Texas 2025 - 89th Regular

Texas House Bill HB3914 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R10050 DNC-D
2	2	By: Martinez H.B. No. 3914
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the health benefit plan coverage of and reimbursement
10	10	for the treatment of a first responder's injuries sustained within
11	11	the course and scope of employment.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
14	14	by adding Chapter 1373 to read as follows:
15	15	CHAPTER 1373. COVERAGE FOR WORK-RELATED INJURIES
16	16	Sec. 1373.001. DEFINITIONS. In this chapter:
17	17	(1) "First responder" means:
18	18	(A) an individual employed by a political
19	19	subdivision of this state who is:
20	20	(i) a peace officer under Article 2A.001,
21	21	Code of Criminal Procedure;
22	22	(ii) a person licensed under Chapter 773,
23	23	Health and Safety Code, as an emergency care attendant, emergency
24	24	medical technician, emergency medical technician-intermediate,
25	25	emergency medical technician-paramedic, or licensed paramedic; or
26	26	(iii) a firefighter subject to
27	27	certification by the Texas Commission on Fire Protection under
28	28	Chapter 419, Government Code, whose principal duties are
29	29	firefighting and aircraft crash and rescue; or
30	30	(B) an individual covered under Section
31	31	504.012(a), Labor Code, who is providing volunteer services to a
32	32	political subdivision of this state as:
33	33	(i) a volunteer firefighter, without regard
34	34	to whether the volunteer firefighter is certified under Subchapter
35	35	D, Chapter 419, Government Code; or
36	36	(ii) an emergency medical services
37	37	volunteer, as defined by Section 773.003, Health and Safety Code.
38	38	(2) "Workers' compensation insurance carrier" means an
39	39	insurance carrier, as that term is defined by Section 401.011,
40	40	Labor Code.
41	41	Sec. 1373.002. APPLICABILITY. (a) This chapter applies
42	42	only to a health benefit plan that provides benefits for medical or
43	43	surgical expenses incurred as a result of a health condition,
44	44	accident, or sickness, including an individual, group, blanket, or
45	45	franchise insurance policy or insurance agreement, a group hospital
46	46	service contract, or an individual or group evidence of coverage or
47	47	similar coverage document that is issued by:
48	48	(1) an insurance company;
49	49	(2) a group hospital service corporation operating
50	50	under Chapter 842;
51	51	(3) a health maintenance organization operating under
52	52	Chapter 843;
53	53	(4) an approved nonprofit health corporation that
54	54	holds a certificate of authority under Chapter 844;
55	55	(5) a multiple employer welfare arrangement that holds
56	56	a certificate of authority under Chapter 846;
57	57	(6) a stipulated premium company operating under
58	58	Chapter 884;
59	59	(7) a fraternal benefit society operating under
60	60	Chapter 885;
61	61	(8) a Lloyd's plan operating under Chapter 941; or
62	62	(9) an exchange operating under Chapter 942.
63	63	(b) Notwithstanding any other law, this chapter applies to:
64	64	(1) a primary care coverage plan under Chapter 1579;
65	65	(2) county employee group health benefits provided
66	66	under Chapter 157, Local Government Code; and
67	67	(3) health and accident coverage provided by a risk
68	68	pool created under Chapter 172, Local Government Code.
69	69	(c) Section 1425.001(a)(6) does not limit the applicability
70	70	of this chapter.
71	71	Sec. 1373.003. COVERAGE REQUIRED. (a) A health benefit
72	72	plan that provides coverage for a first responder may not exclude
73	73	coverage of the first responder's claim for medical benefits for
74	74	treatment of an injury, including all health care required to cure
75	75	or relieve the effects naturally resulting from the injury, because
76	76	the injury was or may have been sustained in the course and scope of
77	77	employment as a first responder or because the injury is or might be
78	78	compensable under workers' compensation insurance coverage.
79	79	(b) For purposes of this chapter, an injury sustained in the
80	80	course and scope of employment includes an injury sustained by a
81	81	first responder providing services on a volunteer basis.
82	82	Sec. 1373.004. REIMBURSEMENT OF CLAIM. (a) A first
83	83	responder whose claim for workers' compensation medical benefits is
84	84	denied by the workers' compensation insurance carrier shall provide
85	85	the health care provider treating the injury with proof of the
86	86	initial denial.
87	87	(b) A health benefit plan issuer shall pay the health care
88	88	provider the allowed amount under the health benefit plan for
89	89	services provided to treat the injury, regardless of whether the
90	90	injury is ultimately determined to be a compensable injury for
91	91	purposes of the first responder's workers' compensation insurance
92	92	coverage.
93	93	(c) If the workers' compensation insurance carrier, after
94	94	the initial denial, accepts the workers' compensation claim for the
95	95	injury, the carrier shall:
96	96	(1) completely reimburse the health benefit plan for
97	97	any amounts paid to a provider for the treatment of the injury; and
98	98	(2) reimburse the injured first responder for any
99	99	copayment or deductible that was paid in connection with treatment
100	100	for the injury.
101	101	SECTION 2. Section 409.0091, Labor Code, is amended by
102	102	amending Subsection (h) and adding Subsection (h-1) to read as
103	103	follows:
104	104	(h) Except as otherwise provided by Subsection (h-1), for
105	105	[For] each medical benefit paid, the workers' compensation
106	106	insurance carrier shall pay to the health care insurer the lesser of
107	107	the amount payable under the applicable fee guideline as of the date
108	108	of service or the actual amount paid by the health care insurer. In
109	109	the absence of a fee guideline for a specific service paid, the
110	110	amount per service paid by the health care insurer shall be
111	111	considered in determining a fair and reasonable payment under rules
112	112	under this subtitle defining fair and reasonable medical
113	113	reimbursement. The health care insurer may not recover interest as
114	114	a part of the subclaim.
115	115	(h-1) The workers' compensation insurance carrier shall
116	116	reimburse a health care insurer for the actual amount paid by the
117	117	health care insurer to a health care provider for the treatment of
118	118	an injured first responder under Section 1373.003, Insurance Code.
119	119	SECTION 3. (a) The division of worker's compensation of the
120	120	Department of Insurance shall conduct a study regarding the impact
121	121	of the changes in law made by this Act. The study must include an
122	122	assessment of:
123	123	(1) the efficiency with which health benefit plans
124	124	provide medical care for injured first responders while awaiting
125	125	resolution of workers' compensation claims;
126	126	(2) the geographic areas where the coverage was
127	127	successful; and
128	128	(3) the health benefit plans that provided coverage to
129	129	an injured first responder.
130	130	(b) Not later than December 1, 2028, the division shall
131	131	submit to the legislature a written report that includes a summary
132	132	of the study and any legislative recommendations based on the
133	133	study.
134	134	SECTION 4. Chapter 1373, Insurance Code, as added by this
135	135	Act, applies only to a health benefit plan that is delivered, issued
136	136	for delivery, or renewed on or after January 1, 2026.
137	137	SECTION 5. This Act takes effect September 1, 2025.