Texas 2023 - 88th Regular

Texas House Bill HB3196 Compare Versions

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Version 2 (New)

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1	1	88R7381 KBB-F
2	2	By: A. Johnson of Harris H.B. No. 3196
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to prompt payment deadlines for health benefit plan
8	8	claims affected by a catastrophic event.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 843.337, Insurance Code, is amended by
11	11	amending Subsections (b) and (c) and adding Subsection (c-1) to
12	12	read as follows:
13	13	(b) If a physician or provider fails to submit a claim in
14	14	compliance with this section, the physician or provider forfeits
15	15	the right to payment [unless the failure to submit the claim in
16	16	compliance with this section is a result of a catastrophic event
17	17	that substantially interferes with the normal business operations
18	18	of the physician or provider].
19	19	(c) The period for submitting a claim under this section may
20	20	be extended by:
21	21	(1) contract;
22	22	(2) notice published by the commissioner allowing an
23	23	extension of prompt payment deadlines to a later date chosen by the
24	24	commissioner due to a catastrophic event; or
25	25	(3) the department's approval of a physician's or
26	26	provider's request for an extension due to a catastrophic event
27	27	that substantially interferes with the normal business operations
28	28	of the physician or provider.
29	29	(c-1) The commissioner may adopt rules to implement
30	30	Subsection (c), including rules establishing requirements for a
31	31	request made under Subsection (c)(3).
32	32	SECTION 2. Section 843.342(h), Insurance Code, is amended
33	33	to read as follows:
34	34	(h) A health maintenance organization is not liable for a
35	35	penalty under this section:
36	36	(1) if the failure to pay the claim in accordance with
37	37	this subchapter is a result of a catastrophic event and:
38	38	(A) the commissioner published a notice allowing
39	39	an extension of the applicable prompt payment deadlines due to the
40	40	catastrophic event; or
41	41	(B) the department approved the health
42	42	maintenance organization's request for an extension due to the
43	43	substantial interference of the catastrophic event [that
44	44	substantially interferes] with the normal business operations of
45	45	the health maintenance organization; or
46	46	(2) if the claim was paid in accordance with this
47	47	subchapter, but for less than the contracted rate, and:
48	48	(A) the physician or provider notifies the health
49	49	maintenance organization of the underpayment after the 270th day
50	50	after the date the underpayment was received; and
51	51	(B) the health maintenance organization pays the
52	52	balance of the claim on or before the 30th day after the date the
53	53	health maintenance organization receives the notice.
54	54	SECTION 3. Section 1301.102, Insurance Code, is amended by
55	55	amending Subsections (d) and (e) and adding Subsection (e-1) to
56	56	read as follows:
57	57	(d) If a physician or health care provider fails to submit a
58	58	claim in compliance with this section, the physician or provider
59	59	forfeits the right to payment [unless the failure to submit the
60	60	claim in compliance with this section is a result of a catastrophic
61	61	event that substantially interferes with the normal business
62	62	operations of the physician or provider].
63	63	(e) The period for submitting a claim under this section may
64	64	be extended by:
65	65	(1) contract;
66	66	(2) notice published by the commissioner allowing an
67	67	extension of prompt payment deadlines to a later date chosen by the
68	68	commissioner due to a catastrophic event; or
69	69	(3) the department's approval of a physician's or
70	70	health care provider's request for an extension due to a
71	71	catastrophic event that substantially interferes with the normal
72	72	business operations of the physician or provider.
73	73	(e-1) The commissioner may adopt rules to implement
74	74	Subsection (e), including rules establishing requirements for a
75	75	request made under Subsection (e)(3).
76	76	SECTION 4. Section 1301.137(h), Insurance Code, is amended
77	77	to read as follows:
78	78	(h) An insurer is not liable for a penalty under this
79	79	section:
80	80	(1) if the failure to pay the claim in accordance with
81	81	Subchapter C is a result of a catastrophic event and:
82	82	(A) the commissioner published a notice allowing
83	83	an extension of the applicable prompt payment deadlines due to the
84	84	catastrophic event; or
85	85	(B) the department approved the insurer's
86	86	request for an extension due to the substantial interference of the
87	87	catastrophic event [that substantially interferes] with the normal
88	88	business operations of the insurer; or
89	89	(2) if the claim was paid in accordance with
90	90	Subchapter C, but for less than the contracted rate, and:
91	91	(A) the preferred provider notifies the insurer
92	92	of the underpayment after the 270th day after the date the
93	93	underpayment was received; and
94	94	(B) the insurer pays the balance of the claim on
95	95	or before the 30th day after the date the insurer receives the
96	96	notice.
97	97	SECTION 5. The changes in law made by this Act apply only to
98	98	a claim submitted on or after the effective date of this Act. A
99	99	claim submitted before the effective date of this Act is governed by
100	100	the law as it existed immediately before the effective date of this
101	101	Act, and that law is continued in effect for that purpose.
102	102	SECTION 6. This Act takes effect September 1, 2023.