Texas 2019 - 86th Regular

Texas House Bill HB3933 Compare Versions

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1	1	By: Martinez Fischer H.B. No. 3933
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to consumer protections against billing and limitations on
7	7	information reported by consumer reporting agencies.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	ARTICLE 1. LIMITATIONS ON SURPRISE BILLING INFORMATION REPORTED BY
10	10	CONSUMER REPORTING AGENCIES
11	11	SECTION 1.01 Section 20.05, Business & Commerce Code, is
12	12	amended by amending Subsection (a) and adding Subsection (d) to
13	13	read as follows:
14	14	(a) Except as provided by Subsection (b), a consumer
15	15	reporting agency may not furnish a consumer report containing
16	16	information related to:
17	17	(1) a case under Title 11 of the United States Code or
18	18	under the federal Bankruptcy Act in which the date of entry of the
19	19	order for relief or the date of adjudication predates the consumer
20	20	report by more than 10 years;
21	21	(2) a suit or judgment in which the date of entry
22	22	predates the consumer report by more than seven years or the
23	23	governing statute of limitations, whichever is longer;
24	24	(3) a tax lien in which the date of payment predates
25	25	the consumer report by more than seven years;
26	26	(4) a record of arrest, indictment, or conviction of a
27	27	crime in which the date of disposition, release, or parole predates
28	28	the consumer report by more than seven years; [or]
29	29	(5) a collection account with a medical industry code,
30	30	if the consumer was covered by a health benefit plan at the time of
31	31	the event giving rise to the collection and the collection is for an
32	32	outstanding balance, after copayments, deductibles, and
33	33	coinsurance, owed to an emergency care provider or a facility-based
34	34	provider for an out-of-network benefit claim; or
35	35	(6) another item or event that predates the consumer
36	36	report by more than seven years.
37	37	(d) In this section:
38	38	(1) "Emergency care provider" means a physician,
39	39	health care practitioner, facility, or other health care provider
40	40	who provides emergency care.
41	41	(2) "Facility" has the meaning assigned by Section
42	42	324.001, Health and Safety Code.
43	43	(3) "Facility-based provider" means a physician,
44	44	health care practitioner, or other health care provider who
45	45	provides health care or medical services to patients of a facility.
46	46	(4) "Health care practitioner" means an individual who
47	47	is licensed to provide health care services.
48	48	ARTICLE 2. ELIMINATION OF SURPRISE BILLING FOR CERTAIN HEALTH
49	49	BENEFIT PLANS
50	50	SECTION 2.01. Section 1271.155, Insurance Code, is amended
51	51	by amending Subsection (a) and adding Subsection (f) to read as
52	52	follows:
53	53	(a) A health maintenance organization shall pay for
54	54	emergency care performed by non-network physicians or providers in
55	55	an amount that the organization determines is reasonable for the
56	56	emergency care [at the usual and customary rate] or at an agreed
57	57	rate.
58	58	(f) A non-network physician or provider may not bill a
59	59	patient described by this section in, and the patient has no
60	60	financial responsibility for, an amount greater than the patient's
61	61	responsibility under the patient's health care plan, including an
62	62	applicable copayment, coinsurance, or deductible.
63	63	SECTION 2.02. Subchapter D, Chapter 1271, Insurance Code,
64	64	is amended by adding Section 1271.157 to read as follows:
65	65	Sec. 1271.157. NON-NETWORK FACILITY-BASED PROVIDERS. (a)
66	66	In this section, "facility-based provider" means a physician or
67	67	health care provider who provides health care services to patients
68	68	of a health care facility.
69	69	(b) A health maintenance organization shall pay for a health
70	70	care service performed by a non-network provider who is a
71	71	facility-based provider in an amount that the organization
72	72	determines is reasonable for the service or at an agreed rate if the
73	73	provider performed the service at a health care facility that is a
74	74	network provider.
75	75	(c) A non-network facility-based provider may not bill a
76	76	patient receiving a health care service described by Subsection (b)
77	77	in, and the patient does not have financial responsibility for, an
78	78	amount greater than the patient's responsibility under the
79	79	patient's health care plan, including an applicable copayment,
80	80	coinsurance, or deductible.
