Texas 2019 - 86th Regular

Texas House Bill HB4391 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	86R13731 PMO-D
2	2	By: Sheffield H.B. No. 4391
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to certain group and individual health benefit plans and
8	8	the provision of health care benefits under health care plans
9	9	through provider networks.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subtitle C, Title 6, Insurance Code, is amended
12	12	by adding Chapter 849 to read as follows:
13	13	CHAPTER 849. PROHIBITION OF PROVIDER NETWORKS
14	14	Sec. 849.0001. PURPOSE; CERTAIN PRACTICES PROHIBITED. The
15	15	purpose of this chapter is to prohibit the provision of health care
16	16	benefits by entities such as insurers and health maintenance
17	17	organizations through provider networks, preferred providers, or
18	18	similar arrangements.
19	19	Sec. 849.0002. DEFINITION. In this chapter, "health
20	20	benefit plan issuer" means:
21	21	(1) a health maintenance organization operating under
22	22	Chapter 843 or other person who arranges for or provides to
23	23	enrollees on a prepaid basis a health care plan, a limited health
24	24	care service plan, or a single health care service plan; and
25	25	(2) a life, health, and accident insurance company,
26	26	health and accident insurance company, health insurance company, or
27	27	other company operating under Chapter 841, 842, 884, 885, 982,
28	28	1301, or 1501, that is authorized to issue, deliver, or issue for
29	29	delivery in this state health insurance policies.
30	30	Sec. 849.0003. PROHIBITION OF NETWORKS. (a) A health
31	31	benefit plan issuer may not:
32	32	(1) arrange for or provide to covered persons health
33	33	care services using a delivery network that directly or indirectly
34	34	contracts or subcontracts with physicians and other health care
35	35	providers;
36	36	(2) provide, through a policy or plan, for the payment
37	37	of a level of coverage that is different from the basic level of
38	38	coverage provided by the policy or plan if the covered person uses a
39	39	physician or health care provider, or an organization of physicians
40	40	or health care providers, who contracts to provide medical or
41	41	health care services to persons covered by the policy or plan; or
42	42	(3) otherwise provide health care benefits or arrange
43	43	for health care benefits to be provided to a covered person by
44	44	contracting directly or indirectly with a physician or health care
45	45	provider, or an organization of physicians or health care
46	46	providers, to provide medical or health care services to a covered
47	47	person on a capitation basis or otherwise.
48	48	(b) This section applies without regard to whether the
49	49	physician or health care provider who is a party to a contract
50	50	described by Subsection (a) is designated as a network provider or a
51	51	preferred provider or uses another designation.
52	52	(c) Notwithstanding any other law, a health benefit plan
53	53	issuer may provide health care benefits only by indemnifying the
54	54	covered person for medical or health care expenses.
55	55	Sec. 849.0004. EXCEPTION. Notwithstanding Section
56	56	849.0003, health care benefits under the following programs may be
57	57	provided through health maintenance organizations, provider
58	58	networks, preferred providers, or similar arrangements:
59	59	(1) the child health plan program operated under
60	60	Chapter 62, Health and Safety Code;
61	61	(2) the state Medicaid program operated under Chapter
62	62	32, Human Resources Code;
63	63	(3) the Medicaid managed care program operated under
64	64	Chapter 533, Government Code;
65	65	(4) the group benefits program under Chapter 1551;
66	66	(5) the group program under Chapter 1575;
67	67	(6) the uniform group coverage program under Chapter
68	68	1579; and
69	69	(7) the uniform program under Chapter 1601.
70	70	SECTION 2. Subtitle B, Title 8, Insurance Code, is amended
71	71	by adding Chapter 1255 to read as follows:
72	72	CHAPTER 1255. RESTRICTION OF AVAILABILITY OF GROUP HEALTH COVERAGE
73	73	IN CERTAIN CIRCUMSTANCES
74	74	Sec. 1255.0001. APPLICABILITY OF CHAPTER. (a) This
75	75	chapter applies only to a health benefit plan that provides
76	76	benefits for medical or surgical expenses incurred as a result of a
77	77	health condition, accident, or sickness, including a group,
78	78	blanket, or franchise insurance policy or insurance agreement, a
79	79	group hospital service contract, or a group evidence of coverage or
80	80	similar coverage document that is issued by:
81	81	(1) an insurance company;
82	82	(2) a group hospital service corporation operating
83	83	under Chapter 842;
84	84	(3) a health maintenance organization operating under
85	85	Chapter 843;
86	86	(4) an approved nonprofit health corporation that
87	87	holds a certificate of authority under Chapter 844;
88	88	(5) a multiple employer welfare arrangement that holds
89	89	a certificate of authority under Chapter 846;
90	90	(6) a stipulated premium company operating under
91	91	Chapter 884;
92	92	(7) a fraternal benefit society operating under
93	93	Chapter 885;
94	94	(8) a Lloyd's plan operating under Chapter 941; or
95	95	(9) an exchange operating under Chapter 942.
96	96	(b) Notwithstanding any other law, this chapter applies to a
97	97	small employer health benefit plan subject to Chapter 1501,
98	98	including coverage provided through a health group cooperative
99	99	under Subchapter B of that chapter.
100	100	Sec. 1255.0002. RESTRICTION ON AVAILABILITY OF GROUP HEALTH
101	101	COVERAGE. (a) Notwithstanding Chapter 1251 or any other law, a
102	102	group health benefit policy that provides health benefits to an
103	103	employer group may not require that each employee eligible to
104	104	receive group health benefit coverage as a member of the employer
105	105	group be covered by the policy.
106	106	(b) An employee who is eligible to receive group health
107	107	benefit coverage as a member of an employer group may elect to
108	108	instead obtain health benefit coverage in the individual market or
109	109	from another source.
110	110	SECTION 3. The commissioner of insurance shall adopt rules
111	111	not later than January 1, 2020, to implement Chapters 849 and 1255,
112	112	Insurance Code, as added by this Act.
113	113	SECTION 4. The changes in law made by this Act apply only to
114	114	a health benefit plan that is delivered, issued for delivery, or
115	115	renewed on or after January 1, 2021. A health benefit plan
116	116	delivered, issued for delivery, or renewed before January 1, 2021,
117	117	is governed by the law as it existed immediately before the
118	118	effective date of this Act, and that law is continued in effect for
119	119	that purpose.
120	120	SECTION 5. This Act takes effect September 1, 2019.