Bill Text: TX SB1342 | 2023-2024 | 88th Legislature | Enrolled

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Bill Title: Relating to requirements applicable to certain third-party health insurers in relation to Medicaid.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Passed) 2023-06-18 - Effective on 9/1/23 [SB1342 Detail]

Download: Texas-2023-SB1342-Enrolled.html

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S.B. No. 1342

AN ACT
relating to requirements applicable to certain third-party health
insurers in relation to Medicaid.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 531.024131(a), Government Code, is
amended to read as follows:
(a) If cost-effective, the commission may:
(1) contract to expand all or part of the billing
coordination system established under Section 531.02413 to process
claims for services provided through other benefits programs
administered by the commission or a health and human services
agency;
(2) expand any other billing coordination tools and
resources used to process claims for health care services provided
through Medicaid to process claims for services provided through
other benefits programs administered by the commission or a health
and human services agency; and
(3) expand the scope of persons about whom information
is collected under Section 32.0424(a) [32.042], Human Resources
Code, to include recipients of services provided through other
benefits programs administered by the commission or a health and
human services agency.
SECTION 2. Section 32.0421(a), Human Resources Code, is
amended to read as follows:
(a) The commission may impose an administrative penalty on a
person who does not comply with a request for information made under
Section 32.0424(a) [32.042(b)].
SECTION 3. Section 32.0424, Human Resources Code, is
amended to read as follows:
Sec. 32.0424. REQUIREMENTS OF THIRD-PARTY HEALTH INSURERS.
(a) A third-party health insurer shall [is required to] provide to
the commission or the commission's designee, on the commission's or
the commission's designee's request, information in a form
prescribed by the executive commissioner necessary to determine:
(1) the period during which an individual entitled to
medical assistance, the individual's spouse, or the individual's
dependents may be, or may have been, covered by coverage issued by
the health insurer;
(2) the nature of the coverage; and
(3) the name, address, and identifying number of the
health plan under which the person may be, or may have been,
covered.
(b) A third-party health insurer shall accept the state's
right of recovery and the assignment under Section 32.033 to the
state of any right of an individual or other entity to payment from
the third-party health insurer for an item or service for which
payment was made under the medical assistance program, including a
waiver program established under the medical assistance program.
(b-1) Except as provided by Subsection (b-2), for an item or
service provided to an individual entitled to medical assistance
that was previously paid for by the commission or the commission's
designee and for which a third-party health insurer is responsible
for payment, the third-party health insurer shall accept
authorization provided by the commission or the commission's
designee that the item or service is covered under the medical
assistance program as if that authorization is a prior
authorization made by the third-party health insurer for the item
or service.
(b-2) Subsection (b-1) does not apply to a third-party
health insurer with respect to providing:
(1) hospital insurance benefits or supplementary
insurance benefits under Part A or B of Title XVIII of the Social
Security Act (42 U.S.C. Section 1395c et seq. or 1395j et seq.);
(2) a health care prepayment plan under Section
1833(a)(1)(A), Social Security Act (42 U.S.C. Section
1395l(a)(1)(A));
(3) a Medicare Advantage plan under Part C of Title
XVIII of the Social Security Act (42 U.S.C. Section 1395w-21 et
seq.);
(4) a prescription drug plan as a prescription drug
plan sponsor under Part D of Title XVIII of the Social Security Act
(42 U.S.C. Section 1395w-101 et seq.); or
(5) a reasonable cost reimbursement plan under Section
1876, Social Security Act (42 U.S.C. Section 1395mm).
(c) Not later than the 60th day after the date a [A]
third-party health insurer receives an [shall respond to any]
inquiry from [by] the commission or the commission's designee
regarding a claim for payment for any health care item or service
submitted to the insurer [reimbursed by the commission under the
medical assistance program] not later than the third year after
[anniversary of] the date the health care item or service was
provided, the insurer shall respond to the inquiry.
(d) A third-party health insurer may not deny a claim
submitted by the commission or the commission's designee for which
payment was made under the medical assistance program solely on the
basis of the date of submission of the claim, the type or format of
the claim form, [or] a failure to present proper documentation at
the point of service that is the basis of the claim, or, for a
responsible third-party health insurer, other than an insurer
described by Subsection (b-2), a failure to obtain prior
authorization for the item or service for which the claim is being
submitted, if:
(1) the claim is submitted by the commission or the
commission's designee not later than the third anniversary of the
date the item or service was provided; and
(2) any action by the commission or the commission's
designee to enforce the state's rights with respect to the claim is
commenced not later than the sixth anniversary of the date the
commission or the commission's designee submits the claim.
(e) In this section, "third-party health insurer" means a
health insurer or other person or arrangement that is legally
responsible by state or federal law or private agreement to pay some
or all claims for health care items or services provided to an
individual. The term includes:
(1) a self-insured plan;
(2) a group health plan as defined by Section 607 of
the Employee Retirement Income Security Act of 1974 (29 U.S.C.
Section 1167);
(3) a service benefit plan;
(4) a managed care organization; and
(5) a pharmacy benefit manager [This section does not
limit the scope or amount of information required by Section
32.042].
SECTION 4. Section 32.042, Human Resources Code, is
repealed.
SECTION 5. 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 6. This Act takes effect September 1, 2023.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1342 passed the Senate on
May 10, 2023, by the following vote: Yeas 30, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1342 passed the House on
May 24, 2023, by the following vote: Yeas 132, Nays 6, one
present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor