Texas 2023 - 88th Regular

Texas House Bill HB3848 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R12914 CJD-F
2	2	By: Oliverson H.B. No. 3848
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health maintenance organization and preferred provider
8	8	benefit plan minimum access standards for nonemergency ambulance
9	9	transport services delivered by emergency medical services
10	10	providers; providing administrative penalties.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Section 843.002(24), Insurance Code, is amended
13	13	to read as follows:
14	14	(24) "Provider" means:
15	15	(A) a person, other than a physician, who is
16	16	licensed or otherwise authorized to provide a health care service
17	17	in this state, including:
18	18	(i) a chiropractor, registered nurse,
19	19	pharmacist, optometrist, or acupuncturist; [or]
20	20	(ii) a pharmacy, hospital, or other
21	21	institution or organization; or
22	22	(iii) an emergency medical services
23	23	provider;
24	24	(B) a person who is wholly owned or controlled by
25	25	a provider or by a group of providers who are licensed or otherwise
26	26	authorized to provide the same health care service; or
27	27	(C) a person who is wholly owned or controlled by
28	28	one or more hospitals and physicians, including a
29	29	physician-hospital organization.
30	30	SECTION 2. Section 843.151, Insurance Code, is amended to
31	31	read as follows:
32	32	Sec. 843.151. RULES. The commissioner may adopt
33	33	reasonable rules as necessary and proper to:
34	34	(1) implement this chapter and Section 1367.053,
35	35	Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapters
36	36	222, 251, and 258, as applicable to a health maintenance
37	37	organization, and Chapters 1271 and 1272, including rules to:
38	38	(A) prescribe authorized investments for a
39	39	health maintenance organization for all investments not otherwise
40	40	addressed in this chapter;
41	41	(B) ensure that enrollees have adequate access to
42	42	health care services; and
43	43	(C) establish minimum physician-to-patient
44	44	ratios, mileage requirements for primary and specialty care,
45	45	minimum access standards for nonemergency ambulance transport
46	46	services delivered by an emergency medical services provider,
47	47	maximum travel time, and maximum waiting time for obtaining an
48	48	appointment; and
49	49	(2) meet the requirements of federal law and
50	50	regulations.
51	51	SECTION 3. Section 843.304(c), Insurance Code, is amended
52	52	to read as follows:
53	53	(c) This section does not require that a health maintenance
54	54	organization:
55	55	(1) use a particular type of provider in its
56	56	operation;
57	57	(2) accept each provider of a category or type, except
58	58	as provided by Article 21.52B; [or]
59	59	(3) contract directly with providers of a particular
60	60	category or type; or
61	61	(4) contract with an emergency medical services
62	62	provider if that provider does not have the authority or ability to
63	63	operate in the health maintenance organization's service area.
64	64	SECTION 4. Subchapter I, Chapter 843, Insurance Code, is
65	65	amended by adding Section 843.3046 to read as follows:
66	66	Sec. 843.3046. NONEMERGENCY AMBULANCE TRANSPORT SERVICES.
67	67	(a) A health maintenance organization offering a health care plan
68	68	that covers a nonemergency ambulance transport service that is
69	69	within the scope of an emergency medical services provider's
70	70	license may not refuse to provide reimbursement to an in-network
71	71	emergency medical services provider for the performance of the
72	72	covered service solely because the service is provided by an
73	73	emergency medical services provider.
74	74	(b) This section does not require a health maintenance
75	75	organization to cover a particular health care or nonemergency
76	76	ambulance transport service.
77	77	(c) This section does not affect the right of a health
78	78	maintenance organization to determine whether a health care or
79	79	nonemergency ambulance transport service is medically necessary.
80	80	(d) A health maintenance organization that violates this
81	81	section is subject to an administrative penalty as provided by
82	82	Chapter 84 of not more than $1,000 for each claim that remains
83	83	unpaid in violation of this section. Each day the violation
84	84	continues constitutes a separate violation.