81	81	SECTION 2.03. Subtitle C, Title 8, Insurance Code, is
82	82	amended by adding Chapter 1276 to read as follows:
83	83	CHAPTER 1276. ELECTIVE PROVISIONS FOR SELF-FUNDED OR SELF-INSURED
84	84	MANAGED CARE PLANS
85	85	Sec. 1276.0001. DEFINITIONS. In this chapter:
86	86	(1) "Eligible plan" means a managed care plan that is a
87	87	self-funded or self-insured employee welfare benefit plan that
88	88	provides health benefits and is established in accordance with the
89	89	Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
90	90	1001 et seq.).
91	91	(2) "Emergency care" has the meaning assigned by
92	92	Section 1301.155.
93	93	(3) "Facility-based provider" means a physician or
94	94	health care provider who provides health care services to patients
95	95	of a health care facility.
96	96	(4) "Managed care plan" means a health benefit plan
97	97	under which the plan administrator provides or arranges for health
98	98	care benefits to plan participants and requires or encourages plan
99	99	participants to use physicians and health care providers the plan
100	100	designates.
101	101	(5) "Out-of-network provider" means, with respect to
102	102	an eligible plan, a physician or health care provider who is not a
103	103	participating provider.
104	104	(6) "Participating provider" means a physician or
105	105	health care provider who has contracted with an eligible plan
106	106	administrator to provide services to enrollees.
107	107	Sec. 1276.0002. ELECTION FOR SURPRISE HEALTH CARE BILLING
108	108	PROHIBITION AND MEDIATION. (a) A plan sponsor of an eligible plan
109	109	may elect on an annual basis for this section and Chapter 1467 to
110	110	apply to the plan. A sponsor making an election shall provide
111	111	written notice of the election to the department in the form and
112	112	manner required by department rule.
113	113	(b) An administrator of an eligible plan for which an
114	114	election is made under Subsection (a) shall pay for a health care
115	115	service performed by an out-of-network provider in an amount that
116	116	the administrator determines is reasonable for the service or at an
117	117	agreed rate if:
118	118	(1) the provider is a facility-based provider who
119	119	performed the service at a health care facility that is a
120	120	participating provider; or
121	121	(2) the service is emergency care.
122	122	(c) An out-of-network provider described by Subsection (b)
123	123	may not bill the patient in, and the patient does not have financial
124	124	responsibility for, an amount greater than the patient's
125	125	responsibility under the patient's eligible plan, including an
126	126	applicable copayment, coinsurance, or deductible.
127	127	(d) An administrator of an eligible plan for which an
128	128	election is made under Subsection (a) shall ensure that the plan and
129	129	any evidence of coverage complies with this section and Chapter
130	130	1467.
131	131	SECTION 2.04. Section 1301.0053, Insurance Code, is amended
132	132	to read as follows:
133	133	Sec. 1301.0053. EXCLUSIVE PROVIDER BENEFIT PLANS:
134	134	EMERGENCY CARE. (a) If a nonpreferred provider provides emergency
135	135	care as defined by Section 1301.155 to an enrollee in an exclusive
136	136	provider benefit plan, the issuer of the plan shall reimburse the
137	137	nonpreferred provider in an amount that the issuer determines is
138	138	reasonable for the emergency care services [at the usual and
139	139	customary rate] or at a rate agreed to by the issuer and the
140	140	nonpreferred provider for the provision of the services.
141	141	(b) An out-of-network provider may not bill an insured
142	142	receiving emergency care in, and the insured does not have
143	143	financial responsibility for, an amount greater than the insured's
144	144	responsibility under the insured's exclusive provider benefit
145	145	plan, including an applicable copayment, coinsurance, or
146	146	deductible.
147	147	SECTION 2.05. Section 1301.155, Insurance Code, is amended
148	148	by amending Subsection (b) and adding Subsection (c) to read as
149	149	follows:
150	150	(b) If an insured cannot reasonably reach a preferred
151	151	provider, an insurer shall provide reimbursement for the following
152	152	emergency care services in an amount that the insurer determines is
153	153	reasonable for the services at the preferred level of benefits
154	154	until the insured can reasonably be expected to transfer to a
155	155	preferred provider:
156	156	(1) a medical screening examination or other
157	157	evaluation required by state or federal law to be provided in the
158	158	emergency facility of a hospital that is necessary to determine
159	159	whether a medical emergency condition exists;
160	160	(2) necessary emergency care services, including the
161	161	treatment and stabilization of an emergency medical condition; and
162	162	(3) services originating in a hospital emergency
163	163	facility or freestanding emergency medical care facility following
164	164	treatment or stabilization of an emergency medical condition.
