Bill Text: TX HB1364 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to a direct payment to a health care provider in lieu of a claim for benefits under a health benefit plan.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2023-03-03 - Referred to Health Care Reform, Select [HB1364 Detail]
Download: Texas-2023-HB1364-Introduced.html
| By: Muñoz, Jr. | H.B. No. 1364 | |
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| relating to a direct payment to a health care provider in lieu of a | ||
| claim for benefits under a health benefit plan. | ||
| 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 TO HEALTH CARE PROVIDER | ||
| Sec. 1204.301. DEFINITION. In this subchapter, "health | ||
| care provider" means a health care practitioner or health care | ||
| facility that 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. | ||
| Sec. 1204.302. APPLICABILITY OF SUBCHAPTER. (a) This | ||
| subchapter applies only to a health benefit plan that provides | ||
| benefits for medical or surgical expenses incurred as a result of a | ||
| health condition, accident, or sickness, including an individual, | ||
| group, blanket, or franchise insurance policy or insurance | ||
| agreement, a group hospital service contract, or an individual or | ||
| group evidence of coverage or similar coverage document that is | ||
| offered by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (4) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844; | ||
| (5) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; | ||
| (6) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (7) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (8) a Lloyd's plan operating under Chapter 941; or | ||
| (9) an exchange operating under Chapter 942. | ||
| (b) Notwithstanding any other law, this subchapter applies | ||
| to: | ||
| (1) a small employer health benefit plan subject to | ||
| Chapter 1501, including coverage provided through a health group | ||
| cooperative under Subchapter B of that chapter; | ||
| (2) a standard health benefit plan issued under | ||
| Chapter 1507; | ||
| (3) a basic coverage plan under Chapter 1551; | ||
| (4) a basic plan under Chapter 1575; | ||
| (5) a primary care coverage plan under Chapter 1579; | ||
| (6) a plan providing basic coverage under Chapter | ||
| 1601; | ||
| (7) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (8) the state Medicaid program, including the Medicaid | ||
| managed care program operated under Chapter 533, Government Code; | ||
| (9) the child health plan program under Chapter 62, | ||
| Health and Safety Code; | ||
| (10) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; | ||
| (11) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code; | ||
| (12) county employee group health benefits provided | ||
| under Chapter 157, Local Government Code; and | ||
| (13) health and accident coverage provided by a risk | ||
| pool created under Chapter 172, Local Government Code. | ||
| Sec. 1204.303. DIRECT PAYMENT IN LIEU OF CLAIM FOR | ||
| BENEFITS; EFFECT ON PLAN. (a) A 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, a | ||
| health care provider's discounted cash price for services rendered | ||
| is considered full payment for purposes of Subsection (a). | ||
| (c) A health benefit plan shall apply the charge for a | ||
| health care service for which a health care provider accepts a | ||
| payment described by Subsection (a) from an enrollee towards the | ||
| enrollee's out-of-pocket maximum if the service is a covered | ||
| service under the plan. Payments for uncovered services are | ||
| ineligible to apply towards an enrollee's out-of-pocket maximum. | ||
| SECTION 2. If before implementing any provision of this Act | ||
| a state agency determines that a waiver or authorization from a | ||
| federal agency is necessary for implementation of that provision, | ||
| the agency affected by the provision shall request the waiver or | ||
| authorization and may delay implementing that provision until the | ||
| waiver or authorization is granted. | ||
| SECTION 3. Section 1204.303, Insurance Code, as added by | ||
| this Act, applies only to a health benefit plan delivered, issued | ||
| for delivery, or renewed on or after January 1, 2024. | ||
| SECTION 4. This Act takes effect September 1, 2023. | ||
