | 1, 2019. |
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