Bill Text: TX HB3848 | 2023-2024 | 88th Legislature | Engrossed
Bill Title: Relating to health maintenance organization and preferred provider benefit plan minimum access standards for nonemergency ambulance transport services delivered by emergency medical services providers; providing administrative penalties.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed - Dead) 2023-05-11 - Referred to Health & Human Services [HB3848 Detail]
Download: Texas-2023-HB3848-Engrossed.html
88R12914 CJD-F | ||
By: Oliverson | H.B. No. 3848 |
|
||
|
||
relating to health maintenance organization and preferred provider | ||
benefit plan minimum access standards for nonemergency ambulance | ||
transport services delivered by emergency medical services | ||
providers; providing administrative penalties. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Section 843.002(24), Insurance Code, is amended | ||
to read as follows: | ||
(24) "Provider" means: | ||
(A) a person, other than a physician, who is | ||
licensed or otherwise authorized to provide a health care service | ||
in this state, including: | ||
(i) a chiropractor, registered nurse, | ||
pharmacist, optometrist, or acupuncturist; [ |
||
(ii) a pharmacy, hospital, or other | ||
institution or organization; or | ||
(iii) an emergency medical services | ||
provider; | ||
(B) a person who is wholly owned or controlled by | ||
a provider or by a group of providers who are licensed or otherwise | ||
authorized to provide the same health care service; or | ||
(C) a person who is wholly owned or controlled by | ||
one or more hospitals and physicians, including a | ||
physician-hospital organization. | ||
SECTION 2. Section 843.151, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 843.151. RULES. The commissioner may adopt | ||
reasonable rules as necessary and proper to: | ||
(1) implement this chapter and Section 1367.053, | ||
Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapters | ||
222, 251, and 258, as applicable to a health maintenance | ||
organization, and Chapters 1271 and 1272, including rules to: | ||
(A) prescribe authorized investments for a | ||
health maintenance organization for all investments not otherwise | ||
addressed in this chapter; | ||
(B) ensure that enrollees have adequate access to | ||
health care services; and | ||
(C) establish minimum physician-to-patient | ||
ratios, mileage requirements for primary and specialty care, | ||
minimum access standards for nonemergency ambulance transport | ||
services delivered by an emergency medical services provider, | ||
maximum travel time, and maximum waiting time for obtaining an | ||
appointment; and | ||
(2) meet the requirements of federal law and | ||
regulations. | ||
SECTION 3. Section 843.304(c), Insurance Code, is amended | ||
to read as follows: | ||
(c) This section does not require that a health maintenance | ||
organization: | ||
(1) use a particular type of provider in its | ||
operation; | ||
(2) accept each provider of a category or type, except | ||
as provided by Article 21.52B; [ |
||
(3) contract directly with providers of a particular | ||
category or type; or | ||
(4) contract with an emergency medical services | ||
provider if that provider does not have the authority or ability to | ||
operate in the health maintenance organization's service area. | ||
SECTION 4. Subchapter I, Chapter 843, Insurance Code, is | ||
amended by adding Section 843.3046 to read as follows: | ||
Sec. 843.3046. NONEMERGENCY AMBULANCE TRANSPORT SERVICES. | ||
(a) A health maintenance organization offering a health care plan | ||
that covers a nonemergency ambulance transport service that is | ||
within the scope of an emergency medical services provider's | ||
license may not refuse to provide reimbursement to an in-network | ||
emergency medical services provider for the performance of the | ||
covered service solely because the service is provided by an | ||
emergency medical services provider. | ||
(b) This section does not require a health maintenance | ||
organization to cover a particular health care or nonemergency | ||
ambulance transport service. | ||
(c) This section does not affect the right of a health | ||
maintenance organization to determine whether a health care or | ||
nonemergency ambulance transport service is medically necessary. | ||
(d) A health maintenance organization that violates this | ||
section is subject to an administrative penalty as provided by | ||
Chapter 84 of not more than $1,000 for each claim that remains | ||
unpaid in violation of this section. Each day the violation | ||
continues constitutes a separate violation. | ||
SECTION 5. Section 843.305(d), Insurance Code, is amended | ||
to read as follows: | ||
(d) This section does not require that a health maintenance | ||
organization: | ||
(1) use a particular type of physician or provider in | ||
its operation; | ||
(2) accept a physician or provider of a category or | ||
type that does not meet the practice standards and qualifications | ||
established by the health maintenance organization; [ |
||
(3) contract directly with physicians or providers of | ||
a particular category or type; or | ||
(4) contract with an emergency medical services | ||
provider if that provider does not have the authority or ability to | ||
operate in the health maintenance organization's service area. | ||
SECTION 6. Section 1301.001(1-a), Insurance Code, is | ||
amended to read as follows: | ||
(1-a) "Health care provider" means a practitioner, | ||
institutional provider, or other person or organization that | ||
furnishes health care services and that is licensed or otherwise | ||
authorized to practice in this state. The term includes an | ||
emergency medical services provider, a pharmacist, and a | ||
pharmacy. The term does not include a physician. | ||
SECTION 7. Section 1301.005, Insurance Code, is amended by | ||
adding Subsection (d) to read as follows: | ||
(d) This section does not require that an insurer contract | ||
with an emergency medical services provider if that provider does | ||
not have the authority or ability to operate in the insurer's | ||
designated service area. | ||
SECTION 8. Section 1301.007, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1301.007. RULES. The commissioner shall adopt rules | ||
as necessary to: | ||
(1) implement this chapter; [ |
||
(2) ensure reasonable accessibility and availability | ||
of preferred provider services to residents of this state; and | ||
(3) establish minimum access standards for | ||
nonemergency ambulance transport services delivered by an | ||
emergency medical services provider. | ||
SECTION 9. Section 1301.051, Insurance Code, is amended by | ||
adding Subsection (f) to read as follows: | ||
(f) This section does not require that an insurer contract | ||
with an emergency medical services provider if that provider does | ||
not have the authority or ability to operate in the insurer's | ||
designated service area. | ||
SECTION 10. Subchapter B, Chapter 1301, Insurance Code, is | ||
amended by adding Section 1301.0517 to read as follows: | ||
Sec. 1301.0517. NONEMERGENCY AMBULANCE TRANSPORT SERVICES. | ||
(a) An insurer offering a preferred provider benefit plan that | ||
covers a nonemergency ambulance transport service that is within | ||
the scope of an emergency medical services provider's license may | ||
not refuse to provide reimbursement to an in-network emergency | ||
medical services provider for the performance of the covered | ||
service solely because the service is provided by an emergency | ||
medical services provider. | ||
(b) This section does not require an insurer to cover a | ||
particular medical or health care service or nonemergency ambulance | ||
transport service. | ||
(c) This section does not affect the right of an insurer to | ||
determine whether a medical or health care service or nonemergency | ||
ambulance transport service is medically necessary. | ||
(d) An insurer that violates this section is subject to an | ||
administrative penalty as provided by Chapter 84 of not more than | ||
$1,000 for each claim that remains unpaid in violation of this | ||
section. Each day a violation continues constitutes a separate | ||
violation. | ||
SECTION 11. The change in law made by this Act applies only | ||
to a health benefit plan that is delivered, issued for delivery, or | ||
renewed on or after January 1, 2024. A health benefit plan that is | ||
delivered, issued for delivery, or renewed before January 1, 2024, | ||
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 12. 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, 2023. |