Bill Text: TX HB3558 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to provider reimbursement for certain emergency health care services.
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2021-03-22 - Referred to Insurance [HB3558 Detail]
Download: Texas-2021-HB3558-Introduced.html
By: Muñoz, Jr. | H.B. No. 3558 |
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relating to provider reimbursement for certain emergency health | ||
care services. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 1271.155, Insurance Code, is amended by | ||
adding Subsection (g-1) to read as follows: | ||
(g-1) A health maintenance organization may not, based on a | ||
patient's final diagnosis, deny or reduce payment on a claim for the | ||
following services provided in a hospital emergency facility, | ||
freestanding emergency medical care facility, or comparable | ||
emergency facility: | ||
(1) a medical screening examination or related health | ||
care service that is within the capability of the facility and the | ||
facility's staff and performed to evaluate the patient's condition; | ||
and | ||
(2) further medical treatment: | ||
(A) necessary to stabilize the patient and to | ||
ensure, with reasonable medical probability, that no material | ||
deterioration of the condition is likely to result from or occur | ||
during the transfer of the patient from the facility; or | ||
(B) provided with respect to emergency care. | ||
SECTION 2. Section 1301.0053, Insurance Code, is amended by | ||
adding Subsection (b-1) to read as follows: | ||
(b-1) An insurer may not, based on a patient's final | ||
diagnosis, deny or reduce payment on a claim for the following | ||
services provided in a hospital emergency facility, freestanding | ||
emergency medical care facility, or comparable emergency facility: | ||
(1) a medical screening examination or related health | ||
care service that is within the capability of the facility and the | ||
facility's staff and performed to evaluate the patient's condition; | ||
and | ||
(2) further medical treatment: | ||
(A) necessary to stabilize the patient and to | ||
ensure, with reasonable medical probability, that no material | ||
deterioration of the condition is likely to result from or occur | ||
during the transfer of the patient from the facility; or | ||
(B) provided with respect to emergency care. | ||
SECTION 3. Section 1301.155, Insurance Code, is amended by | ||
adding Subsection (d-1) to read as follows: | ||
(d-1) An insurer may not, based on a patient's final | ||
diagnosis, deny or reduce payment on a claim for the following | ||
services provided in a hospital emergency facility, freestanding | ||
emergency medical care facility, or comparable emergency facility: | ||
(1) a medical screening examination or related health | ||
care service that is within the capability of the facility and the | ||
facility's staff and performed to evaluate the patient's condition; | ||
and | ||
(2) further medical treatment: | ||
(A) necessary to stabilize the patient and to | ||
assure, with reasonable medical probability, that no material | ||
deterioration of the condition is likely to result from or occur | ||
during the transfer of the patient from the facility; or | ||
(B) provided with respect to emergency care. | ||
SECTION 4. The changes in law made by this Act apply only to | ||
a health benefit plan delivered, issued for delivery, or renewed on | ||
or after January 1, 2022. A health benefit plan delivered, issued | ||
for delivery, or renewed before January 1, 2022, is governed by the | ||
law as it existed immediately before the effective date of this Act, | ||
and that law is continued in effect for that purpose. | ||
SECTION 5. This Act takes effect September 1, 2021. |