165	165	(c) For purposes of Subsection (b), an out-of-network
166	166	provider may not bill an insured in, and the insured does not have
167	167	financial responsibility for, an amount greater than the insured's
168	168	responsibility under the insured's preferred provider benefit
169	169	plan, including an applicable copayment, coinsurance, or
170	170	deductible.
171	171	SECTION 2.06. Subchapter D, Chapter 1301, Insurance Code,
172	172	is amended by adding Section 1301.164 to read as follows:
173	173	Sec. 1301.164. OUT-OF-NETWORK FACILITY-BASED PROVIDER.
174	174	(a) In this section, "facility-based provider" means a physician,
175	175	or health care provider who provides health care services to
176	176	patients of a health care facility.
177	177	(b) An insurer shall pay for a health care service performed
178	178	by a nonpreferred provider who is a facility-based provider in an
179	179	amount that the insurer determines is reasonable for the service or
180	180	at an agreed rate if the provider performed the service at a health
181	181	care facility that is a participating provider.
182	182	(c) A nonpreferred provider who is a facility-based
183	183	provider may not bill an insured receiving a health care service
184	184	described by Subsection (b) in, and the insured does not have
185	185	financial responsibility for, an amount greater than the insured's
186	186	responsibility under the insured's health care plan, including an
187	187	applicable copayment, coinsurance, or deductible.
188	188	SECTION 2.07. Subchapter E, Chapter 1551, Insurance Code,
189	189	is amended by adding Sections 1551.228 and 1551.229 to read as
190	190	follows:
191	191	Sec. 1551.228. EMERGENCY CARE COVERAGE. (a) In this
192	192	section, "emergency care" has the meaning assigned by Section
193	193	1301.155.
194	194	(b) A managed care plan provided under the group benefits
195	195	program must provide out-of-network emergency care coverage for
196	196	participants in accordance with this section.
197	197	(c) The coverage must require the administrator of the plan
198	198	to pay for emergency care performed by an out-of-network provider
199	199	in an amount that the administrator determines is reasonable for
200	200	the emergency care or at an agreed rate.
201	201	(d) For the purposes of Subsection (c), an out-of-network
202	202	provider may not bill an enrollee in, and the enrollee does not have
203	203	financial responsibility for, an amount greater than the enrollee's
204	204	responsibility under the enrollee's managed care plan, including an
205	205	applicable copayment, coinsurance, or deductible.
206	206	Sec. 1551.229. OUT-OF-NETWORK FACILITY-BASED PROVIDER
207	207	COVERAGE. (a) In this section, "facility-based provider" means a
208	208	physician or health care provider who provides health care services
209	209	to patients of a health care facility.
210	210	(b) A managed care plan provided under the group benefits
211	211	program out-of-network facility-based provider must provide
212	212	coverage for participants in accordance with this section.
213	213	(c) The coverage must require the administrator of the plan
214	214	to pay for a health care service performed for an enrollee by an
215	215	out-of-network provider who is a facility-based provider in an
216	216	amount that the administrator determines is reasonable for the
217	217	service or at an agreed rate if the provider performed the service
218	218	at a health care facility that is a participating provider.
219	219	(d) An out-of-network provider who is a facility-based
220	220	provider may not bill an enrollee receiving a health care service
221	221	described by Subsection (c) in, and the enrollee does not have
222	222	financial responsibility for, an amount greater than the enrollee's
223	223	responsibility under the enrollee's managed care plan, including an
224	224	applicable copayment, coinsurance, or deductible.
225	225	SECTION 2.08. Subchapter D, Chapter 1575, Insurance Code,
226	226	is amended by adding Sections 1575.171 and 1575.172 to read as
227	227	follows:
228	228	Sec. 1575.171. EMERGENCY CARE COVERAGE. (a) In this
229	229	section, "emergency care" has the meaning assigned by Section
230	230	1301.155.
231	231	(b) A managed care plan offered under the group program must
232	232	provide out-of-network emergency care coverage in accordance with
233	233	this section.
234	234	(c) The coverage must require the administrator of the plan
235	235	to pay for emergency care performed by an out-of-network provider
236	236	in an amount that the administrator determines is reasonable for
237	237	the emergency care or at an agreed rate.
