Bill Summary – FastDemocracy

         
            S.B. No. 1286
         
Statutes affected: 
Introduced: Insurance Code 843.337, Insurance Code 843.342, Insurance Code 1301.102, Insurance Code 1301.137 (Insurance Code 843, Insurance Code 1301)
Senate Committee Report: Insurance Code 843.337, Insurance Code 843.342, Insurance Code 1301.102, Insurance Code 1301.137 (Insurance Code 843, Insurance Code 1301)
Engrossed: Insurance Code 843.337, Insurance Code 843.342, Insurance Code 1301.102, Insurance Code 1301.137 (Insurance Code 843, Insurance Code 1301)
House Committee Report: Insurance Code 843.337, Insurance Code 843.342, Insurance Code 1301.102, Insurance Code 1301.137 (Insurance Code 843, Insurance Code 1301)
Enrolled: Insurance Code 843.337, Insurance Code 843.342, Insurance Code 1301.102, Insurance Code 1301.137 (Insurance Code 843, Insurance Code 1301)

               AN ACT
            
            relating to prompt payment deadlines for health benefit plan  
         
            claims affected by a catastrophic event.
         
                   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         
                   SECTION 1.  Section 843.337, Insurance Code, is amended by 
         
            amending Subsections (b) and (c) and adding Subsection (c-1) to 
         
            read as follows:
         
                   (b)  If a physician or provider fails to submit a claim in 
         
            compliance with this section, the physician or provider forfeits 
         
            the right to payment [unless the failure to submit the claim in 
         
            compliance with this section is a result of a catastrophic event 
         
            that substantially interferes with the normal business operations 
         
            of the physician or provider].
         
                   (c)  The period for submitting a claim under this section may 
         
            be extended by:
         
                         (1)  contract;
         
                         (2)  notice published by the commissioner allowing an 
         
            extension of prompt payment deadlines to a later date chosen by the 
         
            commissioner due to a catastrophic event; or
         
                         (3)  the department's approval of a physician's or 
         
            provider's request for an extension due to a catastrophic event 
         
            that substantially interferes with the normal business operations 
         
            of the physician or provider.
         
                   (c-1)  The commissioner may adopt rules to implement 
         
            Subsection (c), including rules establishing requirements for a 
         
            request made under Subsection (c)(3).
         
                   SECTION 2.  Section 843.342(h), Insurance Code, is amended 
         
            to read as follows:
         
                   (h)  A health maintenance organization is not liable for a 
         
            penalty under this section:
         
                         (1)  if the failure to pay the claim in accordance with 
         
            this subchapter is a result of a catastrophic event and:
         
                               (A)  the commissioner published a notice allowing 
         
            an extension of the applicable prompt payment deadlines due to the 
         
            catastrophic event; or
         
                               (B)  the department approved the health 
         
            maintenance organization's request for an extension due to the 
         
            substantial interference of the catastrophic event [that 
         
            substantially interferes] with the normal business operations of 
         
            the health maintenance organization; or
         
                         (2)  if the claim was paid in accordance with this 
         
            subchapter, but for less than the contracted rate, and:
         
                               (A)  the physician or provider notifies the health 
         
            maintenance organization of the underpayment after the 270th day 
         
            after the date the underpayment was received; and
         
                               (B)  the health maintenance organization pays the 
         
            balance of the claim on or before the 30th day after the date the 
         
            health maintenance organization receives the notice.
         
                   SECTION 3.  Section 1301.102, Insurance Code, is amended by 
         
            amending Subsections (d) and (e) and adding Subsection (e-1) to 
         
            read as follows:
         
                   (d)  If a physician or health care provider fails to submit a 
         
            claim in compliance with this section, the physician or provider 
         
            forfeits the right to payment [unless the failure to submit the 
         
            claim in compliance with this section is a result of a catastrophic 
         
            event that substantially interferes with the normal business 
         
            operations of the physician or provider].
         
