Bill Text: TX HB3006 | 2015-2016 | 84th Legislature | Comm Sub
Bill Title: Relating to the distribution and use of certain penalties paid by health maintenance organizations and insurers for violating certain provisions governing prompt payment of physicians and health care providers.
Spectrum: Moderate Partisan Bill (Republican 4-1)
Status: (Introduced - Dead) 2015-05-14 - Placed on General State Calendar [HB3006 Detail]
Download: Texas-2015-HB3006-Comm_Sub.html
84R26261 AJA-F | |||
By: Coleman, Bonnen of Galveston, Zerwas, | H.B. No. 3006 | ||
Davis of Harris, Sheffield | |||
Substitute the following for H.B. No. 3006: | |||
By: Sheets | C.S.H.B. No. 3006 |
|
||
|
||
relating to the distribution and use of certain penalties paid by | ||
health maintenance organizations and insurers for violating | ||
certain provisions governing prompt payment of physicians and | ||
health care providers. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 843.342, Insurance Code, is amended by | ||
amending Subsection (m) and adding Subsection (m-1) to read as | ||
follows: | ||
(m) Notwithstanding any other provision of this section, | ||
this subsection governs the payment of a penalty under this | ||
section. For a penalty under this section relating to a clean | ||
claim submitted by a physician or provider other than an | ||
institutional provider, the health maintenance organization shall | ||
pay the entire penalty to the physician or provider, except for any | ||
interest computed under Subsection (c), which shall be paid to the | ||
department to be distributed to the fund established under | ||
Subchapter F, Chapter 1508, to be used for any purpose authorized by | ||
the commissioner by rule to improve access to health benefit | ||
coverage for individuals without coverage [ |
||
|
||
claim submitted by an institutional provider, the health | ||
maintenance organization shall pay 50 percent of the total penalty | ||
amount computed under this section, including interest, to the | ||
institutional provider and the remaining 50 percent of that amount | ||
to the department to be distributed to the fund established under | ||
Subchapter F, Chapter 1508, to be used as provided by Subsection | ||
(m-1). | ||
(m-1) Money in the fund established under Subchapter F, | ||
Chapter 1508, that is derived from penalties under this section | ||
relating to clean claims submitted by institutional providers may | ||
only be appropriated as follows: | ||
(1) the first $5 million may be appropriated only to | ||
the Health and Human Services Commission to be used only to fund the | ||
commission's consumer assistance for Medicaid program; | ||
(2) the next $20 million collected may be appropriated | ||
only to the Health and Human Services Commission to be used only to | ||
provide postpartum coverage through the child health plan program | ||
operated under Chapter 62, Health and Safety Code, and Medicaid; | ||
and | ||
(3) amounts in excess of the amounts described by | ||
Subdivisions (1) and (2) may be appropriated only to the Health and | ||
Human Services Commission to be used only to increase reimbursement | ||
rates to health care providers who provide services through the | ||
Texas Women's Health Program [ |
||
|
||
SECTION 2. Section 1301.137, Insurance Code, is amended by | ||
amending Subsection (l) and adding Subsection (l-1) to read as | ||
follows: | ||
(l) Notwithstanding any other provision of this section, | ||
this subsection governs the payment of a penalty under this | ||
section. For a penalty under this section relating to a clean | ||
claim submitted by a preferred provider other than an institutional | ||
provider, the insurer shall pay the entire penalty to the preferred | ||
provider, except for any interest computed under Subsection (c), | ||
which shall be paid to the department to be distributed to the fund | ||
established under Subchapter F, Chapter 1508, to be used for any | ||
purpose authorized by the commissioner by rule to improve access to | ||
health benefit coverage for individuals without coverage [ |
||
|
||
relating to a clean claim submitted by an institutional provider, | ||
the insurer shall pay 50 percent of the penalty amount computed | ||
under this section, including interest, to the institutional | ||
provider and the remaining 50 percent of that amount to the | ||
department to be distributed to the fund established under | ||
Subchapter F, Chapter 1508, to be used as provided by Subsection | ||
(l-1). | ||
(l-1) Money in the fund established under Subchapter F, | ||
Chapter 1508, that is derived from penalties under this section | ||
relating to clean claims submitted by institutional providers may | ||
only be appropriated as follows: | ||
(1) the first $5 million may be appropriated only to | ||
the Health and Human Services Commission to be used only to fund the | ||
commission's consumer assistance for Medicaid program; | ||
(2) the next $20 million collected may be appropriated | ||
only to the Health and Human Services Commission to be used only to | ||
provide postpartum coverage through the child health plan program | ||
operated under Chapter 62, Health and Safety Code, and Medicaid; | ||
and | ||
(3) amounts in excess of the amounts described by | ||
Subdivisions (1) and (2) may be appropriated only to the Health and | ||
Human Services Commission to be used only to increase reimbursement | ||
rates to health care providers who provide services through the | ||
Texas Women's Health Program [ |
||
SECTION 3. (a) Notwithstanding Section 6(e), Chapter 615 | ||
(S.B. 1367), Acts of the 83rd Legislature, Regular Session, 2013, | ||
any penalties relating to clean claims submitted by institutional | ||
providers that were paid under Section 843.342(m) or 1301.137(l), | ||
Insurance Code, before the effective date of this Act, and that | ||
remain unexpended and unobligated on the effective date of this | ||
Act, shall be used to provide grants to hospitals in this state to | ||
upgrade the hospitals' emergency rooms and trauma facilities. | ||
(b) The commissioner of insurance shall adopt rules | ||
governing the distribution of grants to hospitals under this | ||
section and the contracts under which the grants are awarded. | ||
(c) The commissioner of insurance shall distribute all | ||
money that is subject to this section not later than September 1, | ||
2017. | ||
SECTION 4. (a) The changes in law made by this Act to | ||
Sections 843.342 and 1301.137, Insurance Code, apply only to | ||
penalties paid under those sections on or after the effective date | ||
of this Act. | ||
(b) Except as provided by this Act, penalties paid before | ||
the effective date of this Act are governed by the law applicable to | ||
the penalties immediately before the effective date of this Act, | ||
and that law is continued in effect for that purpose. | ||
SECTION 5. This Act takes effect immediately if it receives | ||
a vote of two-thirds of all the members elected to each house, as | ||
provided by Section 39, Article III, Texas Constitution. If this | ||
Act does not receive the vote necessary for immediate effect, this | ||
Act takes effect September 1, 2015. |