Texas 2019 - 86th Regular

Texas House Bill HB4536

Caption

Relating to the determination of a usual and customary amount under the Insurance Code.

Impact

The implementation of HB 4536 will have significant ramifications for the insurance industry and healthcare providers in Texas. With a mandatory standardized procedure, health benefit plans—including health maintenance organizations and preferred provider organizations—will be required to follow the same method in assessing payments for healthcare services. This could potentially streamline processes, making it easier for providers to receive payment and for patients to understand their financial responsibilities regarding care received.

Summary

House Bill 4536 focuses on establishing a standardized procedure for determining the 'usual and customary' rates for medical care and services within the Texas Insurance Code. This bill aims to provide clarity and consistency for healthcare providers and insurers on how payments for medical services are determined. By establishing clear guidelines, the bill seeks to address discrepancies in payments for healthcare services, potentially reducing confusion and disputes between healthcare providers and insurance companies.

Contention

Despite its intentions for standardization, there are notable concerns regarding HB 4536. Critics argue that a one-size-fits-all approach may not adequately cater to the diverse landscape of healthcare services across Texas. Particularly, specialists or niche healthcare providers might find it challenging to align their billing practices with standardized procedures that do not account for the unique aspects of their services. The bill's passage could also raise questions about its effect on reimbursement rates and the financial viability of certain healthcare providers.

Companion Bills

No companion bills found.

Previously Filed As

TX HB4595

Relating to nonsubstantive additions to, revisions of, and corrections in enacted codes and to the nonsubstantive codification or disposition of various laws omitted from enacted codes.

TX HB1293

Relating to the reimbursement of prescription drugs under Medicaid and the child health plan program.

TX HB1128

Relating to availability of and benefits provided under health benefit plan coverage.

TX HB4912

Relating to availability of and benefits provided under health benefit plan coverage.

TX HB116

Relating to the basic allotment and guaranteed yield under the public school finance system, certain allotments under the Foundation School Program, determination of a school district's assets to liabilities ratio under the public school financial accountability rating system, and credit for prepayment of the amount required to be paid by a school district for the purchase of attendance credit under the public school finance system.

TX HB3214

Relating to the determination of prescription drug reimbursement amounts under the Medicaid vendor drug program.

TX SB1619

Relating to the determination of prescription drug reimbursement amounts under the Medicaid vendor drug program.

TX HB4611

Relating to the nonsubstantive revision of the health and human services laws governing the Health and Human Services Commission, Medicaid, and other social services.

TX SB344

Relating to the creation of the Texas Health Insurance Exchange and premium assistance and cost-sharing reduction programs; authorizing a fee.

TX HB1129

Relating to the creation of a health insurance risk pool for certain health benefit plan enrollees; authorizing an assessment.

Similar Bills

No similar bills found.