86R8535 SMT-D
By: Lucio III H.B. No. 3299
A BILL TO BE ENTITLED
AN ACT
relating to the applicability of mediation requirements for balance
billing to certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1467.001, Insurance Code, is amended by
amending Subdivisions (1), (2-a), (2-b), and (3) and adding
Subdivision (2-c) to read as follows:
(1) "Administrator" means:
(A) an administering firm for a health benefit
plan providing coverage under Chapter 1551, 1575, or 1579; [and]
(B) if applicable, the claims administrator for
the health benefit plan; and
(C) if applicable, an administrating firm for an
eligible plan for which an election is made under Section
1467.0021.
(2-a) "Eligible plan" means a managed care plan that
is a self-funded or self-insured employee welfare benefit plan that
provides health benefits and is established in accordance with the
Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
1001 et seq.).
(2-b) "Emergency care" has the meaning assigned by
Section 1301.155.
(2-c) [(2-b)] "Emergency care provider" means a
physician, health care practitioner, facility, or other health care
provider who provides and bills an enrollee, administrator, or
health benefit plan for emergency care.
(3) "Enrollee" means an individual who is eligible to
receive benefits through a [preferred provider benefit plan or a]
health benefit plan subject to this chapter [under Chapter 1551,
1575, or 1579].
SECTION 2. Section 1467.002, Insurance Code, is amended to
read as follows:
Sec. 1467.002. APPLICABILITY OF CHAPTER. This chapter
applies to:
(1) a preferred provider benefit plan offered by an
insurer under Chapter 1301; [and]
(2) an administrator of a health benefit plan, other
than a health maintenance organization plan, under Chapter 1551,
1575, or 1579; and
(3) an eligible plan for which the plan sponsor makes
an election under Section 1467.0021.
SECTION 3. Subchapter A, Chapter 1467, Insurance Code, is
amended by adding Section 1467.0021 to read as follows:
Sec. 1467.0021. ELECTIVE APPLICABILITY. (a) A plan
sponsor of an eligible plan may elect on an annual basis for this
chapter to apply to the plan. A sponsor making an election shall
provide written notice of the election to the department in the form
and manner required by department rule.
(b) An administrator of an eligible plan for which an
election is made under Subsection (a) shall ensure that the plan and
any evidence of coverage complies with this chapter.
SECTION 4. The Texas Department of Insurance shall adopt
rules necessary to implement Section 1467.0021, Insurance Code, as
added by this Act, not later than December 31, 2019.
SECTION 5. The changes in law made by this Act apply only to
a managed care plan that is delivered, issued for delivery, or
renewed on or after January 1, 2020. A managed care plan delivered,
issued for delivery, or renewed before January 1, 2020, is governed
by the law as it existed immediately before the effective date of
this Act, and that law is continued in effect for that purpose.
SECTION 6. This Act takes effect September 1, 2019.