238	238	(d) For the purposes of Subsection (c), an out-of-network
239	239	provider may not bill an enrollee in, and the enrollee does not have
240	240	financial responsibility for, an amount greater than the enrollee's
241	241	responsibility under the enrollee's managed care plan, including an
242	242	applicable copayment, coinsurance, or deductible.
243	243	Sec. 1575.172. OUT-OF-NETWORK FACILITY-BASED PROVIDER
244	244	COVERAGE. (a) In this section, "facility-based provider" means a
245	245	physician or health care provider who provides health care services
246	246	to patients of a health care facility.
247	247	(b) A managed care plan offered under the group program must
248	248	provide out-of-network facility-based provider coverage in
249	249	accordance with this section.
250	250	(c) The coverage must require the administrator of the plan
251	251	to pay for a health care service performed for an enrollee by an
252	252	out-of-network provider who is a facility-based provider in an
253	253	amount that the administrator determines is reasonable for the
254	254	service or at an agreed rate if the provider performed the service
255	255	at a health care facility that is a participating provider.
256	256	(d) An out-of-network provider who is a facility-based
257	257	provider may not bill an enrollee receiving a health care service
258	258	described by Subsection (c) in, and the enrollee does not have
259	259	financial responsibility for, an amount greater than the enrollee's
260	260	responsibility under the enrollee's managed care plan, including an
261	261	applicable copayment, coinsurance, or deductible.
262	262	SECTION 2.09. Subchapter C, Chapter 1579, Insurance Code,
263	263	is amended by adding Sections 1579.109 and 1579.110 to read as
264	264	follows:
265	265	Sec. 1579.109. EMERGENCY CARE COVERAGE. (a) In this
266	266	section, "emergency care" has the meaning assigned by Section
267	267	1301.155.
268	268	(b) A managed care plan provided under this chapter must
269	269	provide out-of-network emergency care coverage in accordance with
270	270	this section.
271	271	(c) The coverage must require the administrator of the plan
272	272	to pay for emergency care performed for an enrollee by an
273	273	out-of-network provider in an amount that the administrator
274	274	determines is reasonable for the emergency care or at an agreed
275	275	rate.
276	276	(d) For the purposes of Subsection (c), an out-of-network
277	277	provider may not bill an enrollee in, and the enrollee does not have
278	278	financial responsibility for, an amount greater than the enrollee's
279	279	responsibility under the enrollee's managed care plan, including an
280	280	applicable copayment, coinsurance, or deductible.
281	281	Sec. 1579.110. OUT-OF-NETWORK FACILITY-BASED PROVIDER
282	282	COVERAGE. (a) In this section, "facility-based provider" means a
283	283	physician or health care provider who provides health care services
284	284	to patients of a health care facility.
285	285	(b) A managed care plan provided under this chapter must
286	286	provide out-of-network facility-based provider coverage in
287	287	accordance with this section.
288	288	(c) The coverage must require the administrator of the plan
289	289	to pay for a health care service performed for an enrollee by an
290	290	out-of-network provider who is a facility-based provider in an
291	291	amount that the administrator determines is reasonable for the
292	292	service or at an agreed rate if the provider performed the service
293	293	at a health care facility that is a participating provider.
294	294	(d) An out-of-network provider who is a facility-based
295	295	provider may not bill an enrollee receiving a health care service
296	296	described by Subsection (c) in, and the enrollee does not have
297	297	financial responsibility for, an amount greater than the enrollee's
298	298	responsibility under the enrollee's managed care plan, including an
299	299	applicable copayment, coinsurance, or deductible.
300	300	ARTICLE 3. MANDATORY MEDIATION REQUESTED BY PROVIDER, ISSUER, OR
301	301	ADMINISTRATOR
302	302	SECTION 3.01. Sections 1467.001(1), (3), (5), and (7),
303	303	Insurance Code, are amended to read as follows:
304	304	(1) "Administrator" means:
305	305	(A) an administering firm for a health benefit
306	306	plan providing coverage under Chapter 1551, 1575, or 1579; [and]
307	307	(B) if applicable, the claims administrator for
308	308	the health benefit plan; and
309	309	(C) if applicable, an administrating firm for an
310	310	eligible plan for which an election is made under Section
311	311	1276.0002.
