Bill Summary – FastDemocracy

      
            S.B. No. 2476
         
      Statutes affected: 
Introduced: Insurance Code 1271.008, Insurance Code 1275.003, Insurance Code 1301.0045, Insurance Code 1301.010, Insurance Code 1551.015, Insurance Code 1575.009, Insurance Code 1579.009, Insurance Code 1467.001, Insurance Code 1467.050, Insurance Code 1467.051 (Insurance Code 1271, Insurance Code 1301, Insurance Code 1579, Insurance Code 1467, Insurance Code 1275, Insurance Code 1551, Insurance Code 1575)
Senate Committee Report: Insurance Code 1271.008, Subchapter D, Chapter , Insurance Code 1271.155, Insurance Code 1275.003, Subchapter B, Chapter , Insurance Code 1275.051, Insurance Code 1301.0045, Insurance Code 1301.010, Subchapter D, Chapter , Insurance Code 1301.0053, Insurance Code 1551.015, Subchapter E, Chapter , Insurance Code 1551.228, Insurance Code 1575.009, Subchapter D, Chapter , Insurance Code 1575.171, Insurance Code 1579.009, Subchapter C, Chapter , Insurance Code 1579.109 (Insurance Code 1271, Subchapter D, Chapter , Insurance Code 1301, Subchapter D, Chapter , Insurance Code 1575, Subchapter C, Chapter , Insurance Code 1579, Subchapter B, Chapter , Insurance Code 1275, Insurance Code 1301, Insurance Code 1579, Insurance Code 1467, Insurance Code 1275, Subchapter D, Chapter , Insurance Code 1271, Insurance Code 1551, Insurance Code 1575, Subchapter E, Chapter , Insurance Code 1551)
Engrossed: Insurance Code 1271.008, Subchapter D, Chapter , Insurance Code 1271.155, Insurance Code 1275.003, Subchapter B, Chapter , Insurance Code 1275.051, Insurance Code 1301.0045, Insurance Code 1301.010, Subchapter D, Chapter , Insurance Code 1301.0053, Insurance Code 1551.015, Subchapter E, Chapter , Insurance Code 1551.228, Insurance Code 1575.009, Subchapter D, Chapter , Insurance Code 1575.171, Insurance Code 1579.009, Subchapter C, Chapter , Insurance Code 1579.109 (Insurance Code 1271, Subchapter D, Chapter , Insurance Code 1301, Subchapter D, Chapter , Insurance Code 1575, Subchapter C, Chapter , Insurance Code 1

               AN ACT
            
            relating to consumer protections against certain medical and health 
         
            care billing by emergency medical services providers.
         
                   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         
                   SECTION 1.  Subchapter A, Chapter 38, Insurance Code, is 
         
            amended by adding Section 38.006 to read as follows:
         
                   Sec. 38.006.  EMERGENCY MEDICAL SERVICES PROVIDER BALANCE 
         
            BILLING RATE DATABASE.  (a)  A political subdivision may submit to 
         
            the department, in the form and manner prescribed by the 
         
            commissioner, a rate set, controlled, or regulated by the political 
         
            subdivision for purposes of Section 1271.159, 1275.054, 1301.166, 
         
            1551.231, 1575.174, or 1579.112.  The department shall establish 
         
            and maintain on the department's Internet website a publicly 
         
            accessible database for the rates.
         
                   (b)  This section expires September 1, 2025.
         
                   SECTION 2.  (a)  Section 1271.008, Insurance Code, is 
         
            amended to read as follows:
         
                   Sec. 1271.008.  BALANCE BILLING PROHIBITION NOTICE.  (a)  A 
         
            health maintenance organization shall provide written notice in 
         
            accordance with this section in an explanation of benefits provided 
         
            to the enrollee and the physician or provider in connection with a 
         
            health care service or supply or transport provided by a 
         
            non-network physician or provider.  The notice must include:
         
                         (1)  a statement of the billing prohibition under 
         
            Section 1271.155, 1271.157, [or] 1271.158, or 1271.159, as 
         
            applicable;
         
                         (2)  the total amount the physician or provider may 
         
            bill the enrollee under the enrollee's health benefit plan and an 
         
            itemization of copayments, coinsurance, deductibles, and other 
         
            amounts included in that total; and
         
                         (3)  for an explanation of benefits provided to the 
         
            physician or provider, information required by commissioner rule 
         
            advising the physician or provider of the availability of mediation 
         
            or arbitration, as applicable, under Chapter 1467.
         
                   (b)  A health maintenance organization shall provide the 
         
            explanation of benefits with the notice required by this section to 
         
            a physician or health care provider not later than the date the 
         
            health maintenance organization makes a payment under Section 
         
            1271.155, 1271.157, [or] 1271.158, or 1271.159, as applicable.
         
                   (b)  Effective September 1, 2025, Section 1271.008, 
         
            Insurance Code, is amended to read as follows:
         
                   Sec. 1271.008.  BALANCE BILLING PROHIBITION NOTICE.  (a)  A 
         
            health maintenance organization shall provide written notice in 
         
            accordance with this section in an explanation of benefits provided 
         
            to the enrollee and the physician or provider in connection with a 
         
            health care service or supply provided by a non-network physician 
         
            or provider.  The notice must include:
         
                         (1)  a statement of the billing prohibition under 
         
            Section 1271.155, 1271.157, or 1271.158, as applicable;
         
                         (2)  the total amount the physician or provider may 
         
            bill the enrollee under the enrollee's health benefit plan and an 
         
            itemization of copayments, coinsurance, deductibles, and other 
         
            amounts included in that total; and
         
                         (3)  for an explanation of benefits provided to the 
         
            physician or provider, information required by commissioner rule 
         
            advising the physician or provider of the availability of mediation 
         
            or arbitration, as applicable, under Chapter 1467.
         
