By: Schwertner	S.B. No. 1286
	(In the Senate - Filed February 28, 2023; March 9, 2023,
	read first time and referred to Committee on Health & Human
	Services; April 6, 2023, reported favorably by the following vote:
	Yeas 9, Nays 0; April 6, 2023, sent to printer.)
Click here to see the committee vote

	A BILL TO BE ENTITLED
	AN ACT
	relating to prompt payment deadlines for health benefit plan
	claims affected by a catastrophic event.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Section 843.337, Insurance Code, is amended by
	amending Subsections (b) and (c) and adding Subsection (c-1) to
	read as follows:
	(b)  If a physician or provider fails to submit a claim in
	compliance with this section, the physician or provider forfeits
	the right to payment [unless the failure to submit the claim in
	compliance with this section is a result of a catastrophic event
	that substantially interferes with the normal business operations
	of the physician or provider].
	(c)  The period for submitting a claim under this section may
	be extended by:
	(1)  contract;
	(2)  notice published by the commissioner allowing an
	extension of prompt payment deadlines to a later date chosen by the
	commissioner due to a catastrophic event; or
	(3)  the department's approval of a physician's or
	provider's request for an extension due to a catastrophic event
	that substantially interferes with the normal business operations
	of the physician or provider.
	(c-1)  The commissioner may adopt rules to implement
	Subsection (c), including rules establishing requirements for a
	request made under Subsection (c)(3).
	SECTION 2.  Section 843.342(h), Insurance Code, is amended
	to read as follows:
	(h)  A health maintenance organization is not liable for a
	penalty under this section:
	(1)  if the failure to pay the claim in accordance with
	this subchapter is a result of a catastrophic event and:
	(A)  the commissioner published a notice allowing
	an extension of the applicable prompt payment deadlines due to the
	catastrophic event; or
	(B)  the department approved the health
	maintenance organization's request for an extension due to the
	substantial interference of the catastrophic event [that
	substantially interferes] with the normal business operations of
	the health maintenance organization; or
	(2)  if the claim was paid in accordance with this
	subchapter, but for less than the contracted rate, and:
	(A)  the physician or provider notifies the health
	maintenance organization of the underpayment after the 270th day
	after the date the underpayment was received; and
	(B)  the health maintenance organization pays the
	balance of the claim on or before the 30th day after the date the
	health maintenance organization receives the notice.
	SECTION 3.  Section 1301.102, Insurance Code, is amended by
	amending Subsections (d) and (e) and adding Subsection (e-1) to
	read as follows:
	(d)  If a physician or health care provider fails to submit a
	claim in compliance with this section, the physician or provider
	forfeits the right to payment [unless the failure to submit the
	claim in compliance with this section is a result of a catastrophic
	event that substantially interferes with the normal business
	operations of the physician or provider].
	(e)  The period for submitting a claim under this section may
	be extended by:
	(1)  contract;
	(2)  notice published by the commissioner allowing an
	extension of prompt payment deadlines to a later date chosen by the
	commissioner due to a catastrophic event; or
	(3)  the department's approval of a physician's or
	health care provider's request for an extension due to a
	catastrophic event that substantially interferes with the normal
	business operations of the physician or provider.
	(e-1)  The commissioner may adopt rules to implement
	Subsection (e), including rules establishing requirements for a
	request made under Subsection (e)(3).
	SECTION 4.  Section 1301.137(h), Insurance Code, is amended
	to read as follows:
	(h)  An insurer is not liable for a penalty under this
	section:
	(1)  if the failure to pay the claim in accordance with
	Subchapter C is a result of a catastrophic event and:
	(A)  the commissioner published a notice allowing
	an extension of the applicable prompt payment deadlines due to the
	catastrophic event; or
	(B)  the department approved the insurer's
	request for an extension due to the substantial interference of the
	catastrophic event [that substantially interferes] with the normal
	business operations of the insurer; or
	(2)  if the claim was paid in accordance with
	Subchapter C, but for less than the contracted rate, and:
	(A)  the preferred provider notifies the insurer
	of the underpayment after the 270th day after the date the
	underpayment was received; and
	(B)  the insurer pays the balance of the claim on
	or before the 30th day after the date the insurer receives the
	notice.
	SECTION 5.  The changes in law made by this Act apply only to
	a claim submitted on or after the effective date of this Act. A
	claim submitted before the effective date of this Act 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 6.  This Act takes effect September 1, 2023.
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