Texas 2023 - 88th Regular

Texas Senate Bill SB1286 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	S.B. No. 1286
2	2
3	3
4	4	AN ACT
5	5	relating to prompt payment deadlines for health benefit plan
6	6	claims affected by a catastrophic event.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Section 843.337, Insurance Code, is amended by
9	9	amending Subsections (b) and (c) and adding Subsection (c-1) to
10	10	read as follows:
11	11	(b) If a physician or provider fails to submit a claim in
12	12	compliance with this section, the physician or provider forfeits
13	13	the right to payment [unless the failure to submit the claim in
14	14	compliance with this section is a result of a catastrophic event
15	15	that substantially interferes with the normal business operations
16	16	of the physician or provider].
17	17	(c) The period for submitting a claim under this section may
18	18	be extended by:
19	19	(1) contract;
20	20	(2) notice published by the commissioner allowing an
21	21	extension of prompt payment deadlines to a later date chosen by the
22	22	commissioner due to a catastrophic event; or
23	23	(3) the department's approval of a physician's or
24	24	provider's request for an extension due to a catastrophic event
25	25	that substantially interferes with the normal business operations
26	26	of the physician or provider.
27	27	(c-1) The commissioner may adopt rules to implement
28	28	Subsection (c), including rules establishing requirements for a
29	29	request made under Subsection (c)(3).
30	30	SECTION 2. Section 843.342(h), Insurance Code, is amended
31	31	to read as follows:
32	32	(h) A health maintenance organization is not liable for a
33	33	penalty under this section:
34	34	(1) if the failure to pay the claim in accordance with
35	35	this subchapter is a result of a catastrophic event and:
36	36	(A) the commissioner published a notice allowing
37	37	an extension of the applicable prompt payment deadlines due to the
38	38	catastrophic event; or
39	39	(B) the department approved the health
40	40	maintenance organization's request for an extension due to the
41	41	substantial interference of the catastrophic event [that
42	42	substantially interferes] with the normal business operations of
43	43	the health maintenance organization; or
44	44	(2) if the claim was paid in accordance with this
45	45	subchapter, but for less than the contracted rate, and:
46	46	(A) the physician or provider notifies the health
47	47	maintenance organization of the underpayment after the 270th day
48	48	after the date the underpayment was received; and
49	49	(B) the health maintenance organization pays the
50	50	balance of the claim on or before the 30th day after the date the
51	51	health maintenance organization receives the notice.
52	52	SECTION 3. Section 1301.102, Insurance Code, is amended by
53	53	amending Subsections (d) and (e) and adding Subsection (e-1) to
54	54	read as follows:
55	55	(d) If a physician or health care provider fails to submit a
56	56	claim in compliance with this section, the physician or provider
57	57	forfeits the right to payment [unless the failure to submit the
58	58	claim in compliance with this section is a result of a catastrophic
59	59	event that substantially interferes with the normal business
60	60	operations of the physician or provider].
61	61	(e) The period for submitting a claim under this section may
62	62	be extended by:
63	63	(1) contract;
64	64	(2) notice published by the commissioner allowing an
65	65	extension of prompt payment deadlines to a later date chosen by the
66	66	commissioner due to a catastrophic event; or
67	67	(3) the department's approval of a physician's or
68	68	health care provider's request for an extension due to a
69	69	catastrophic event that substantially interferes with the normal
70	70	business operations of the physician or provider.
71	71	(e-1) The commissioner may adopt rules to implement
72	72	Subsection (e), including rules establishing requirements for a
73	73	request made under Subsection (e)(3).
74	74	SECTION 4. Section 1301.137(h), Insurance Code, is amended
75	75	to read as follows:
76	76	(h) An insurer is not liable for a penalty under this
77	77	section:
78	78	(1) if the failure to pay the claim in accordance with
79	79	Subchapter C is a result of a catastrophic event and:
80	80	(A) the commissioner published a notice allowing
81	81	an extension of the applicable prompt payment deadlines due to the
82	82	catastrophic event; or
83	83	(B) the department approved the insurer's
84	84	request for an extension due to the substantial interference of the
85	85	catastrophic event [that substantially interferes] with the normal
86	86	business operations of the insurer; or
87	87	(2) if the claim was paid in accordance with
88	88	Subchapter C, but for less than the contracted rate, and:
89	89	(A) the preferred provider notifies the insurer
90	90	of the underpayment after the 270th day after the date the
91	91	underpayment was received; and
92	92	(B) the insurer pays the balance of the claim on
93	93	or before the 30th day after the date the insurer receives the
94	94	notice.
95	95	SECTION 5. The changes in law made by this Act apply only to
96	96	a claim submitted on or after the effective date of this Act. A
97	97	claim submitted before the effective date of this Act is governed by
98	98	the law as it existed immediately before the effective date of this
99	99	Act, and that law is continued in effect for that purpose.
100	100	SECTION 6. This Act takes effect September 1, 2023.
101	101	______________________________ ______________________________
102	102	President of the Senate Speaker of the House
103	103	I hereby certify that S.B. No. 1286 passed the Senate on
104	104	April 20, 2023, by the following vote: Yeas 31, Nays 0.
105	105	______________________________
106	106	Secretary of the Senate
107	107	I hereby certify that S.B. No. 1286 passed the House on
108	108	May 5, 2023, by the following vote: Yeas 142, Nays 2, three
109	109	present not voting.
110	110	______________________________
111	111	Chief Clerk of the House
112	112	Approved:
113	113	______________________________
114	114	Date
115	115	______________________________
116	116	Governor