Bill Text: TX HB4500 | 2023-2024 | 88th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Relating to electronic verification of health benefits by health benefit plan issuers for certain physicians and health care providers.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2023-06-13 - Effective on 1/1/24 [HB4500 Detail]
Download: Texas-2023-HB4500-Introduced.html
Bill Title: Relating to electronic verification of health benefits by health benefit plan issuers for certain physicians and health care providers.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2023-06-13 - Effective on 1/1/24 [HB4500 Detail]
Download: Texas-2023-HB4500-Introduced.html
| 88R10353 CJD-D | ||
| By: Harris of Williamson | H.B. No. 4500 | |
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| relating to electronic verification of health benefits by health | ||
| benefit plan issuers for certain physicians and health care | ||
| providers. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subtitle A, Title 8, Insurance Code, is amended | ||
| by adding Chapter 1223 to read as follows: | ||
| CHAPTER 1223. VERIFICATION OF HEALTH BENEFITS | ||
| Sec. 1223.001. APPLICABILITY OF CHAPTER. (a) This chapter | ||
| 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 issued 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 chapter 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) nonprofit agricultural organization health | ||
| benefits offered by a nonprofit agricultural organization under | ||
| Chapter 1682; | ||
| (8) alternative health benefit coverage offered by a | ||
| subsidiary of the Texas Mutual Insurance Company under Subchapter | ||
| M, Chapter 2054; | ||
| (9) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (10) group health coverage made available by a school | ||
| district in accordance with Section 22.004, Education Code; | ||
| (11) the state Medicaid program, including the | ||
| Medicaid managed care program operated under Chapter 533, | ||
| Government Code; | ||
| (12) the child health plan program under Chapter 62, | ||
| Health and Safety Code; | ||
| (13) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; | ||
| (14) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code; | ||
| (15) county employee group health benefits provided | ||
| under Chapter 157, Local Government Code; and | ||
| (16) health and accident coverage provided by a risk | ||
| pool created under Chapter 172, Local Government Code. | ||
| Sec. 1223.002. INTERNET WEBSITE FOR VERIFICATION REQUIRED | ||
| FOR EMERGENCY PHYSICIANS AND HEALTH CARE PROVIDERS. A health | ||
| benefit plan issuer shall maintain and make available a secure | ||
| system on the issuer's Internet website that allows a physician or | ||
| health care provider for a hospital or freestanding emergency | ||
| medical care facility to determine at any time: | ||
| (1) whether the physician's or provider's patient is | ||
| covered by the issuer's health benefit plan; | ||
| (2) whether the issuer will pay the physician or | ||
| provider for the proposed health care service or supply the | ||
| physician or provider intends to provide to the patient; and | ||
| (3) the deductible, copayment, or coinsurance for | ||
| which the patient is responsible. | ||
| SECTION 2. If before implementing any provision of Chapter | ||
| 1223, Insurance Code, as added by 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. This Act takes effect January 1, 2024. | ||
