Bill Text: TX HB1364 | 2023-2024 | 88th Legislature | Introduced


Bill Title: Relating to a direct payment to a health care provider in lieu of a claim for benefits under a health benefit plan.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced - Dead) 2023-03-03 - Referred to Health Care Reform, Select [HB1364 Detail]

Download: Texas-2023-HB1364-Introduced.html
 
 
  By: Muñoz, Jr. H.B. No. 1364
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to a direct payment to a health care provider in lieu of a
  claim for benefits under a health benefit plan.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1204, Insurance Code, is amended by
  adding Subchapter G to read as follows:
  SUBCHAPTER G.  DIRECT PAYMENT TO HEALTH CARE PROVIDER
         Sec. 1204.301.  DEFINITION.  In this subchapter, "health
  care provider" means a health care practitioner or health care
  facility that provides health care services under a license,
  certificate, registration, or other similar evidence of regulation
  issued by this or another state of the United States.
         Sec. 1204.302.  APPLICABILITY OF SUBCHAPTER. (a)  This
  subchapter applies only to a health benefit plan that provides
  benefits for medical or surgical expenses incurred as a result of a
  health condition, accident, or sickness, including an individual,
  group, blanket, or franchise insurance policy or insurance
  agreement, a group hospital service contract, or an individual or
  group evidence of coverage or similar coverage document that is
  offered by:
               (1)  an insurance company;
               (2)  a group hospital service corporation operating
  under Chapter 842;
               (3)  a health maintenance organization operating under
  Chapter 843;
               (4)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844;
               (5)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846;
               (6)  a stipulated premium company operating under
  Chapter 884;
               (7)  a fraternal benefit society operating under
  Chapter 885;
               (8)  a Lloyd's plan operating under Chapter 941; or
               (9)  an exchange operating under Chapter 942.
         (b)  Notwithstanding any other law, this subchapter applies
  to:
               (1)  a small employer health benefit plan subject to
  Chapter 1501, including coverage provided through a health group
  cooperative under Subchapter B of that chapter;
               (2)  a standard health benefit plan issued under
  Chapter 1507;
               (3)  a basic coverage plan under Chapter 1551;
               (4)  a basic plan under Chapter 1575;
               (5)  a primary care coverage plan under Chapter 1579;
               (6)  a plan providing basic coverage under Chapter
  1601;
               (7)  health benefits provided by or through a church
  benefits board under Subchapter I, Chapter 22, Business
  Organizations Code;
               (8)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapter 533, Government Code;
               (9)  the child health plan program under Chapter 62,
  Health and Safety Code;
               (10)  a regional or local health care program operated
  under Section 75.104, Health and Safety Code;
               (11)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code;
               (12)  county employee group health benefits provided
  under Chapter 157, Local Government Code; and
               (13)  health and accident coverage provided by a risk
  pool created under Chapter 172, Local Government Code.
         Sec. 1204.303.   DIRECT PAYMENT IN LIEU OF CLAIM FOR
  BENEFITS; EFFECT ON PLAN.  (a)  A health care provider may not be
  prohibited from accepting directly from an enrollee full payment
  for a health care service in lieu of submitting a claim to the
  enrollee's health benefit plan.
         (b)  Notwithstanding Section 552.003 or any other law, a
  health care provider's discounted cash price for services rendered
  is considered full payment for purposes of Subsection (a).
         (c)  A health benefit plan shall apply the charge for a
  health care service for which a health care provider accepts a
  payment described by Subsection (a) from an enrollee towards the
  enrollee's out-of-pocket maximum if the service is a covered
  service under the plan. Payments for uncovered services are
  ineligible to apply towards an enrollee's out-of-pocket maximum.
         SECTION 2.  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 that provision until the
  waiver or authorization is granted.
         SECTION 3.  Section 1204.303, Insurance Code, as added by
  this Act, applies only to a health benefit plan delivered, issued
  for delivery, or renewed on or after January 1, 2024.
         SECTION 4.  This Act takes effect September 1, 2023.
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