                   (e)  The period for submitting a claim under this section may 
         
            be extended by:
         
                         (1)  contract;
         
                         (2)  notice published by the commissioner allowing an 
         
            extension of prompt payment deadlines to a later date chosen by the 
         
            commissioner due to a catastrophic event; or
         
                         (3)  the department's approval of a physician's or 
         
            health care provider's request for an extension due to a 
         
            catastrophic event that substantially interferes with the normal 
         
            business operations of the physician or provider.
         
                   (e-1)  The commissioner may adopt rules to implement 
         
            Subsection (e), including rules establishing requirements for a 
         
            request made under Subsection (e)(3).
         
                   SECTION 4.  Section 1301.137(h), Insurance Code, is amended 
         
            to read as follows:
         
                   (h)  An insurer is not liable for a penalty under this 
         
            section:




	AN ACT
	relating to prompt payment deadlines for health benefit plan
	claims affected by a catastrophic event.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1. Section 843.337, Insurance Code, is amended by
	amending Subsections (b) and (c) and adding Subsection (c-1) to
	read as follows:
	(b) If a physician or provider fails to submit a claim in
	compliance with this section, the physician or provider forfeits
	the right to payment [~~unless the failure to submit the claim in~~
	~~compliance with this section is a result of a catastrophic event~~
	~~that substantially interferes with the normal business operations~~
	~~of the physician or provider~~].
	(c) The period for submitting a claim under this section may
	be extended by:
	(1) contract;
	(2) notice published by the commissioner allowing an
	extension of prompt payment deadlines to a later date chosen by the
	commissioner due to a catastrophic event; or
	(3) the department's approval of a physician's or
	provider's request for an extension due to a catastrophic event
	that substantially interferes with the normal business operations
	of the physician or provider.
	(c-1) The commissioner may adopt rules to implement
	Subsection (c), including rules establishing requirements for a
	request made under Subsection (c)(3).
	SECTION 2. Section 843.342(h), Insurance Code, is amended
	to read as follows:
	(h) A health maintenance organization is not liable for a
	penalty under this section:
	(1) if the failure to pay the claim in accordance with
	this subchapter is a result of a catastrophic event and:
	(A) the commissioner published a notice allowing
	an extension of the applicable prompt payment deadlines due to the
	catastrophic event; or
	(B) the department approved the health
	maintenance organization's request for an extension due to the
	substantial interference of the catastrophic event [~~that~~
	~~substantially interferes~~] with the normal business operations of
	the health maintenance organization; or
	(2) if the claim was paid in accordance with this
	subchapter, but for less than the contracted rate, and:
	(A) the physician or provider notifies the health
	maintenance organization of the underpayment after the 270th day
	after the date the underpayment was received; and
	(B) the health maintenance organization pays the
	balance of the claim on or before the 30th day after the date the
	health maintenance organization receives the notice.
	SECTION 3. Section 1301.102, Insurance Code, is amended by
	amending Subsections (d) and (e) and adding Subsection (e-1) to
	read as follows:
	(d) If a physician or health care provider fails to submit a
	claim in compliance with this section, the physician or provider
	forfeits the right to payment [~~unless the failure to submit the~~
	~~claim in compliance with this section is a result of a catastrophic~~
	~~event that substantially interferes with the normal business~~
	~~operations of the physician or provider~~].
	(e) The period for submitting a claim under this section may
	be extended by:
	(1) contract;
	(2) notice published by the commissioner allowing an
	extension of prompt payment deadlines to a later date chosen by the
	commissioner due to a catastrophic event; or
	(3) the department's approval of a physician's or
	health care provider's request for an extension due to a
	catastrophic event that substantially interferes with the normal
	business operations of the physician or provider.
	(e-1) The commissioner may adopt rules to implement
	Subsection (e), including rules establishing requirements for a
	request made under Subsection (e)(3).
	SECTION 4. Section 1301.137(h), Insurance Code, is amended
	to read as follows:
	(h) An insurer is not liable for a penalty under this
	section: