| 1 | 1 | | 89R658 RDS-D |
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| 2 | 2 | | By: Bell of Montgomery H.B. No. 4872 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to the calculation of penalties for violating certain laws |
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| 10 | 10 | | governing the prompt payment of claims submitted by a physician or |
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| 11 | 11 | | health care provider to certain health benefit plan issuers. |
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| 12 | 12 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 13 | 13 | | SECTION 1. Section 843.342, Insurance Code, is amended by |
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| 14 | 14 | | adding Subsection (o) to read as follows: |
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| 15 | 15 | | (o) For the purposes of calculating a penalty under this |
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| 16 | 16 | | section related to a claim by a physician or provider described by |
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| 17 | 17 | | Section 843.351, the contracted rate for health care services |
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| 18 | 18 | | provided by the physician or provider is the usual and customary |
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| 19 | 19 | | rate for the service in the geographic area in which the service is |
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| 20 | 20 | | provided. |
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| 21 | 21 | | SECTION 2. Section 1301.137, Insurance Code, is amended by |
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| 22 | 22 | | adding Subsection (m) to read as follows: |
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| 23 | 23 | | (m) For the purposes of calculating a penalty under this |
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| 24 | 24 | | section related to a claim by a physician or health care provider |
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| 25 | 25 | | described by Section 1301.069, the contracted rate for health care |
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| 26 | 26 | | services provided by the physician or provider is the usual and |
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| 27 | 27 | | customary rate for the service in the geographic area in which the |
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| 28 | 28 | | service is provided. |
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| 29 | 29 | | SECTION 3. The changes in law made by this Act apply only to |
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| 30 | 30 | | a penalty or interest on a penalty owed with respect to a claim |
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| 31 | 31 | | submitted on or after the effective date of this Act. |
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| 32 | 32 | | SECTION 4. This Act takes effect September 1, 2025. |
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