| 1 | 1 | | 89R12615 SCF-F |
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| 2 | 2 | | By: Cook S.B. No. 2267 |
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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 prohibited steering or directing use of certain |
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| 10 | 10 | | facilities for emergency care under certain health benefit plans. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. Subchapter F, Chapter 540, Government Code, as |
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| 13 | 13 | | effective April 1, 2025, is amended by adding Section 540.02611 to |
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| 14 | 14 | | read as follows: |
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| 15 | 15 | | Sec. 540.02611. COMPLIANCE WITH PROHIBITION ON STEERING TO |
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| 16 | 16 | | FACILITY FOR EMERGENCY CARE. A contract to which this subchapter |
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| 17 | 17 | | applies must require the contracting Medicaid managed care |
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| 18 | 18 | | organization to comply with Section 541.062, Insurance Code. |
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| 19 | 19 | | SECTION 2. Subchapter B, Chapter 541, Insurance Code, is |
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| 20 | 20 | | amended by adding Section 541.062 to read as follows: |
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| 21 | 21 | | Sec. 541.062. STEERING OR DIRECTING USE OF FACILITY FOR |
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| 22 | 22 | | EMERGENCY CARE PROHIBITED. (a) In this section, "emergency care" |
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| 23 | 23 | | has the meaning assigned by Section 4201.002. |
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| 24 | 24 | | (b) It is an unfair method of competition or an unfair or |
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| 25 | 25 | | deceptive act or practice in the business of insurance for an |
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| 26 | 26 | | insurer or health maintenance organization, or an individual or |
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| 27 | 27 | | entity acting on behalf of an insurer or health maintenance |
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| 28 | 28 | | organization, to steer or direct an enrollee to use a certain |
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| 29 | 29 | | facility to obtain emergency care. |
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| 30 | 30 | | (c) A violation of this section does not create a private |
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| 31 | 31 | | cause of action under Section 541.151 or 541.251. |
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| 32 | 32 | | SECTION 3. If before implementing any provision of this Act |
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| 33 | 33 | | a state agency determines that a waiver or authorization from a |
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| 34 | 34 | | federal agency is necessary for implementation of that provision, |
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| 35 | 35 | | the agency affected by the provision shall request the waiver or |
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| 36 | 36 | | authorization and may delay implementing the provision until the |
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| 37 | 37 | | waiver or authorization is granted. |
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| 38 | 38 | | SECTION 4. The changes in law made by this Act apply only to |
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| 39 | 39 | | a health benefit plan delivered, issued for delivery, or renewed on |
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| 40 | 40 | | or after January 1, 2026. A health benefit plan delivered, issued |
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| 41 | 41 | | for delivery, or renewed before January 1, 2026, is governed by the |
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| 42 | 42 | | law as it existed immediately before the effective date of this Act, |
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| 43 | 43 | | and that law is continued in effect for that purpose. |
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| 44 | 44 | | SECTION 5. This Act takes effect September 1, 2025. |
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