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