| 4 | 6 | | AN ACT |
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| 5 | 7 | | relating to payment for care provided by a chiropractor under |
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| 6 | 8 | | certain health benefit plans; providing administrative penalties. |
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| 7 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 8 | 10 | | SECTION 1. Subchapter I, Chapter 843, Insurance Code, is |
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| 9 | 11 | | amended by adding Section 843.3042 to read as follows: |
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| 10 | 12 | | Sec. 843.3042. CHIROPRACTIC SERVICES. (a) A health |
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| 11 | 13 | | maintenance organization offering a health care plan that covers a |
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| 12 | 14 | | service that is within the scope of a chiropractor's license may not |
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| 13 | 15 | | refuse to provide reimbursement to an in-network chiropractor for |
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| 14 | 16 | | the performance of the covered service solely because the service |
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| 15 | 17 | | is provided by a chiropractor. |
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| 16 | 18 | | (b) This section does not require a health maintenance |
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| 17 | 19 | | organization to cover a particular health care service. |
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| 18 | 20 | | (c) This section does not affect the right of a health |
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| 19 | 21 | | maintenance organization to determine whether a health care service |
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| 20 | 22 | | is medically necessary. |
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| 21 | 23 | | (d) A health maintenance organization that violates this |
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| 22 | 24 | | section is subject to an administrative penalty as provided by |
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| 23 | 25 | | Chapter 84 of not more than $1,000 for each claim that remains |
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| 24 | 26 | | unpaid in violation of this section. Each day the violation |
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| 25 | 27 | | continues constitutes a separate violation. |
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| 26 | 28 | | SECTION 2. Subchapter B, Chapter 1301, Insurance Code, is |
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| 27 | 29 | | amended by adding Section 1301.0516 to read as follows: |
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| 28 | 30 | | Sec. 1301.0516. CHIROPRACTIC SERVICES. (a) An insurer |
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| 29 | 31 | | offering a preferred provider benefit plan that covers a service |
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| 30 | 32 | | that is within the scope of a chiropractor's license may not refuse |
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| 31 | 33 | | to provide reimbursement for the performance of the covered service |
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| 32 | 34 | | solely because the service is provided by a chiropractor. |
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| 33 | 35 | | (b) This section does not require an insurer to cover a |
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| 34 | 36 | | particular medical or health care service. |
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| 35 | 37 | | (c) This section does not affect the right of an insurer to |
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| 36 | 38 | | determine whether a medical or health care service is medically |
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| 37 | 39 | | necessary. |
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| 38 | 40 | | (d) An insurer that violates this section is subject to an |
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| 39 | 41 | | administrative penalty as provided by Chapter 84 of not more than |
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| 40 | 42 | | $1,000 for each claim that remains unpaid in violation of this |
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| 41 | 43 | | section. Each day a violation continues constitutes a separate |
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| 42 | 44 | | violation. |
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| 43 | 45 | | SECTION 3. Section 1451.109, Insurance Code, is amended by |
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| 44 | 46 | | adding Subsection (e) to read as follows: |
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| 45 | 47 | | (e) A health insurance policy issuer that violates this |
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| 46 | 48 | | section is subject to an administrative penalty as provided by |
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| 47 | 49 | | Chapter 84 of not more than $1,000 for each claim that remains |
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| 48 | 50 | | unpaid in violation of this section. Each day the violation |
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| 49 | 51 | | continues constitutes a separate violation. |
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| 50 | 52 | | SECTION 4. The change in law made by this Act applies only |
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| 51 | 53 | | to a health benefit plan that is delivered, issued for delivery, or |
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| 52 | 54 | | renewed on or after January 1, 2020. A health benefit plan that is |
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| 53 | 55 | | delivered, issued for delivery, or renewed before January 1, 2020, |
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| 54 | 56 | | is governed by the law as it existed immediately before the |
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| 55 | 57 | | effective date of this Act, and that law is continued in effect for |
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| 56 | 58 | | that purpose. |
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| 57 | 59 | | SECTION 5. This Act takes effect September 1, 2019. |
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| 58 | | - | ______________________________ ______________________________ |
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| 59 | | - | President of the Senate Speaker of the House |
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| 60 | | - | I hereby certify that S.B. No. 1739 passed the Senate on May |
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| 61 | | - | 3, 2019, by the following vote: Yeas 30, Nays 1. |
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| 62 | | - | ______________________________ |
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| 63 | | - | Secretary of the Senate |
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| 64 | | - | I hereby certify that S.B. No. 1739 passed the House on May |
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| 65 | | - | 10, 2019, by the following vote: Yeas 129, Nays 12, two present |
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| 66 | | - | not voting. |
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| 67 | | - | ______________________________ |
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| 68 | | - | Chief Clerk of the House |
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| 69 | | - | Approved: |
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| 70 | | - | ______________________________ |
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| 71 | | - | Date |
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| 72 | | - | ______________________________ |
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| 73 | | - | Governor |
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