312	312	(3) "Enrollee" means an individual who is eligible to
313	313	receive benefits through a [preferred provider benefit plan or a]
314	314	health benefit plan subject to this chapter [under Chapter 1551,
315	315	1575, or 1579].
316	316	(5) "Mediation" means a process in which an impartial
317	317	mediator facilitates and promotes agreement between the health
318	318	[insurer offering a preferred provider] benefit plan issuer or the
319	319	administrator and a facility-based provider or emergency care
320	320	provider or the provider's representative to settle a health
321	321	benefit claim of an enrollee.
322	322	(7) "Party" means a health benefit plan issuer [an
323	323	insurer] offering a health [a preferred provider] benefit plan, an
324	324	administrator, or a facility-based provider or emergency care
325	325	provider or the provider's representative who participates in a
326	326	mediation conducted under this chapter. [The enrollee is also
327	327	considered a party to the mediation.]
328	328	SECTION 3.02. Sections 1467.002 and 1467.005, Insurance
329	329	Code, are amended to read as follows:
330	330	Sec. 1467.002. APPLICABILITY OF CHAPTER. This chapter
331	331	applies to:
332	332	(1) a health benefit plan offered by a health
333	333	maintenance organization operating under Chapter 843;
334	334	(2) a preferred provider benefit plan, including an
335	335	exclusive provider benefit plan, offered by an insurer under
336	336	Chapter 1301; and
337	337	(3) [(2)] an administrator of a health benefit plan,
338	338	other than a health maintenance organization plan, under Chapter
339	339	1551, 1575, or 1579 or of an eligible plan for which an election is
340	340	made under Section 1276.0002.
341	341	Sec. 1467.005. REFORM. This chapter may not be construed to
342	342	prohibit:
343	343	(1) a health [an insurer offering a preferred
344	344	provider] benefit plan issuer or administrator from, at any time,
345	345	offering a reformed claim settlement; or
346	346	(2) a facility-based provider or emergency care
347	347	provider from, at any time, offering a reformed charge for health
348	348	care or medical services or supplies.
349	349	SECTION 3.03. Sections 1467.051(a) and (b), Insurance Code,
350	350	are amended to read as follows:
351	351	(a) A facility-based provider, emergency care provider,
352	352	health benefit plan issuer, or administrator [An enrollee] may
353	353	request mediation of a settlement of an out-of-network health
354	354	benefit claim if:
355	355	(1) the amount charged by the provider and unpaid by
356	356	the issuer or administrator [for which the enrollee is responsible
357	357	to a facility-based provider or emergency care provider], after
358	358	copayments, deductibles, and coinsurance, [including the amount
359	359	unpaid by the administrator or insurer,] is greater than $500; and
360	360	(2) the health benefit claim is for:
361	361	(A) emergency care; or
362	362	(B) a health care or medical service or supply
363	363	provided by a facility-based provider in a facility that is a
364	364	preferred provider or that has a contract with the administrator.
365	365	(b) If a person [Except as provided by Subsections (c) and
366	366	(d), if an enrollee] requests mediation under this subchapter, the
367	367	facility-based provider or emergency care provider, or the
368	368	provider's representative, and the health benefit plan issuer
369	369	[insurer] or the administrator, as appropriate, shall participate
370	370	in the mediation.
371	371	SECTION 3.04. Section 1467.052(c), Insurance Code, is
372	372	amended to read as follows:
373	373	(c) A person may not act as mediator for a claim settlement
374	374	dispute if the person has been employed by, consulted for, or
375	375	otherwise had a business relationship with a health benefit plan
376	376	issuer or administrator of a health [an insurer offering the
377	377	preferred provider] benefit plan that is subject to this chapter or
378	378	a physician, health care practitioner, or other health care
379	379	provider during the three years immediately preceding the request
380	380	for mediation.
381	381	SECTION 3.05. Section 1467.053(d), Insurance Code, is
382	382	amended to read as follows:
383	383	(d) The mediator's fees shall be split evenly and paid by
384	384	the health benefit plan issuer [insurer] or administrator and the
385	385	facility-based provider or emergency care provider.
386	386	SECTION 3.06. Sections 1467.054(a), (b), (c), and (d),
387	387	Insurance Code, are amended to read as follows:
388	388	(a) A facility-based provider, emergency care provider,
389	389	health benefit plan issuer, or administrator [An enrollee] may
390	390	request mandatory mediation under this subchapter [chapter].