85	85	SECTION 5. Section 843.305(d), Insurance Code, is amended
86	86	to read as follows:
87	87	(d) This section does not require that a health maintenance
88	88	organization:
89	89	(1) use a particular type of physician or provider in
90	90	its operation;
91	91	(2) accept a physician or provider of a category or
92	92	type that does not meet the practice standards and qualifications
93	93	established by the health maintenance organization; [or]
94	94	(3) contract directly with physicians or providers of
95	95	a particular category or type; or
96	96	(4) contract with an emergency medical services
97	97	provider if that provider does not have the authority or ability to
98	98	operate in the health maintenance organization's service area.
99	99	SECTION 6. Section 1301.001(1-a), Insurance Code, is
100	100	amended to read as follows:
101	101	(1-a) "Health care provider" means a practitioner,
102	102	institutional provider, or other person or organization that
103	103	furnishes health care services and that is licensed or otherwise
104	104	authorized to practice in this state. The term includes an
105	105	emergency medical services provider, a pharmacist, and a
106	106	pharmacy. The term does not include a physician.
107	107	SECTION 7. Section 1301.005, Insurance Code, is amended by
108	108	adding Subsection (d) to read as follows:
109	109	(d) This section does not require that an insurer contract
110	110	with an emergency medical services provider if that provider does
111	111	not have the authority or ability to operate in the insurer's
112	112	designated service area.
113	113	SECTION 8. Section 1301.007, Insurance Code, is amended to
114	114	read as follows:
115	115	Sec. 1301.007. RULES. The commissioner shall adopt rules
116	116	as necessary to:
117	117	(1) implement this chapter; [and]
118	118	(2) ensure reasonable accessibility and availability
119	119	of preferred provider services to residents of this state; and
120	120	(3) establish minimum access standards for
121	121	nonemergency ambulance transport services delivered by an
122	122	emergency medical services provider.
123	123	SECTION 9. Section 1301.051, Insurance Code, is amended by
124	124	adding Subsection (f) to read as follows:
125	125	(f) This section does not require that an insurer contract
126	126	with an emergency medical services provider if that provider does
127	127	not have the authority or ability to operate in the insurer's
128	128	designated service area.
129	129	SECTION 10. Subchapter B, Chapter 1301, Insurance Code, is
130	130	amended by adding Section 1301.0517 to read as follows:
131	131	Sec. 1301.0517. NONEMERGENCY AMBULANCE TRANSPORT SERVICES.
132	132	(a) An insurer offering a preferred provider benefit plan that
133	133	covers a nonemergency ambulance transport service that is within
134	134	the scope of an emergency medical services provider's license may
135	135	not refuse to provide reimbursement to an in-network emergency
136	136	medical services provider for the performance of the covered
137	137	service solely because the service is provided by an emergency
138	138	medical services provider.
139	139	(b) This section does not require an insurer to cover a
140	140	particular medical or health care service or nonemergency ambulance
141	141	transport service.
142	142	(c) This section does not affect the right of an insurer to
143	143	determine whether a medical or health care service or nonemergency
144	144	ambulance transport service is medically necessary.
145	145	(d) An insurer that violates this section is subject to an
146	146	administrative penalty as provided by Chapter 84 of not more than
147	147	$1,000 for each claim that remains unpaid in violation of this
148	148	section. Each day a violation continues constitutes a separate
149	149	violation.
150	150	SECTION 11. The change in law made by this Act applies only
151	151	to a health benefit plan that is delivered, issued for delivery, or
152	152	renewed on or after January 1, 2024. A health benefit plan that is
153	153	delivered, issued for delivery, or renewed before January 1, 2024,
154	154	is governed by the law as it existed immediately before the
155	155	effective date of this Act, and that law is continued in effect for
156	156	that purpose.
157	157	SECTION 12. This Act takes effect immediately if it
158	158	receives a vote of two-thirds of all the members elected to each
159	159	house, as provided by Section 39, Article III, Texas Constitution.
160	160	If this Act does not receive the vote necessary for immediate
161	161	effect, this Act takes effect September 1, 2023.