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  H.B. No. 1342
 
 
 
 
AN ACT
  relating to adoption of certain information technology.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle J, Title 8, Insurance Code, is amended
  by adding Chapter 1661 to read as follows:
  CHAPTER 1661.  INFORMATION TECHNOLOGY
         Sec. 1661.001.  DEFINITIONS.  In this chapter:
               (1)  "Health benefit plan" means a 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 that is offered by:
                     (A)  an insurance company;
                     (B)  a group hospital service corporation
  operating under Chapter 842;
                     (C)  a fraternal benefit society operating under
  Chapter 885;
                     (D)  a stipulated premium company operating under
  Chapter 884;
                     (E)  a Lloyd's plan operating under Chapter 941;
                     (F)  an exchange operating under Chapter 942;
                     (G)  a health maintenance organization operating
  under Chapter 843;
                     (H)  a multiple employer welfare arrangement that
  holds a certificate of authority under Chapter 846;
                     (I)  an approved nonprofit health corporation
  that holds a certificate of authority under Chapter 844; or
                     (J)  an entity not authorized under this code or
  another insurance law of this state that contracts directly for
  health care services on a risk-sharing basis, including a
  capitation basis.
               (2)  "Health benefit plan issuer" means an entity
  authorized to issue a health benefit plan in this state.
               (3)  "Health care provider" means:
                     (A)  an individual who is licensed, certified, or
  otherwise authorized to provide health care services; or
                     (B)  a hospital, emergency clinic, outpatient
  clinic, or other facility providing health care services.
               (4)  "Participating provider" means a health care
  provider who has contracted with a health benefit plan issuer to
  provide services to enrollees.
         Sec. 1661.002.  USE OF CERTAIN INFORMATION TECHNOLOGY
  REQUIRED.  (a)  A health benefit plan issuer shall use information
  technology that provides a participating provider with real-time
  information at the point of care concerning:
               (1)  the enrollee's:
                     (A)  copayment and coinsurance;
                     (B)  applicable deductibles; and
                     (C)  covered benefits and services; and
               (2)  the enrollee's estimated total financial
  responsibility for the care.
         (b)  A health benefit plan issuer shall use information
  technology that provides an enrollee with information concerning
  the enrollee's:
               (1)  copayment and coinsurance;
               (2)  applicable deductibles;
               (3)  covered benefits and services; and
               (4)  estimated financial responsibility for the health
  care provided to the enrollee.
         (c)  Nothing in this section may be interpreted as a
  guarantee of payment for health care services.
         (d)  A health benefit plan issuer's Internet website may be
  used to meet the information technology requirements of this
  chapter.
         Sec. 1661.003.  EXCEPTIONS.  This chapter does not apply to:
               (1)  a health benefit plan that provides coverage only:
                     (A)  for a specified disease or diseases or under
  a limited benefit policy;
                     (B)  for accidental death or dismemberment;
                     (C)  as a supplement to a liability insurance
  policy; or
                     (D)  for dental or vision care;
               (2)  disability income insurance coverage;
               (3)  credit insurance coverage;
               (4)  a hospital confinement indemnity policy;
               (5)  a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
               (6)  a workers' compensation insurance policy;
               (7)  medical payment insurance coverage provided under
  a motor vehicle insurance policy;
               (8)  a long-term care insurance policy, including a
  nursing home fixed indemnity policy, unless the commissioner
  determines that the policy provides benefits so comprehensive that
  the policy is a health benefit plan and should not be subject to the
  exemption provided under this section;
               (9)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; or
               (10)  a Medicaid managed care program operated under
  Chapter 533, Government Code, or a Medicaid program operated under
  Chapter 32, Human Resources Code.
         Sec. 1661.004.  REQUIRED USE OF TECHNOLOGY BY PROVIDERS.  A
  physician, hospital, or other health care provider shall use
  information technology as required under this chapter beginning not
  later than September 1, 2013.
         Sec. 1661.005.  REFUND OF OVERPAYMENT.  A physician,
  hospital, or other health care provider that receives an
  overpayment from an enrollee must refund the amount of the
  overpayment to the enrollee not later than the 30th day after the
  date the physician, hospital, or health care provider determines
  that an overpayment has been made. This section does not apply to an