391	391	(b) A request for mandatory mediation must be provided to
392	392	the department on a form prescribed by the commissioner and must
393	393	include:
394	394	(1) the name of the person [enrollee] requesting
395	395	mediation;
396	396	(2) a brief description of the claim to be mediated;
397	397	(3) contact information, including a telephone
398	398	number, for the requesting person [enrollee] and the person's
399	399	[enrollee's] counsel, if the person [enrollee] retains counsel;
400	400	(4) the name of the facility-based provider or
401	401	emergency care provider and name of the health benefit plan issuer
402	402	[insurer] or administrator; and
403	403	(5) any other information the commissioner may require
404	404	by rule.
405	405	(c) On receipt of a request for mediation, the department
406	406	shall notify, as applicable, the facility-based provider or
407	407	emergency care provider and health benefit plan issuer [insurer] or
408	408	administrator of the request.
409	409	(d) In an effort to settle the claim before mediation, all
410	410	parties must participate in an informal settlement teleconference
411	411	not later than the 30th day after the date on which a person [the
412	412	enrollee] submits a request for mediation under this subchapter
413	413	[section].
414	414	SECTION 3.07. Section 1467.055(g), Insurance Code, is
415	415	amended to read as follows:
416	416	(g) A [Except at the request of an enrollee, a] mediation
417	417	shall be held not later than the 180th day after the date of the
418	418	request for mediation.
419	419	SECTION 3.08. Sections 1467.056(a), (b), and (d), Insurance
420	420	Code, are amended to read as follows:
421	421	(a) In a mediation under this subchapter [chapter], the
422	422	parties shall[:
423	423	[(1)] evaluate whether:
424	424	(1) [(A)] the amount charged by the facility-based
425	425	provider or emergency care provider for the health care or medical
426	426	service or supply is excessive; and
427	427	(2) [(B)] the amount paid by the health benefit plan
428	428	issuer [insurer] or administrator represents a reasonable amount
429	429	[the usual and customary rate] for the health care or medical
430	430	service or supply or is unreasonably low[; and
431	431	[(2) as a result of the amounts described by
432	432	Subdivision (1), determine the amount, after copayments,
433	433	deductibles, and coinsurance are applied, for which an enrollee is
434	434	responsible to the facility-based provider or emergency care
435	435	provider].
436	436	(b) The facility-based provider or emergency care provider
437	437	may present information regarding the amount charged for the health
438	438	care or medical service or supply. The health benefit plan issuer
439	439	[insurer] or administrator may present information regarding the
440	440	amount paid by the issuer [insurer] or administrator.
441	441	(d) The goal of the mediation is to reach an agreement among
442	442	[the enrollee,] the facility-based provider or emergency care
443	443	provider[,] and the health benefit plan issuer [insurer] or
444	444	administrator, as applicable, as to the amount paid by the issuer
445	445	[insurer] or administrator to the facility-based provider or
446	446	emergency care provider and[,] the amount charged by the
447	447	facility-based provider or emergency care provider[, and the amount
448	448	paid to the facility-based provider or emergency care provider by
449	449	the enrollee].
450	450	SECTION 3.09. Sections 1467.058 and 1467.059, Insurance
451	451	Code, are amended to read as follows:
452	452	Sec. 1467.058. CONTINUATION OF MEDIATION. After a referral
453	453	is made under Section 1467.057, the facility-based provider or
454	454	emergency care provider and the health benefit plan issuer
455	455	[insurer] or administrator may elect to continue the mediation to
456	456	further determine their responsibilities. [Continuation of
457	457	mediation under this section does not affect the amount of the
458	458	billed charge to the enrollee.]
459	459	Sec. 1467.059. MEDIATION AGREEMENT. The mediator shall
460	460	prepare a confidential mediation agreement and order that states[:
461	461	[(1) the total amount for which the enrollee will be
462	462	responsible to the facility-based provider or emergency care
463	463	provider, after copayments, deductibles, and coinsurance; and
464	464	[(2)] any agreement reached by the parties under
465	465	Section 1467.058.
