By: Menéndez S.B. No. 1739
(In the Senate - Filed March 6, 2019; March 14, 2019, read
first time and referred to Committee on Business & Commerce;
April 25, 2019, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 9, Nays 0; April 25, 2019,
sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR S.B. No. 1739 By: Menéndez
A BILL TO BE ENTITLED
AN ACT
relating to payment for care provided by a chiropractor under
certain health benefit plans; providing administrative penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
amended by adding Section 843.3042 to read as follows:
Sec. 843.3042. CHIROPRACTIC SERVICES. (a) A health
maintenance organization offering a health care plan that covers a
service that is within the scope of a chiropractor's license may not
refuse to provide reimbursement to an in-network chiropractor for
the performance of the covered service solely because the service
is provided by a chiropractor.
(b) This section does not require a health maintenance
organization to cover a particular health care service.
(c) This section does not affect the right of a health
maintenance organization to determine whether a health care service
is medically necessary.
(d) A health maintenance organization that violates this
section is subject to an administrative penalty as provided by
Chapter 84 of not more than $1,000 for each claim that remains
unpaid in violation of this section. Each day the violation
continues constitutes a separate violation.
SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is
amended by adding Section 1301.0516 to read as follows:
Sec. 1301.0516. CHIROPRACTIC SERVICES. (a) An insurer
offering a preferred provider benefit plan that covers a service
that is within the scope of a chiropractor's license may not refuse
to provide reimbursement for the performance of the covered service
solely because the service is provided by a chiropractor.
(b) This section does not require an insurer to cover a
particular medical or health care service.
(c) This section does not affect the right of an insurer to
determine whether a medical or health care service is medically
necessary.
(d) An insurer that violates this section is subject to an
administrative penalty as provided by Chapter 84 of not more than
$1,000 for each claim that remains unpaid in violation of this
section. Each day a violation continues constitutes a separate
violation.
SECTION 3. Section 1451.109, Insurance Code, is amended by
adding Subsection (e) to read as follows:
(e) A health insurance policy issuer that violates this
section is subject to an administrative penalty as provided by
Chapter 84 of not more than $1,000 for each claim that remains
unpaid in violation of this section. Each day the violation
continues constitutes a separate violation.
SECTION 4. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2020. A health benefit plan that is
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 5. This Act takes effect September 1, 2019.
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