Texas 2021 - 87th Regular

Texas House Bill HB3558 Compare Versions

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

Old	New	Differences
1	1	By: Muñoz, Jr. H.B. No. 3558
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to provider reimbursement for certain emergency health
7	7	care services.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Section 1271.155, Insurance Code, is amended by
10	10	adding Subsection (g-1) to read as follows:
11	11	(g-1) A health maintenance organization may not, based on a
12	12	patient's final diagnosis, deny or reduce payment on a claim for the
13	13	following services provided in a hospital emergency facility,
14	14	freestanding emergency medical care facility, or comparable
15	15	emergency facility:
16	16	(1) a medical screening examination or related health
17	17	care service that is within the capability of the facility and the
18	18	facility's staff and performed to evaluate the patient's condition;
19	19	and
20	20	(2) further medical treatment:
21	21	(A) necessary to stabilize the patient and to
22	22	ensure, with reasonable medical probability, that no material
23	23	deterioration of the condition is likely to result from or occur
24	24	during the transfer of the patient from the facility; or
25	25	(B) provided with respect to emergency care.
26	26	SECTION 2. Section 1301.0053, Insurance Code, is amended by
27	27	adding Subsection (b-1) to read as follows:
28	28	(b-1) An insurer may not, based on a patient's final
29	29	diagnosis, deny or reduce payment on a claim for the following
30	30	services provided in a hospital emergency facility, freestanding
31	31	emergency medical care facility, or comparable emergency facility:
32	32	(1) a medical screening examination or related health
33	33	care service that is within the capability of the facility and the
34	34	facility's staff and performed to evaluate the patient's condition;
35	35	and
36	36	(2) further medical treatment:
37	37	(A) necessary to stabilize the patient and to
38	38	ensure, with reasonable medical probability, that no material
39	39	deterioration of the condition is likely to result from or occur
40	40	during the transfer of the patient from the facility; or
41	41	(B) provided with respect to emergency care.
42	42	SECTION 3. Section 1301.155, Insurance Code, is amended by
43	43	adding Subsection (d-1) to read as follows:
44	44	(d-1) An insurer may not, based on a patient's final
45	45	diagnosis, deny or reduce payment on a claim for the following
46	46	services provided in a hospital emergency facility, freestanding
47	47	emergency medical care facility, or comparable emergency facility:
48	48	(1) a medical screening examination or related health
49	49	care service that is within the capability of the facility and the
50	50	facility's staff and performed to evaluate the patient's condition;
51	51	and
52	52	(2) further medical treatment:
53	53	(A) necessary to stabilize the patient and to
54	54	assure, with reasonable medical probability, that no material
55	55	deterioration of the condition is likely to result from or occur
56	56	during the transfer of the patient from the facility; or
57	57	(B) provided with respect to emergency care.
58	58	SECTION 4. The changes in law made by this Act apply only to
59	59	a health benefit plan delivered, issued for delivery, or renewed on
60	60	or after January 1, 2022. A health benefit plan delivered, issued
61	61	for delivery, or renewed before January 1, 2022, is governed by the
62	62	law as it existed immediately before the effective date of this Act,
63	63	and that law is continued in effect for that purpose.
64	64	SECTION 5. This Act takes effect September 1, 2021.