Bill Text: TX HB4051 | 2021-2022 | 87th Legislature | Comm Sub
Bill Title: Relating to the method of payment for certain health care and certain contract provisions affecting health care reimbursement rates.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2021-05-12 - Placed on General State Calendar [HB4051 Detail]
Download: Texas-2021-HB4051-Comm_Sub.html
| 87R18910 SMT-F | |||
| By: Frank | H.B. No. 4051 | ||
| Substitute the following for H.B. No. 4051: | |||
| By: Oliverson | C.S.H.B. No. 4051 | ||
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| relating to the method of payment for certain health care and | ||
| certain contract provisions affecting health care reimbursement | ||
| rates. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1204, Insurance Code, is amended by | ||
| adding Subchapter G to read as follows: | ||
| SUBCHAPTER G. DIRECT PAYMENT OF PHYSICIAN OR HEALTH CARE PROVIDER | ||
| Sec. 1204.301. DEFINITIONS. In this subchapter: | ||
| (1) "Enrollee" means an individual who is enrolled in | ||
| a health care plan or entitled to coverage under a health benefit | ||
| plan. | ||
| (2) "Health benefit plan" means an individual, group, | ||
| blanket, or franchise insurance policy, a group hospital service | ||
| contract, or a group subscriber contract or evidence of coverage | ||
| issued by a health maintenance organization, that provides benefits | ||
| for health care services. | ||
| (3) "Health care provider" means a person who provides | ||
| health care services under a license, certificate, registration, or | ||
| other similar evidence of regulation issued by this or another | ||
| state of the United States. | ||
| (4) "Health care service" means a service to diagnose, | ||
| prevent, alleviate, cure, or heal a human illness or injury that is | ||
| provided to a covered person by a physician or other health care | ||
| provider. | ||
| (5) "Physician" means an individual licensed to | ||
| practice medicine in this or another state of the United States. | ||
| Sec. 1204.302. APPLICABILITY TO CERTAIN PLANS. In addition | ||
| to the health benefit plans described by Section 1204.301, | ||
| notwithstanding any other law, this subchapter applies to: | ||
| (1) a basic coverage plan under Chapter 1551; | ||
| (2) a basic plan under Chapter 1575; | ||
| (3) a primary care coverage plan under Chapter 1579; | ||
| and | ||
| (4) a plan providing basic coverage under Chapter | ||
| 1601. | ||
| Sec. 1204.303. PAYMENT IN LIEU OF CLAIM FOR BENEFITS; OTHER | ||
| DIRECT PAYMENTS. (a) A physician or health care provider may not | ||
| be prohibited from accepting directly from an enrollee full payment | ||
| for a health care service in lieu of submitting a claim to the | ||
| enrollee's health benefit plan. | ||
| (b) Notwithstanding Section 552.003 or any other law, the | ||
| charge for a health care service for which a physician or health | ||
| care provider accepts a payment as described by Subsection (a) or | ||
| from a patient without a health benefit plan may not exceed the | ||
| lowest contract rate for the health care service allowable under | ||
| any health benefit plan with respect to which the physician or | ||
| health care provider is a contracted, preferred, or participating | ||
| provider. | ||
| SECTION 2. Section 1458.001, Insurance Code, is amended by | ||
| adding Subdivision (5-a) to read as follows: | ||
| (5-a) "Most favored nation clause" means a provision | ||
| in a provider network contract that: | ||
| (A) prohibits or grants an option to prohibit: | ||
| (i) a provider from contracting with | ||
| another contracting entity to provide health care services at a | ||
| lower rate; or | ||
| (ii) a contracting entity from contracting | ||
| with another provider to provide health care services at a higher | ||
| rate; | ||
| (B) requires or grants an option to require: | ||
| (i) a provider to accept a lower rate for | ||
| health care services if the provider agrees with another | ||
| contracting entity to accept a lower rate for the services; or | ||
| (ii) a contracting entity to pay a higher | ||
| rate for health care services if the entity agrees with another | ||
| provider to pay a higher rate for the services; | ||
| (C) requires or grants an option to require | ||
| termination or renegotiation of an existing provider network | ||
| contract if: | ||
| (i) a provider agrees with another | ||
| contracting entity to accept a lower rate for providing health care | ||
| services; or | ||
| (ii) a contracting entity agrees with a | ||
| provider to pay a higher rate for health care services; or | ||
| (D) requires: | ||
| (i) a provider to disclose the provider's | ||
| contractual reimbursement rates with other contracting entities; | ||
| or | ||
| (ii) a contracting entity to disclose the | ||
| contracting entity's contractual reimbursement rates with other | ||
| providers. | ||
| SECTION 3. Section 1458.101, Insurance Code, is amended by | ||
| adding Subsection (g) to read as follows: | ||
| (g) A contracting entity may not: | ||
| (1) offer to a provider a provider network contract | ||
| that includes a most favored nation clause; | ||
| (2) enter into a provider network contract that | ||
| includes a most favored nation clause; or | ||
| (3) amend or renew an existing provider network | ||
| contract previously entered into with a provider so that the | ||
| contract as amended or renewed adds or retains a most favored nation | ||
| clause. | ||
| SECTION 4. This Act takes effect September 1, 2021. | ||