                   (b)  A health maintenance organization shall provide the 
         
            explanation of benefits with the notice required by this section to 
         
            a physician or health care provider not later than the date the 
         
            health maintenance organization makes a payment under Section 
         
            1271.155, 1271.157, or 1271.158, as applicable.
         
                   SECTION 3.  Subchapter D, Chapter 1271, Insurance Code, is 
         
            amended by adding Section 1271.159 to read as follows:
         
                   Sec. 1271.159.  NON-NETWORK EMERGENCY MEDICAL SERVICES 
         
            PROVIDER.  (a)  In this section, "emergency medical services 
         
            provider" has the meaning assigned by Section 773.003, Health and 
         
            Safety Code, except that the term does not include an air ambulance.
         
                   (b)  Except as provided by Subsection (c), a health 
         
            maintenance organization shall pay for a covered health care 
         
            service performed for, or a covered supply or covered transport 
         
            related to that service provided to, an enrollee by a non-network 
         
            emergency medical services provider at:
         
                         (1)  if the political subdivision has submitted the 
         
            rate to the department under Section 38.006, the rate set,




	AN ACT
	relating to consumer protections against certain medical and health
	care billing by emergency medical services providers.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1. Subchapter A, Chapter 38, Insurance Code, is
	amended by adding Section 38.006 to read as follows:
	Sec. 38.006. EMERGENCY MEDICAL SERVICES PROVIDER BALANCE
	BILLING RATE DATABASE. (a) A political subdivision may submit to
	the department, in the form and manner prescribed by the
	commissioner, a rate set, controlled, or regulated by the political
	subdivision for purposes of Section 1271.159, 1275.054, 1301.166,
	1551.231, 1575.174, or 1579.112. The department shall establish
	and maintain on the department's Internet website a publicly
	accessible database for the rates.
	(b) This section expires September 1, 2025.
	SECTION 2. (a) Section 1271.008, Insurance Code, is
	amended to read as follows:
	Sec. 1271.008. BALANCE BILLING PROHIBITION NOTICE. (a) A
	health maintenance organization shall provide written notice in
	accordance with this section in an explanation of benefits provided
	to the enrollee and the physician or provider in connection with a
	health care service or supply or transport provided by a
	non-network physician or provider. The notice must include:
	(1) a statement of the billing prohibition under
	Section 1271.155, 1271.157, [or] 1271.158, or 1271.159, as
	applicable;
	(2) the total amount the physician or provider may
	bill the enrollee under the enrollee's health benefit plan and an
	itemization of copayments, coinsurance, deductibles, and other
	amounts included in that total; and
	(3) for an explanation of benefits provided to the
	physician or provider, information required by commissioner rule
	advising the physician or provider of the availability of mediation
	or arbitration, as applicable, under Chapter 1467.
	(b) A health maintenance organization shall provide the
	explanation of benefits with the notice required by this section to
	a physician or health care provider not later than the date the
	health maintenance organization makes a payment under Section
	1271.155, 1271.157, [or] 1271.158, or 1271.159, as applicable.
	(b) Effective September 1, 2025, Section 1271.008,
	Insurance Code, is amended to read as follows:
	Sec. 1271.008. BALANCE BILLING PROHIBITION NOTICE. (a) A
	health maintenance organization shall provide written notice in
	accordance with this section in an explanation of benefits provided
	to the enrollee and the physician or provider in connection with a
	health care service or supply provided by a non-network physician
	or provider. The notice must include:
	(1) a statement of the billing prohibition under
	Section 1271.155, 1271.157, or 1271.158, as applicable;
	(2) the total amount the physician or provider may
	bill the enrollee under the enrollee's health benefit plan and an
	itemization of copayments, coinsurance, deductibles, and other
	amounts included in that total; and
	(3) for an explanation of benefits provided to the
	physician or provider, information required by commissioner rule
	advising the physician or provider of the availability of mediation
	or arbitration, as applicable, under Chapter 1467.
	(b) A health maintenance organization shall provide the
	explanation of benefits with the notice required by this section to
	a physician or health care provider not later than the date the
	health maintenance organization makes a payment under Section
	1271.155, 1271.157, or 1271.158, as applicable.
	SECTION 3. Subchapter D, Chapter 1271, Insurance Code, is
	amended by adding Section 1271.159 to read as follows:
	Sec. 1271.159. NON-NETWORK EMERGENCY MEDICAL SERVICES
	PROVIDER. (a) In this section, "emergency medical services
	provider" has the meaning assigned by Section 773.003, Health and
	Safety Code, except that the term does not include an air ambulance.
	(b) Except as provided by Subsection (c), a health
	maintenance organization shall pay for a covered health care
	service performed for, or a covered supply or covered transport
	related to that service provided to, an enrollee by a non-network
	emergency medical services provider at:
	(1) if the political subdivision has submitted the
	rate to the department under Section 38.006, the rate set,