Bill Text: TX HB174 | 2021 | 87th Legislature 3rd Special Session | Introduced

Texas House Bill 174 (Prior Session Legislation)

Introduced

Bill Title: Relating to preferred provider benefit plan reimbursement of certain services provided by out-of-network providers.

Sponsorship: Partisan Bill (Republican 1)

Status: (Introduced - Dead) 2021-10-13 - Filed [HB174 Detail]

Download: Texas-2021-HB174-Introduced.html

	87S30841 JES-D

	By: Jetton	H.B. No. 174



	A BILL TO BE ENTITLED
	AN ACT
	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.