Texas 2023 - 88th Regular

Texas House Bill HB1236 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1	By: Oliverson, Raymond H.B. No. 1236
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to the definition of and certain determinations regarding
7	7	emergency care for purposes of certain health benefit plan
8	8	coverage.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 843.002(7), Insurance Code, is amended
11	11	to read as follows:
12	12	(7) "Emergency care" means health care services
13	13	provided in a hospital emergency facility, freestanding emergency
14	14	medical care facility, or comparable emergency facility to evaluate
15	15	and stabilize medical conditions of a recent onset and severity,
16	16	including severe pain, regardless of the final diagnosis of the
17	17	conditions, that would lead a prudent layperson possessing an
18	18	average knowledge of medicine and health to believe that the
19	19	individual's condition, sickness, or injury is of such a nature
20	20	that failure to get immediate medical care could:
21	21	(A) place the individual's health in serious
22	22	jeopardy;
23	23	(B) result in serious impairment to bodily
24	24	functions;
25	25	(C) result in serious dysfunction of a bodily
26	26	organ or part;
27	27	(D) result in serious disfigurement; or
28	28	(E) for a pregnant woman, result in serious
29	29	jeopardy to the health of the fetus.
30	30	SECTION 2. Subchapter A, Chapter 843, Insurance Code, is
31	31	amended by adding Section 843.011 to read as follows:
32	32	Sec. 843.011. EMERGENCY SERVICE DETERMINATIONS. Nothing in
33	33	this subchapter prohibits a health maintenance organization from
34	34	considering diagnosis codes to detect fraud or abuse.
35	35	SECTION 3. Section 1301.155(a), Insurance Code, is amended
36	36	to read as follows:
37	37	(a) In this section, "emergency care" means health care
38	38	services provided in a hospital emergency facility, freestanding
39	39	emergency medical care facility, or comparable emergency facility
40	40	to evaluate and stabilize a medical condition of a recent onset and
41	41	severity, including severe pain, regardless of the final diagnosis
42	42	of the condition, that would lead a prudent layperson possessing an
43	43	average knowledge of medicine and health to believe that the
44	44	person's condition, sickness, or injury is of such a nature that
45	45	failure to get immediate medical care could result in:
46	46	(1) placing the person's health in serious jeopardy;
47	47	(2) serious impairment to bodily functions;
48	48	(3) serious dysfunction of a bodily organ or part;
49	49	(4) serious disfigurement; or
50	50	(5) in the case of a pregnant woman, serious jeopardy
51	51	to the health of the fetus.
52	52	SECTION 4. Subchapter D, Chapter 1301, Insurance Code, is
53	53	amended by adding Section 1301.166 to read as follows:
54	54	Sec. 1301.166. EMERGENCY SERVICE DETERMINATIONS. Nothing
55	55	in this subchapter prohibits a preferred provider benefit plan from
56	56	considering diagnosis codes to detect fraud or abuse.
57	57	SECTION 5. Section 4201.002(2), Insurance Code, is amended
58	58	to read as follows:
59	59	(2) "Emergency care" means health care services
60	60	provided in a hospital emergency facility or comparable facility to
61	61	evaluate and stabilize medical conditions of a recent onset and
62	62	severity, including severe pain, regardless of the final diagnosis
63	63	of the conditions, that would lead a prudent layperson possessing
64	64	an average knowledge of medicine and health to believe that the
65	65	individual's condition, sickness, or injury is of such a nature
66	66	that failure to get immediate medical care could:
67	67	(A) place the individual's health in serious
68	68	jeopardy;
69	69	(B) result in serious impairment to bodily
70	70	functions;
71	71	(C) result in serious dysfunction of a bodily
72	72	organ or part;
73	73	(D) result in serious disfigurement; or
74	74	(E) for a pregnant woman, result in serious
75	75	jeopardy to the health of the fetus.
76	76	SECTION 6. Subchapter A, Chapter 4201, Insurance Code, is
77	77	amended by adding Section 4201.005 to read as follows:
78	78	Sec. 4201.005. EMERGENCY SERVICE DETERMINATIONS. Nothing
79	79	in this subchapter prohibits a payor from considering diagnosis
80	80	codes to detect fraud or abuse.
81	81	SECTION 7. The changes in law made by this Act apply only to
82	82	a health benefit plan delivered, issued for delivery, or renewed on
83	83	or after January 1, 2024. A health benefit plan delivered, issued
84	84	for delivery, or renewed before January 1, 2024, is governed by the
85	85	law as it existed immediately before the effective date of this Act,
86	86	and that law is continued in effect for that purpose.
87	87	SECTION 8. This Act takes effect September 1, 2023.