89R658 RDS-D
By: Bell of Montgomery H.B. No. 4872
A BILL TO BE ENTITLED
AN ACT
relating to the calculation of penalties for violating certain laws
governing the prompt payment of claims submitted by a physician or
health care provider to certain health benefit plan issuers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.342, Insurance Code, is amended by
adding Subsection (o) to read as follows:
(o) For the purposes of calculating a penalty under this
section related to a claim by a physician or provider described by
Section 843.351, the contracted rate for health care services
provided by the physician or provider is the usual and customary
rate for the service in the geographic area in which the service is
provided.
SECTION 2. Section 1301.137, Insurance Code, is amended by
adding Subsection (m) to read as follows:
(m) For the purposes of calculating a penalty under this
section related to a claim by a physician or health care provider
described by Section 1301.069, the contracted rate for health care
services provided by the physician or provider is the usual and
customary rate for the service in the geographic area in which the
service is provided.
SECTION 3. The changes in law made by this Act apply only to
a penalty or interest on a penalty owed with respect to a claim
submitted on or after the effective date of this Act.
SECTION 4. This Act takes effect September 1, 2025.