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A BILL TO BE ENTITLED
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AN ACT
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relating to the applicability of mediation requirements for balance |
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billing to certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1467.001, Insurance Code, is amended by |
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amending Subdivisions (1), (2-a), (2-b), and (3) and adding |
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Subdivision (2-c) to read as follows: |
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(1) "Administrator" means: |
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(A) an administering firm for a health benefit |
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plan providing coverage under Chapter 1551, 1575, or 1579; [and] |
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(B) if applicable, the claims administrator for |
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the health benefit plan; and |
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(C) if applicable, an administrating firm for an |
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eligible plan for which an election is made under Section |
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1467.0021. |
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(2-a) "Eligible plan" means a managed care plan that |
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is a self-funded or self-insured employee welfare benefit plan that |
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provides health benefits and is established in accordance with the |
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Employee Retirement Income Security Act of 1974 (29 U.S.C. Section |
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1001 et seq.). |
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(2-b) "Emergency care" has the meaning assigned by |
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Section 1301.155. |
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(2-c) [(2-b)] "Emergency care provider" means a |
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physician, health care practitioner, facility, or other health care |
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provider who provides and bills an enrollee, administrator, or |
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health benefit plan for emergency care. |
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(3) "Enrollee" means an individual who is eligible to |
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receive benefits through a [preferred provider benefit plan or a] |
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health benefit plan subject to this chapter [under Chapter 1551,
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1575, or 1579]. |
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SECTION 2. Section 1467.002, Insurance Code, is amended to |
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read as follows: |
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Sec. 1467.002. APPLICABILITY OF CHAPTER. This chapter |
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applies to: |
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(1) a preferred provider benefit plan offered by an |
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insurer under Chapter 1301; [and] |
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(2) an administrator of a health benefit plan, other |
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than a health maintenance organization plan, under Chapter 1551, |
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1575, or 1579; and |
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(3) an eligible plan for which the plan sponsor makes |
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an election under Section 1467.0021. |
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SECTION 3. Subchapter A, Chapter 1467, Insurance Code, is |
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amended by adding Section 1467.0021 to read as follows: |
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Sec. 1467.0021. ELECTIVE APPLICABILITY. (a) A plan |
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sponsor of an eligible plan may elect on an annual basis for this |
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chapter to apply to the plan. A sponsor making an election shall |
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provide written notice of the election to the department in the form |
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and manner required by department rule. |
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(b) An administrator of an eligible plan for which an |
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election is made under Subsection (a) shall ensure that the plan and |
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any evidence of coverage complies with this chapter. |
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SECTION 4. The Texas Department of Insurance shall adopt |
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rules necessary to implement Section 1467.0021, Insurance Code, as |
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added by this Act, not later than August 31, 2021. |
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SECTION 5. The changes in law made by this Act apply only to |
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a managed care plan that is delivered, issued for delivery, or |
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renewed on or after September 1, 2021. A managed care plan |
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delivered, issued for delivery, or renewed before September 1, |
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2021, is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 6. This Act takes effect January 1, 2020. |