Texas 2023 - 88th Regular

Texas Senate Bill SB583 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R3200 CJD-D
2	2	By: Hughes S.B. No. 583
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a direct payment to a health care provider in lieu of a
8	8	claim for benefits under a health benefit plan.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1204, Insurance Code, is amended by
11	11	adding Subchapter G to read as follows:
12	12	SUBCHAPTER G. DIRECT PAYMENT TO HEALTH CARE PROVIDER
13	13	Sec. 1204.301. DEFINITION. In this subchapter, "health
14	14	care provider" means a health care practitioner or health care
15	15	facility that provides health care services under a license,
16	16	certificate, registration, or other similar evidence of regulation
17	17	issued by this or another state of the United States.
18	18	Sec. 1204.302. APPLICABILITY OF SUBCHAPTER. (a) This
19	19	subchapter applies only to a health benefit plan that provides
20	20	benefits for medical or surgical expenses incurred as a result of a
21	21	health condition, accident, or sickness, including an individual,
22	22	group, blanket, or franchise insurance policy or insurance
23	23	agreement, a group hospital service contract, or an individual or
24	24	group evidence of coverage or similar coverage document that is
25	25	offered by:
26	26	(1) an insurance company;
27	27	(2) a group hospital service corporation operating
28	28	under Chapter 842;
29	29	(3) a health maintenance organization operating under
30	30	Chapter 843;
31	31	(4) an approved nonprofit health corporation that
32	32	holds a certificate of authority under Chapter 844;
33	33	(5) a multiple employer welfare arrangement that holds
34	34	a certificate of authority under Chapter 846;
35	35	(6) a stipulated premium company operating under
36	36	Chapter 884;
37	37	(7) a fraternal benefit society operating under
38	38	Chapter 885;
39	39	(8) a Lloyd's plan operating under Chapter 941; or
40	40	(9) an exchange operating under Chapter 942.
41	41	(b) Notwithstanding any other law, this subchapter applies
42	42	to:
43	43	(1) a small employer health benefit plan subject to
44	44	Chapter 1501, including coverage provided through a health group
45	45	cooperative under Subchapter B of that chapter;
46	46	(2) a standard health benefit plan issued under
47	47	Chapter 1507;
48	48	(3) a basic coverage plan under Chapter 1551;
49	49	(4) a basic plan under Chapter 1575;
50	50	(5) a primary care coverage plan under Chapter 1579;
51	51	(6) a plan providing basic coverage under Chapter
52	52	1601;
53	53	(7) health benefits provided by or through a church
54	54	benefits board under Subchapter I, Chapter 22, Business
55	55	Organizations Code;
56	56	(8) the state Medicaid program, including the Medicaid
57	57	managed care program operated under Chapter 533, Government Code;
58	58	(9) the child health plan program under Chapter 62,
59	59	Health and Safety Code;
60	60	(10) a regional or local health care program operated
61	61	under Section 75.104, Health and Safety Code;
62	62	(11) a self-funded health benefit plan sponsored by a
63	63	professional employer organization under Chapter 91, Labor Code;
64	64	(12) county employee group health benefits provided
65	65	under Chapter 157, Local Government Code; and
66	66	(13) health and accident coverage provided by a risk
67	67	pool created under Chapter 172, Local Government Code.
68	68	Sec. 1204.303. DIRECT PAYMENT IN LIEU OF CLAIM FOR
69	69	BENEFITS; EFFECT ON PLAN. (a) A health care provider may not be
70	70	prohibited from accepting directly from an enrollee full payment
71	71	for a health care service in lieu of submitting a claim to the
72	72	enrollee's health benefit plan.
73	73	(b) Notwithstanding Section 552.003 or any other law, a
74	74	health care provider's discounted cash price for services rendered
75	75	is considered full payment for purposes of Subsection (a).
76	76	(c) A health benefit plan shall apply the charge for a
77	77	health care service for which a health care provider accepts a
78	78	payment described by Subsection (a) from an enrollee towards the
79	79	enrollee's out-of-pocket maximum if the service is a covered
80	80	service under the plan. Payments for uncovered services are
81	81	ineligible to apply towards an enrollee's out-of-pocket maximum.
82	82	SECTION 2. If before implementing any provision of this Act
83	83	a state agency determines that a waiver or authorization from a
84	84	federal agency is necessary for implementation of that provision,
85	85	the agency affected by the provision shall request the waiver or
86	86	authorization and may delay implementing that provision until the
87	87	waiver or authorization is granted.
88	88	SECTION 3. Section 1204.303, Insurance Code, as added by
89	89	this Act, applies only to a health benefit plan delivered, issued
90	90	for delivery, or renewed on or after January 1, 2024.
91	91	SECTION 4. This Act takes effect September 1, 2023.