Bill Text: TX HB4500 | 2023-2024 | 88th Legislature | Comm Sub
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-Comm_Sub.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-Comm_Sub.html
By: Harris of Williamson (Senate Sponsor - Hughes) | H.B. No. 4500 | |
(In the Senate - Received from the House May 10, 2023; | ||
May 11, 2023, read first time and referred to Committee on Health & | ||
Human Services; May 21, 2023, reported adversely, with favorable | ||
Committee Substitute by the following vote: Yeas 8, Nays 0; | ||
May 21, 2023, sent to printer.) | ||
COMMITTEE SUBSTITUTE FOR H.B. No. 4500 | By: Hughes |
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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 Lloyd's plan operating under Chapter 941; or | ||
(8) 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) alternative health benefit coverage offered by a | ||
subsidiary of the Texas Mutual Insurance Company under Subchapter | ||
M, Chapter 2054; | ||
(8) group health coverage made available by a school | ||
district in accordance with Section 22.004, Education Code; | ||
(9) a regional or local health care program operated | ||
under Section 75.104, Health and Safety Code; and | ||
(10) a self-funded health benefit plan sponsored by a | ||
professional employer organization under Chapter 91, Labor Code. | ||
(c) This chapter does not apply to the state Medicaid | ||
program, including the Medicaid managed care program operated under | ||
Chapter 533, Government Code, or the child health plan program | ||
operated under Chapter 62, Health and Safety Code. | ||
Sec. 1223.002. INTERNET WEBSITE FOR VERIFICATION REQUIRED | ||
FOR EMERGENCY PHYSICIANS AND HEALTH CARE PROVIDERS. (a) 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; and | ||
(2) the deductible, copayment, or coinsurance for | ||
which the patient is responsible. | ||
(b) A health benefit plan issuer may provide the information | ||
described by Subsection (a) through: | ||
(1) an existing Internet portal that is available at | ||
all times; or | ||
(2) an Internet portal that is: | ||
(A) provided by a third party contracting with | ||
the issuer; and | ||
(B) available at all times. | ||
SECTION 2. This Act takes effect January 1, 2024. | ||
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