Texas 2021 - 87th Regular

Texas House Bill HB2241 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	87R16579 MWC-F
2		-	By: Oliverson, A. Johnson of Harris H.B. No. 2241
3		-	Substitute the following for H.B. No. 2241:
4		-	By: Oliverson C.S.H.B. No. 2241
	1	+	87R6443 MWC-F
	2	+	By: Oliverson H.B. No. 2241
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to the definition of emergency care for purposes of
10	8		certain health benefit plans.
11	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	10		SECTION 1. Section 843.002(7), Insurance Code, is amended
13	11		to read as follows:
14	12		(7) "Emergency care" means health care services
15	13		provided in a hospital emergency facility, freestanding emergency
16	14		medical care facility, or comparable emergency facility to evaluate
17	15		and stabilize medical conditions of a recent onset and severity,
18	16		including severe pain, regardless of the final diagnosis of the
19	17		conditions, that would lead a prudent layperson possessing an
20	18		average knowledge of medicine and health to believe that the
21	19		individual's condition, sickness, or injury is of such a nature
22	20		that failure to get immediate medical care could:
23	21		(A) place the individual's health in serious
24	22		jeopardy;
25	23		(B) result in serious impairment to bodily
26	24		functions;
27	25		(C) result in serious dysfunction of a bodily
28	26		organ or part;
29	27		(D) result in serious disfigurement; or
30	28		(E) for a pregnant woman, result in serious
31	29		jeopardy to the health of the fetus.
32	30		SECTION 2. Section 1301.155(a), Insurance Code, is amended
33	31		to read as follows:
34	32		(a) In this section, "emergency care" means health care
35	33		services provided in a hospital emergency facility, freestanding
36	34		emergency medical care facility, or comparable emergency facility
37	35		to evaluate and stabilize a medical condition of a recent onset and
38	36		severity, including severe pain, regardless of the final diagnosis
39	37		of the condition, that would lead a prudent layperson possessing an
40	38		average knowledge of medicine and health to believe that the
41	39		person's condition, sickness, or injury is of such a nature that
42	40		failure to get immediate medical care could result in:
43	41		(1) placing the person's health in serious jeopardy;
44	42		(2) serious impairment to bodily functions;
45	43		(3) serious dysfunction of a bodily organ or part;
46	44		(4) serious disfigurement; or
47	45		(5) in the case of a pregnant woman, serious jeopardy
48	46		to the health of the fetus.
49		-	SECTION 3. ~~Sections~~ 4201.002(2) ~~and (13)~~, Insurance Code,
50		-	~~are amended~~ to read as follows:
	47	+	SECTION 3. Section 4201.002(2), Insurance Code, is amended
	48	+	to read as follows:
51	49		(2) "Emergency care" means health care services
52	50		provided in a hospital emergency facility or comparable facility to
53	51		evaluate and stabilize medical conditions of a recent onset and
54	52		severity, including severe pain, regardless of the final diagnosis
55	53		of the conditions, that would lead a prudent layperson possessing
56	54		an average knowledge of medicine and health to believe that the
57	55		individual's condition, sickness, or injury is of such a nature
58	56		that failure to get immediate medical care could:
59	57		(A) place the individual's health in serious
60	58		jeopardy;
61	59		(B) result in serious impairment to bodily
62	60		functions;
63	61		(C) result in serious dysfunction of a bodily
64	62		organ or part;
65	63		(D) result in serious disfigurement; or
66	64		(E) for a pregnant woman, result in serious
67	65		jeopardy to the health of the fetus.
68		-	(13) "Utilization review" includes a system for
69		-	prospective, concurrent, or retrospective review of the medical
70		-	necessity and appropriateness of health care services, including a
71		-	determination that the services do not meet the definition of
72		-	emergency care, and a system for prospective, concurrent, or
73		-	retrospective review to determine the experimental or
74		-	investigational nature of health care services. The term does not
75		-	include a review in response to an elective request for
76		-	clarification of coverage.
77	66		SECTION 4. The changes in law made by this Act apply only to
78	67		a health benefit plan delivered, issued for delivery, or renewed on
79	68		or after January 1, 2022. A health benefit plan delivered, issued
80	69		for delivery, or renewed before January 1, 2022, is governed by the
81	70		law as it existed immediately before the effective date of this Act,
82	71		and that law is continued in effect for that purpose.
83	72		SECTION 5. This Act takes effect September 1, 2021.