Bill Text: TX HB2162 | 2013-2014 | 83rd Legislature | Comm Sub
Bill Title: Relating to health benefit plan coverage for certain nonemergency ambulance transportation services.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2013-04-26 - Committee report sent to Calendars [HB2162 Detail]
Download: Texas-2013-HB2162-Comm_Sub.html
| 83R17036 SCL-F | |||
| By: Eiland | H.B. No. 2162 | ||
| Substitute the following for H.B. No. 2162: | |||
| By: Eiland | C.S.H.B. No. 2162 | ||
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| relating to health benefit plan coverage for certain nonemergency | ||
| ambulance transportation services. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1451, Insurance Code, is amended by | ||
| adding Subchapter J to read as follows: | ||
| SUBCHAPTER J. ACCESS TO TRANSPORTATION SERVICES | ||
| Sec. 1451.451. APPLICABILITY. This subchapter applies only | ||
| to a health benefit plan that provides benefits for nonemergency | ||
| ambulance transportation services and that: | ||
| (1) provides benefits for medical or surgical expenses | ||
| incurred as a result of a health condition, accident, or sickness, | ||
| including: | ||
| (A) 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: | ||
| (i) an insurance company; | ||
| (ii) a group hospital service corporation | ||
| operating under Chapter 842; | ||
| (iii) a fraternal benefit society operating | ||
| under Chapter 885; | ||
| (iv) a stipulated premium company operating | ||
| under Chapter 884; or | ||
| (v) a health maintenance organization | ||
| operating under Chapter 843; and | ||
| (B) to the extent permitted by the Employee | ||
| Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et | ||
| seq.), a health benefit plan that is offered by: | ||
| (i) a multiple employer welfare arrangement | ||
| as defined by Section 3 of that Act; or | ||
| (ii) another analogous benefit | ||
| arrangement; | ||
| (2) is offered by: | ||
| (A) an approved nonprofit health corporation | ||
| that holds a certificate of authority under Chapter 844; or | ||
| (B) an entity that is not authorized under this | ||
| code or another insurance law of this state that contracts directly | ||
| for health care services on a risk-sharing basis, including a | ||
| capitation basis; or | ||
| (3) provides health and accident coverage through a | ||
| risk pool created under Chapter 172, Local Government Code, | ||
| notwithstanding Section 172.014, Local Government Code, or any | ||
| other law. | ||
| Sec. 1451.452. EXCEPTION. This subchapter does not apply | ||
| to: | ||
| (1) a plan that provides coverage: | ||
| (A) only for a specified disease; | ||
| (B) only for accidental death or dismemberment; | ||
| (C) for wages or payments instead of wages for a | ||
| period during which an employee is absent from work because of | ||
| sickness or injury; or | ||
| (D) as a supplement to a liability insurance | ||
| policy; | ||
| (2) a small employer health benefit plan under Chapter | ||
| 1501; | ||
| (3) a Medicare supplemental policy as defined by | ||
| Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); | ||
| (4) a workers' compensation insurance policy; | ||
| (5) medical payment insurance coverage provided under | ||
| a motor vehicle insurance policy; or | ||
| (6) a long-term care insurance policy, including a | ||
| nursing home fixed indemnity policy, unless the commissioner | ||
| determines that the policy provides benefit coverage so | ||
| comprehensive that the policy is a health benefit plan described by | ||
| Section 1451.451. | ||
| Sec. 1451.453. RULES. The commissioner shall adopt rules | ||
| necessary to implement this subchapter. | ||
| Sec. 1451.454. LIMITS ON NONEMERGENCY AMBULANCE | ||
| TRANSPORTATION PROVIDERS. (a) The issuer of a health benefit plan | ||
| that provides coverage for nonemergency ambulance transportation | ||
| services may not contract with a nonemergency ambulance | ||
| transportation service provider who has a direct or indirect | ||
| ownership interest in a transportation brokerage service that | ||
| contracts with the plan and provides for the establishment of a | ||
| nonemergency ambulance transportation network. | ||
| (b) Subsection (a) does not apply to nonemergency ambulance | ||
| transportation services provided in an area of the state in which | ||
| there is only one nonemergency ambulance transportation service | ||
| provider available to provide the transportation service needed. A | ||
| health benefit plan that provides coverage for nonemergency | ||
| ambulance transportation services under this subsection shall | ||
| maintain documentation evidencing that no other provider is | ||
| available to provide the service in the area. | ||
| Sec. 1451.455. LIMITS ON PAYMENTS. A transportation | ||
| service provider may not offer or make any payment or other form of | ||
| remuneration, including any kickback, rebate, cash, gift, or | ||
| service in kind, to the issuer of a health benefit plan for | ||
| referrals to the provider, or for contracting with the provider, to | ||
| provide nonemergency ambulance transportation services. | ||
| SECTION 2. The change in law made by this Act applies only | ||
| to a health benefit plan delivered, issued for delivery, or renewed | ||
| on or after January 1, 2014. A plan delivered, issued for delivery, | ||
| or renewed before January 1, 2014, is governed by the law in effect | ||
| immediately before the effective date of this Act, and that law is | ||
| continued in effect for that purpose. | ||
| SECTION 3. This Act takes effect September 1, 2013. | ||
