Bill Text: TX HB174 | 2021 | 87th Legislature 3rd Special Session | Introduced
Bill Title: Relating to preferred provider benefit plan reimbursement of certain services provided by out-of-network providers.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2021-10-13 - Filed [HB174 Detail]
Download: Texas-2021-HB174-Introduced.html
| 87S30841 JES-D | ||
| By: Jetton | H.B. No. 174 | |
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| relating to preferred provider benefit plan reimbursement of | ||
| certain services provided by out-of-network providers. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Section 1301.069, Insurance Code, is amended to | ||
| read as follows: | ||
| Sec. 1301.069. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND | ||
| HEALTH CARE PROVIDERS. (a) The provisions of this chapter relating | ||
| to prompt payment by an insurer of a physician or health care | ||
| provider and to verification of medical care or health care | ||
| services apply to a physician or provider who: | ||
| (1) is not a preferred provider included in the | ||
| preferred provider network; and | ||
| (2) provides to an insured: | ||
| (A) care related to an emergency or its attendant | ||
| episode of care as required by state or federal law; or | ||
| (B) specialty or other medical care or health | ||
| care services at the request of the insurer or a preferred provider | ||
| because the services are not reasonably available from a preferred | ||
| provider who is included in the preferred delivery network. | ||
| (b) In reimbursing a physician or health care provider who | ||
| is not a preferred provider included in the preferred provider | ||
| network for services provided to an insured under Subsection | ||
| (a)(2)(B) after the physician or provider received a waiver from | ||
| the insurer to provide the services to the insured, the insurer: | ||
| (1) may not base the reimbursement to the physician or | ||
| provider on the insurer's usual and customary rate; and | ||
| (2) shall reimburse the physician or provider at the | ||
| physician's or provider's specialty rate in accordance with the | ||
| physician's or provider's expertise, experience, and rate history. | ||
| SECTION 2. The changes in law made by this Act apply only to | ||
| a health benefit plan delivered, issued for delivery, or renewed on | ||
| or after June 1, 2022. | ||
| SECTION 3. This Act takes effect on the 91st day after the | ||
| last day of the legislative session. | ||
