Texas 2019 - 86th Regular

Texas Senate Bill SB1740 Compare Versions

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

Old	New	Differences
1	1	86R12010 JES-F
2	2	By: Menéndez S.B. No. 1740
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to disclosures by certain health benefit plans to
8	8	enrollees regarding certain preauthorized medical care and health
9	9	care services.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter F, Chapter 843, Insurance Code, is
12	12	amended by adding Section 843.2025 to read as follows:
13	13	Sec. 843.2025. DISCLOSURES CONCERNING CERTAIN
14	14	PREAUTHORIZED SERVICES. (a) In this section:
15	15	(1) "Elective health care service" means a covered
16	16	health care service that is scheduled in advance.
17	17	(2) "Licensed medical facility" means:
18	18	(A) a hospital licensed under Chapter 241, Health
19	19	and Safety Code;
20	20	(B) an ambulatory surgical center licensed under
21	21	Chapter 243, Health and Safety Code; or
22	22	(C) a birthing center licensed under Chapter 244,
23	23	Health and Safety Code.
24	24	(3) "Preauthorization" has the meaning assigned by
25	25	Section 843.348.
26	26	(b) If a health maintenance organization preauthorizes an
27	27	elective health care service to be provided at a licensed medical
28	28	facility, the health maintenance organization shall, within a
29	29	reasonable period before the date the health care service is
30	30	scheduled to be performed, provide to the enrollee:
31	31	(1) a statement of the name and network status of any
32	32	facility-based physician or provider that the health maintenance
33	33	organization reasonably expects will provide and charge for the
34	34	preauthorized service;
35	35	(2) an estimate of:
36	36	(A) the payment that will be made for the
37	37	preauthorized service; and
38	38	(B) the enrollee's financial responsibility for
39	39	the preauthorized service, including any copayment or other
40	40	out-of-pocket amount for which the enrollee is responsible;
41	41	(3) a statement that the actual charges and payment
42	42	for the health care service and the enrollee's financial
43	43	responsibility for the health care service may vary from the
44	44	estimate provided by the health maintenance organization based on
45	45	the enrollee's medical condition and other factors associated with
46	46	the performance of the health care service; and
47	47	(4) a statement that the enrollee may be personally
48	48	liable for the amount charged for health care services provided to
49	49	the enrollee depending on the enrollee's health benefit plan
50	50	coverage.
51	51	(c) A general statement that some facility-based physicians
52	52	or providers may be out-of-network does not satisfy the notice
53	53	requirement of Subsection (b).
54	54	SECTION 2. Subchapter C-1, Chapter 1301, Insurance Code, is
55	55	amended by adding Section 1301.1355 to read as follows:
56	56	Sec. 1301.1355. DISCLOSURES CONCERNING CERTAIN
57	57	PREAUTHORIZED SERVICES. (a) In this section:
58	58	(1) "Elective medical care or health care service"
59	59	means a covered medical care or health care service that is
60	60	scheduled in advance.
61	61	(2) "Licensed medical facility" means:
62	62	(A) a hospital licensed under Chapter 241, Health
63	63	and Safety Code;
64	64	(B) an ambulatory surgical center licensed under
65	65	Chapter 243, Health and Safety Code; or
66	66	(C) a birthing center licensed under Chapter 244,
67	67	Health and Safety Code.
68	68	(b) If an insurer preauthorizes an elective medical care or
69	69	health care service to be provided at a licensed medical facility,
70	70	the insurer shall, within a reasonable period before the date the
71	71	medical care or health care service is scheduled to be performed,
72	72	provide to the insured:
73	73	(1) a statement of the name and network status of any
74	74	facility-based physician or health care provider that the insurer
75	75	reasonably expects will provide and charge for the preauthorized
76	76	service;
77	77	(2) an estimate of:
78	78	(A) the payment that will be made for the
79	79	preauthorized service; and
80	80	(B) the insured's financial responsibility for
81	81	the preauthorized service, including any copayment, coinsurance,
82	82	deductible, or other out-of-pocket amount for which the insured is
83	83	responsible;
84	84	(3) a statement that the actual charges and payment
85	85	for the medical care or health care service and the insured's
86	86	financial responsibility for the medical care or health care
87	87	service may vary from the estimate provided by the insurer based on
88	88	the insured's medical condition and other factors associated with
89	89	the performance of the medical care or health care service; and
90	90	(4) a statement that the insured may be personally
91	91	liable for the amount charged for medical care or health care
92	92	services provided to the insured depending on the insured's health
93	93	benefit plan coverage.
94	94	(c) A general statement that some facility-based physicians
95	95	or health care providers may be out-of-network does not satisfy the
96	96	notice requirement of Subsection (b).
97	97	SECTION 3. The changes in law made by this Act apply only to
98	98	a health benefit plan that is delivered, issued for delivery, or
99	99	renewed on or after January 1, 2020.
100	100	SECTION 4. This Act takes effect January 1, 2020.