88R10353 CJD-D
By: Hughes S.B. No. 863
A BILL TO BE ENTITLED
AN ACT
relating to electronic verification of health benefits by health
benefit plan issuers for certain physicians and health care
providers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
by adding Chapter 1223 to read as follows:
CHAPTER 1223. VERIFICATION OF HEALTH BENEFITS
Sec. 1223.001. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan that provides benefits for
medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including an individual, group,
blanket, or franchise insurance policy or insurance agreement, a
group hospital service contract, or an individual or group evidence
of coverage or similar coverage document that is issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
Chapter 1682;
(8) alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
M, Chapter 2054;
(9) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(10) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(11) the state Medicaid program, including the
Medicaid managed care program operated under Chapter 533,
Government Code;
(12) the child health plan program under Chapter 62,
Health and Safety Code;
(13) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(14) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(15) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(16) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
Sec. 1223.002. INTERNET WEBSITE FOR VERIFICATION REQUIRED
FOR EMERGENCY PHYSICIANS AND HEALTH CARE PROVIDERS. A health
benefit plan issuer shall maintain and make available a secure
system on the issuer's Internet website that allows a physician or
health care provider for a hospital or freestanding emergency
medical care facility to determine at any time:
(1) whether the physician's or provider's patient is
covered by the issuer's health benefit plan;
(2) whether the issuer will pay the physician or
provider for the proposed health care service or supply the
physician or provider intends to provide to the patient; and
(3) the deductible, copayment, or coinsurance for
which the patient is responsible.
SECTION 2. If before implementing any provision of Chapter
1223, Insurance Code, as added by this Act, a state agency
determines that a waiver or authorization from a federal agency is
necessary for implementation of that provision, the agency affected
by the provision shall request the waiver or authorization and may
delay implementing that provision until the waiver or authorization
is granted.
SECTION 3. This Act takes effect January 1, 2024.