466	466	SECTION 3.10. Section 1467.101(a), Insurance Code, is
467	467	amended to read as follows:
468	468	(a) The following conduct constitutes bad faith mediation
469	469	for purposes of this chapter:
470	470	(1) failing to participate in the mediation;
471	471	(2) failing to provide information the mediator
472	472	believes is necessary to facilitate an agreement; [or]
473	473	(3) failing to designate a representative
474	474	participating in the mediation with full authority to enter into
475	475	any mediated agreement; or
476	476	(4) failing to appear for mediation.
477	477	SECTION 2.11. Section 1467.151(b), Insurance Code, is
478	478	amended to read as follows:
479	479	(b) The department and the Texas Medical Board or other
480	480	appropriate regulatory agency shall maintain information:
481	481	(1) on each complaint filed that concerns a claim or
482	482	mediation subject to this chapter; and
483	483	(2) related to a claim that is the basis of an enrollee
484	484	complaint, including:
485	485	(A) the type of services that gave rise to the
486	486	dispute;
487	487	(B) the type and specialty, if any, of the
488	488	facility-based provider or emergency care provider who provided the
489	489	out-of-network service;
490	490	(C) the county and metropolitan area in which the
491	491	health care or medical service or supply was provided;
492	492	(D) whether the health care or medical service or
493	493	supply was for emergency care; and
494	494	(E) any other information about:
495	495	(i) the health benefit plan issuer
496	496	[insurer] or administrator that the commissioner by rule requires;
497	497	or
498	498	(ii) the facility-based provider or
499	499	emergency care provider that the Texas Medical Board or other
500	500	appropriate regulatory agency by rule requires.
501	501	ARTICLE 4. CONFORMING AMENDMENTS
502	502	SECTION 4.01. Sections 1456.002(a) and (c), Insurance Code,
503	503	are amended to read as follows:
504	504	(a) This chapter applies to any health benefit plan that:
505	505	(1) provides benefits for medical or surgical expenses
506	506	incurred as a result of a health condition, accident, or sickness,
507	507	including an individual, group, blanket, or franchise insurance
508	508	policy or insurance agreement, a group hospital service contract,
509	509	or an individual or group evidence of coverage that is offered by:
510	510	(A) an insurance company;
511	511	(B) a group hospital service corporation
512	512	operating under Chapter 842;
513	513	(C) a fraternal benefit society operating under
514	514	Chapter 885;
515	515	(D) a stipulated premium company operating under
516	516	Chapter 884;
517	517	(E) [a health maintenance organization operating
518	518	under Chapter 843;
519	519	[(F)] a multiple employer welfare arrangement
520	520	that holds a certificate of authority under Chapter 846;
521	521	(F) [(G)] an approved nonprofit health
522	522	corporation that holds a certificate of authority under Chapter
523	523	844; or
524	524	(G) [(H)] an entity not authorized under this
525	525	code or another insurance law of this state that contracts directly
526	526	for health care services on a risk-sharing basis, including a
527	527	capitation basis; or
528	528	(2) provides health and accident coverage through a
529	529	risk pool created under Chapter 172, Local Government Code,
530	530	notwithstanding Section 172.014, Local Government Code, or any
531	531	other law.
532	532	(c) This chapter does not apply to:
533	533	(1) Medicaid managed care programs operated under
534	534	Chapter 533, Government Code;
535	535	(2) Medicaid programs operated under Chapter 32, Human
536	536	Resources Code; [or]
537	537	(3) the state child health plan operated under Chapter
538	538	62 or 63, Health and Safety Code; or
539	539	(4) a health benefit plan subject to Section 1271.155,
540	540	1301.164, 1551.229, 1575.172, or 1579.110, or an eligible plan for
541	541	which an election is made under Section 1276.0002.
542	542	SECTION 4.02. The following provisions of the Insurance
543	543	Code are repealed:
544	544	(1) Sections 1467.051(c) and (d);
545	545	(2) Section 1467.0511;
546	546	(3) Sections 1467.054(f) and (g);
547	547	(4) Section 1467.055(d); and
548	548	(5) Section 1467.151(d).
549	549	ARTICLE 5. TRANSITION AND EFFECTIVE DATE
550	550	SECTION 5.01. The changes in law made by this Act apply only
551	551	to a health care or medical service or supply provided on or after
552	552	the effective date of this Act. A health care or medical service or
553	553	supply provided before the effective date of this Act is governed by
554	554	the law in effect immediately before the effective date of this Act,
555	555	and that law is continued in effect for that purpose.
556	556	SECTION 4.02. This Act takes effect September 1, 2019.