Bill Text: TX HB2077 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to data collection related to certain health benefit plan issuers' calculation of payments to out-of-network physicians and providers.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced - Dead) 2017-04-18 - Left pending in committee [HB2077 Detail]
Download: Texas-2017-HB2077-Introduced.html
85R8865 PMO-D | ||
By: Bonnen of Galveston | H.B. No. 2077 |
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relating to data collection related to certain health benefit plan | ||
issuers' calculation of payments to out-of-network physicians and | ||
providers. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 38, Insurance Code, is amended by adding | ||
Subchapter J to read as follows: | ||
SUBCHAPTER J. DATA COLLECTION RELATED TO PAYMENT OF OUT-OF-NETWORK | ||
PHYSICIANS AND HEALTH CARE PROVIDERS | ||
Sec. 38.451. APPLICABILITY. This subchapter applies to an | ||
issuer of a preferred provider benefit plan as defined by Section | ||
1301.001 or an evidence of coverage for a health care plan that | ||
provides basic health care services as defined by Section 843.002. | ||
Sec. 38.452. DEFINITION. In this subchapter, | ||
"out-of-network physicians and health care providers" means | ||
physicians and health care providers who are not preferred | ||
providers or are not otherwise included in a health benefit plan | ||
issuer's delivery network. | ||
Sec. 38.453. COLLECTION OF INFORMATION; REPORT. (a) A | ||
health benefit plan issuer described by Section 38.451 shall report | ||
biennially to the department the information required by the | ||
commissioner under Subsection (b) relating to the health benefit | ||
plan issuer's calculation of payment rates for and payments to | ||
out-of-network physicians and health care providers. | ||
(b) The commissioner by rule shall prescribe the form and | ||
required content of the report required under Subsection (a). The | ||
report must include payment methodologies and formulas used to | ||
calculate payment rates for and payments to out-of-network | ||
physicians and health care providers. | ||
(c) On or before December 31 of each even-numbered year, the | ||
commissioner shall assemble and analyze the information submitted | ||
under this section during the preceding biennium and submit to the | ||
speaker of the house of representatives, the lieutenant governor, | ||
and the appropriate committees of each house of the legislature a | ||
report of the information and the commissioner's analysis. | ||
SECTION 2. Not later than December 31, 2017, the | ||
commissioner of insurance shall adopt rules as necessary to | ||
implement Subchapter J, Chapter 38, Insurance Code, as added by | ||
this Act. The rules must require that a health benefit plan issuer | ||
subject to that subchapter make the initial submission of data | ||
under that subchapter not later than the 60th day after the | ||
effective date of the rules. | ||
SECTION 3. This Act takes effect September 1, 2017. |