88R7381 KBB-F
By: A. Johnson of Harris H.B. No. 3196
A BILL TO BE ENTITLED
AN ACT
relating to prompt payment deadlines for health benefit plan
claims affected by a catastrophic event.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.337, Insurance Code, is amended by
amending Subsections (b) and (c) and adding Subsection (c-1) to
read as follows:
(b) If a physician or provider fails to submit a claim in
compliance with this section, the physician or provider forfeits
the right to payment [unless the failure to submit the claim in
compliance with this section is a result of a catastrophic event
that substantially interferes with the normal business operations
of the physician or provider].
(c) The period for submitting a claim under this section may
be extended by:
(1) contract;
(2) notice published by the commissioner allowing an
extension of prompt payment deadlines to a later date chosen by the
commissioner due to a catastrophic event; or
(3) the department's approval of a physician's or
provider's request for an extension due to a catastrophic event
that substantially interferes with the normal business operations
of the physician or provider.
(c-1) The commissioner may adopt rules to implement
Subsection (c), including rules establishing requirements for a
request made under Subsection (c)(3).
SECTION 2. Section 843.342(h), Insurance Code, is amended
to read as follows:
(h) A health maintenance organization is not liable for a
penalty under this section:
(1) if the failure to pay the claim in accordance with
this subchapter is a result of a catastrophic event and:
(A) the commissioner published a notice allowing
an extension of the applicable prompt payment deadlines due to the
catastrophic event; or
(B) the department approved the health
maintenance organization's request for an extension due to the
substantial interference of the catastrophic event [that
substantially interferes] with the normal business operations of
the health maintenance organization; or
(2) if the claim was paid in accordance with this
subchapter, but for less than the contracted rate, and:
(A) the physician or provider notifies the health
maintenance organization of the underpayment after the 270th day
after the date the underpayment was received; and
(B) the health maintenance organization pays the
balance of the claim on or before the 30th day after the date the
health maintenance organization receives the notice.
SECTION 3. Section 1301.102, Insurance Code, is amended by
amending Subsections (d) and (e) and adding Subsection (e-1) to
read as follows:
(d) If a physician or health care provider fails to submit a
claim in compliance with this section, the physician or provider
forfeits the right to payment [unless the failure to submit the
claim in compliance with this section is a result of a catastrophic
event that substantially interferes with the normal business
operations of the physician or provider].
(e) The period for submitting a claim under this section may
be extended by:
(1) contract;
(2) notice published by the commissioner allowing an
extension of prompt payment deadlines to a later date chosen by the
commissioner due to a catastrophic event; or
(3) the department's approval of a physician's or
health care provider's request for an extension due to a
catastrophic event that substantially interferes with the normal
business operations of the physician or provider.
(e-1) The commissioner may adopt rules to implement
Subsection (e), including rules establishing requirements for a
request made under Subsection (e)(3).
SECTION 4. Section 1301.137(h), Insurance Code, is amended
to read as follows:
(h) An insurer is not liable for a penalty under this
section:
(1) if the failure to pay the claim in accordance with
Subchapter C is a result of a catastrophic event and:
(A) the commissioner published a notice allowing
an extension of the applicable prompt payment deadlines due to the
catastrophic event; or
(B) the department approved the insurer's
request for an extension due to the substantial interference of the
catastrophic event [that substantially interferes] with the normal
business operations of the insurer; or
(2) if the claim was paid in accordance with
Subchapter C, but for less than the contracted rate, and:
(A) the preferred provider notifies the insurer
of the underpayment after the 270th day after the date the
underpayment was received; and
(B) the insurer pays the balance of the claim on
or before the 30th day after the date the insurer receives the
notice.
SECTION 5. The changes in law made by this Act apply only to
a claim submitted on or after the effective date of this Act. A
claim submitted before the effective date of this Act is governed by
the law as it existed immediately before the effective date of this
Act, and that law is continued in effect for that purpose.
SECTION 6. This Act takes effect September 1, 2023.