  overpayment subject to Section 843.350 or 1301.132.
         Sec. 1661.0055.  USE OF TECHNOLOGY: WAIVER. (a)
  Notwithstanding Section 1661.004, physicians or health care
  providers with fewer than five full-time-equivalent employees are
  not required to use information technology as required under this
  chapter.
         (b)  A health benefit plan issuer may not require, through
  contract or otherwise, physicians or health care providers with
  fewer than five full-time-equivalent employees to use information
  technology as required under this chapter.
         (c)  A contract between the issuer of a health benefit plan
  and a physician or health care provider must provide for a waiver of
  any requirement for the use of information technology as
  established or required under this chapter.
         (d)  The commissioner shall establish the circumstances
  under which the requirements of this chapter do not apply to a
  physician or health care provider including:
               (1)  undue hardship, including fiscal or operational
  hardship; or
               (2)  any other special circumstance that would justify
  an exclusion.
         (e)  The commissioner shall establish circumstances under
  which a waiver under Subsection (c) is required, including:
               (1)  undue hardship, including fiscal or operational
  hardship; or
               (2)  any other special circumstance that would justify
  a waiver.
         (f)  Any physician or health care provider that is denied a
  waiver by a health benefit plan issuer may appeal the denial to the
  commissioner. The commissioner shall determine whether a waiver
  must be granted.
         (g)  A health benefit plan issuer may not refuse to contract
  or renew a contract with a physician or health care provider based
  in whole or in part on the physician or provider requesting or
  receiving a waiver or appealing a waiver determination. A health
  benefit plan issuer may not refuse to contract or renew a contract
  with a physician or health care provider based in whole or in part
  on the physician or provider meeting the exemptions contained in
  Subsections (a) and (b).
         (h)  A waiver approved under this section expires September
  1, 2013.
         Sec. 1661.006.  HEALTH BENEFIT PLAN ISSUER CONDUCT.  A
  contract between a health benefit plan issuer and a physician,
  hospital, or other health care provider may not prohibit the
  physician, hospital, or health care provider from collecting, at
  the time of care, the estimated amount for which the enrollee may be
  financially responsible.
         Sec. 1661.007.  CERTAIN FEES PROHIBITED.  A health benefit
  plan issuer may not directly charge or collect from an enrollee or a
  physician, or other health care provider, a fee to cover the costs
  incurred by the health benefit plan issuer in complying with this
  chapter.
         Sec. 1661.008.  WAIVER.  (a)  A health benefit plan issuer
  may apply to the commissioner for a waiver of the requirement under
  this chapter to use information technology.
         (b)  The commissioner by rule shall identify circumstances
  that justify a waiver, including:
               (1)  undue hardship, including financial or
  operational hardship;
               (2)  the geographical area in which the health benefit
  plan issuer operates;
               (3)  the number of enrollees covered by a health
  benefit plan issuer; and
               (4)  other special circumstances.
         (c)  The commissioner shall approve or deny a waiver
  application under this section not later than the 60th day after the
  date of receipt of the application.
         (d)  This section expires January 1, 2012.
         (e)  A waiver approved under this section expires September
  1, 2013.
         Sec. 1661.009.  RULES.  (a) The commissioner shall adopt
  rules as necessary to implement this chapter, including rules that
  ensure that the information technology used by a health benefit
  plan issuer does not have legal or technical restrictions for
  encoding, displaying, exchanging, reading, printing, transmitting,
  or storing information or data in electronic form.
         (b)  Rules adopted by the commissioner must be consistent
  with national standards established by the Workgroup for Electronic
  Data Interchange or by other similar organizations recognized by
  the commissioner.
         SECTION 2.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution. If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect January 1, 2010.
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
 
         I certify that H.B. No. 1342 was passed by the House on April
  28, 2009, by the following vote:  Yeas 149, Nays 0, 1 present, not
  voting; and that the House concurred in Senate amendments to H.B.
  No. 1342 on May 18, 2009, by the following vote:  Yeas 139, Nays 0,
  2 present, not voting.
 
  ______________________________
  Chief Clerk of the House   
 
         I certify that H.B. No. 1342 was passed by the Senate, with
  amendments, on May 14, 2009, by the following vote:  Yeas 31, Nays
  0.
 
  ______________________________
  Secretary of the Senate   
  APPROVED: __________________
                  Date       
   
           __________________
                Governor