Texas 2023 - 88th Regular

Texas House Bill HB3773 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1	88R11672 CJD-D
2	2	By: Johnson of Dallas H.B. No. 3773
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to claims submitted and requests for verification made by
8	8	a physician or health care provider to certain health benefit plan
9	9	issuers and administrators.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Section 843.3385, Insurance Code, is amended by
12	12	adding Subsection (g) to read as follows:
13	13	(g) A health maintenance organization shall accept relevant
14	14	clinical records submitted by a treating physician or provider with
15	15	a claim related to the records or at any time after submission of
16	16	the claim.
17	17	SECTION 2. Section 843.342, Insurance Code, is amended by
18	18	adding Subsection (o) to read as follows:
19	19	(o) For the purposes of calculating a penalty under this
20	20	section related to a claim by a physician or provider described by
21	21	Section 843.351, the contracted rate for health care services
22	22	provided by the physician or provider is the usual and customary
23	23	rate for the service in the geographic area in which the service is
24	24	provided.
25	25	SECTION 3. Section 843.351, Insurance Code, is amended to
26	26	read as follows:
27	27	Sec. 843.351. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND
28	28	PROVIDERS. The provisions of this subchapter relating to prompt
29	29	payment by a health maintenance organization of a physician or
30	30	provider and to verification of health care services apply to a
31	31	physician or provider who:
32	32	(1) is not included in the health maintenance
33	33	organization delivery network; and
34	34	(2) provides health care services to an enrollee[:
35	35	[(A) care related to an emergency or its
36	36	attendant episode of care as required by state or federal law; or
37	37	[(B) specialty or other health care services at
38	38	the request of the health maintenance organization or a physician
39	39	or provider who is included in the health maintenance organization
40	40	delivery network because the services are not reasonably available
41	41	within the network].
42	42	SECTION 4. Section 1301.069, Insurance Code, is amended to
43	43	read as follows:
44	44	Sec. 1301.069. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND
45	45	HEALTH CARE PROVIDERS. The provisions of this chapter relating to
46	46	prompt payment by an insurer of a physician or health care provider
47	47	and to verification of medical care or health care services apply to
48	48	a physician or provider who:
49	49	(1) is not a preferred provider included in the
50	50	preferred provider network; and
51	51	(2) provides health care services to an insured[:
52	52	[(A) care related to an emergency or its
53	53	attendant episode of care as required by state or federal law; or
54	54	[(B) specialty or other medical care or health
55	55	care services at the request of the insurer or a preferred provider
56	56	because the services are not reasonably available from a preferred
57	57	provider who is included in the preferred delivery network].
58	58	SECTION 5. Section 1301.1054, Insurance Code, is amended by
59	59	adding Subsection (f) to read as follows:
60	60	(f) An insurer shall accept relevant clinical records
61	61	submitted by a treating physician or provider with a claim related
62	62	to the records or at any time after submission of the claim.
63	63	SECTION 6. Section 1301.137, Insurance Code, is amended by
64	64	adding Subsection (m) to read as follows:
65	65	(m) For the purposes of calculating a penalty under this
66	66	section related to a claim by a physician or health care provider
67	67	described by Section 1301.069, the contracted rate for health care
68	68	services provided by the physician or provider is the usual and
69	69	customary rate for the service in the geographic area in which the
70	70	service is provided.
71	71	SECTION 7. Subchapter E, Chapter 1551, Insurance Code, is
72	72	amended by adding Section 1551.231 to read as follows:
73	73	Sec. 1551.231. ACCEPTANCE OF CLINICAL RECORDS. The
74	74	administrator of a managed care plan provided under the group
75	75	benefits program shall accept relevant clinical records submitted
76	76	by a treating physician or provider with a claim related to the
77	77	records or at any time after submission of the claim.
78	78	SECTION 8. Subchapter D, Chapter 1575, Insurance Code, is
79	79	amended by adding Section 1575.174 to read as follows:
80	80	Sec. 1575.174. ACCEPTANCE OF CLINICAL RECORDS. The
81	81	administrator of a managed care plan provided under the group
82	82	program shall accept relevant clinical records submitted by a
83	83	treating physician or provider with a claim related to the records
84	84	or at any time after submission of the claim.
85	85	SECTION 9. Subchapter C, Chapter 1579, Insurance Code, is
86	86	amended by adding Section 1579.112 to read as follows:
87	87	Sec. 1579.112. ACCEPTANCE OF CLINICAL RECORDS. The
88	88	administrator of a managed care plan provided under this chapter
89	89	shall accept relevant clinical records submitted by a treating
90	90	physician or provider with a claim related to the records or at any
91	91	time after submission of the claim.
92	92	SECTION 10. Subchapter D, Chapter 1601, Insurance Code, is
93	93	amended by adding Section 1601.156 to read as follows:
94	94	Sec. 1601.156. ACCEPTANCE OF CLINICAL RECORDS. The
95	95	administering carrier of a managed care plan provided under this
96	96	chapter shall accept relevant clinical records submitted by a
97	97	treating physician or provider with a claim related to the records
98	98	or at any time after submission of the claim.
99	99	SECTION 11. (a) Sections 843.342(o) and 1301.137(m),
100	100	Insurance Code, as added by this Act, apply only to a penalty or
101	101	interest on a penalty owed with respect to a claim submitted on or
102	102	after the effective date of this Act.
103	103	(b) Sections 843.351 and 1301.069, Insurance Code, as
104	104	amended by this Act, apply only to health care services provided and
105	105	verification requests made on or after the effective date of this
106	106	Act. Health care services provided and verification requests made
107	107	before the effective date of this Act are governed by the law as it
108	108	existed immediately before the effective date of this Act, and that
109	109	law is continued in effect for that purpose.
110	110	SECTION 12. This Act takes effect September 1, 2023.