| 1 | 1 | | 88R10353 CJD-D |
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| 2 | 2 | | By: Hughes S.B. No. 863 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to electronic verification of health benefits by health |
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| 8 | 8 | | benefit plan issuers for certain physicians and health care |
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| 9 | 9 | | providers. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Subtitle A, Title 8, Insurance Code, is amended |
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| 12 | 12 | | by adding Chapter 1223 to read as follows: |
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| 13 | 13 | | CHAPTER 1223. VERIFICATION OF HEALTH BENEFITS |
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| 14 | 14 | | Sec. 1223.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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| 15 | 15 | | applies only to a health benefit plan that provides benefits for |
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| 16 | 16 | | medical or surgical expenses incurred as a result of a health |
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| 17 | 17 | | condition, accident, or sickness, including an individual, group, |
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| 18 | 18 | | blanket, or franchise insurance policy or insurance agreement, a |
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| 19 | 19 | | group hospital service contract, or an individual or group evidence |
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| 20 | 20 | | of coverage or similar coverage document that is issued by: |
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| 21 | 21 | | (1) an insurance company; |
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| 22 | 22 | | (2) a group hospital service corporation operating |
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| 23 | 23 | | under Chapter 842; |
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| 24 | 24 | | (3) a health maintenance organization operating under |
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| 25 | 25 | | Chapter 843; |
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| 26 | 26 | | (4) an approved nonprofit health corporation that |
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| 27 | 27 | | holds a certificate of authority under Chapter 844; |
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| 28 | 28 | | (5) a multiple employer welfare arrangement that holds |
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| 29 | 29 | | a certificate of authority under Chapter 846; |
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| 30 | 30 | | (6) a stipulated premium company operating under |
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| 31 | 31 | | Chapter 884; |
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| 32 | 32 | | (7) a fraternal benefit society operating under |
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| 33 | 33 | | Chapter 885; |
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| 34 | 34 | | (8) a Lloyd's plan operating under Chapter 941; or |
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| 35 | 35 | | (9) an exchange operating under Chapter 942. |
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| 36 | 36 | | (b) Notwithstanding any other law, this chapter applies to: |
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| 37 | 37 | | (1) a small employer health benefit plan subject to |
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| 38 | 38 | | Chapter 1501, including coverage provided through a health group |
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| 39 | 39 | | cooperative under Subchapter B of that chapter; |
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| 40 | 40 | | (2) a standard health benefit plan issued under |
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| 41 | 41 | | Chapter 1507; |
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| 42 | 42 | | (3) a basic coverage plan under Chapter 1551; |
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| 43 | 43 | | (4) a basic plan under Chapter 1575; |
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| 44 | 44 | | (5) a primary care coverage plan under Chapter 1579; |
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| 45 | 45 | | (6) a plan providing basic coverage under Chapter |
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| 46 | 46 | | 1601; |
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| 47 | 47 | | (7) nonprofit agricultural organization health |
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| 48 | 48 | | benefits offered by a nonprofit agricultural organization under |
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| 49 | 49 | | Chapter 1682; |
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| 50 | 50 | | (8) alternative health benefit coverage offered by a |
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| 51 | 51 | | subsidiary of the Texas Mutual Insurance Company under Subchapter |
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| 52 | 52 | | M, Chapter 2054; |
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| 53 | 53 | | (9) health benefits provided by or through a church |
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| 54 | 54 | | benefits board under Subchapter I, Chapter 22, Business |
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| 55 | 55 | | Organizations Code; |
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| 56 | 56 | | (10) group health coverage made available by a school |
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| 57 | 57 | | district in accordance with Section 22.004, Education Code; |
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| 58 | 58 | | (11) the state Medicaid program, including the |
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| 59 | 59 | | Medicaid managed care program operated under Chapter 533, |
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| 60 | 60 | | Government Code; |
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| 61 | 61 | | (12) the child health plan program under Chapter 62, |
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| 62 | 62 | | Health and Safety Code; |
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| 63 | 63 | | (13) a regional or local health care program operated |
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| 64 | 64 | | under Section 75.104, Health and Safety Code; |
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| 65 | 65 | | (14) a self-funded health benefit plan sponsored by a |
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| 66 | 66 | | professional employer organization under Chapter 91, Labor Code; |
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| 67 | 67 | | (15) county employee group health benefits provided |
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| 68 | 68 | | under Chapter 157, Local Government Code; and |
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| 69 | 69 | | (16) health and accident coverage provided by a risk |
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| 70 | 70 | | pool created under Chapter 172, Local Government Code. |
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| 71 | 71 | | Sec. 1223.002. INTERNET WEBSITE FOR VERIFICATION REQUIRED |
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| 72 | 72 | | FOR EMERGENCY PHYSICIANS AND HEALTH CARE PROVIDERS. A health |
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| 73 | 73 | | benefit plan issuer shall maintain and make available a secure |
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| 74 | 74 | | system on the issuer's Internet website that allows a physician or |
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| 75 | 75 | | health care provider for a hospital or freestanding emergency |
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| 76 | 76 | | medical care facility to determine at any time: |
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| 77 | 77 | | (1) whether the physician's or provider's patient is |
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| 78 | 78 | | covered by the issuer's health benefit plan; |
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| 79 | 79 | | (2) whether the issuer will pay the physician or |
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| 80 | 80 | | provider for the proposed health care service or supply the |
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| 81 | 81 | | physician or provider intends to provide to the patient; and |
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| 82 | 82 | | (3) the deductible, copayment, or coinsurance for |
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| 83 | 83 | | which the patient is responsible. |
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| 84 | 84 | | SECTION 2. If before implementing any provision of Chapter |
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| 85 | 85 | | 1223, Insurance Code, as added by this Act, a state agency |
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| 86 | 86 | | determines that a waiver or authorization from a federal agency is |
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| 87 | 87 | | necessary for implementation of that provision, the agency affected |
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| 88 | 88 | | by the provision shall request the waiver or authorization and may |
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| 89 | 89 | | delay implementing that provision until the waiver or authorization |
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| 90 | 90 | | is granted. |
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| 91 | 91 | | SECTION 3. This Act takes effect January 1, 2024. |
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