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AN ACT
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relating to premium discounts for certain participants in the Texas |
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Health Insurance Risk Pool and to funding for those discounts |
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through certain penalties. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.342, Insurance Code, is amended by |
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adding Subsections (m) and (n) to read as follows: |
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(m) Notwithstanding any other provision of this section, |
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this subsection governs the payment of a penalty under this |
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section. For a penalty under this section relating to a clean claim |
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submitted by a physician or provider other than an institutional |
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provider, the health maintenance organization shall pay the entire |
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penalty to the physician or provider, except for any interest |
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computed under Subsection (c), which shall be paid to the Texas |
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Health Insurance Risk Pool. For a penalty under this section |
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relating to a clean claim submitted by an institutional provider, |
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the health maintenance organization shall pay 50 percent of the |
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total penalty amount computed under this section, including |
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interest, to the institutional provider and the remaining 50 |
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percent of that amount to the Texas Health Insurance Risk Pool. |
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(n) In this section, "institutional provider" means a |
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hospital or other medical or health-related service facility that |
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provides care for the sick or injured or other care that may be |
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covered in an evidence of coverage. |
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SECTION 2. Section 1301.137, Insurance Code, is amended by |
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adding Subsection (l) to read as follows: |
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(l) Notwithstanding any other provision of this section, |
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this subsection governs the payment of a penalty under this |
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section. For a penalty under this section relating to a clean claim |
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submitted by a preferred provider other than an institutional |
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provider, the insurer shall pay the entire penalty to the preferred |
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provider, except for any interest computed under Subsection (c), |
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which shall be paid to the Texas Health Insurance Risk Pool. For a |
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penalty under this section relating to a clean claim submitted by an |
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institutional provider, the insurer shall pay 50 percent of the |
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penalty amount computed under this section, including interest, to |
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the institutional provider and the remaining 50 percent of that |
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amount to the Texas Health Insurance Risk Pool. |
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SECTION 3. Section 1506.105, Insurance Code, is amended by |
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amending Subsection (e) and adding Subsection (e-1) to read as |
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follows: |
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(e) Premium rates shall be established to provide fully for |
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all of the expected costs of claims, including recovery of prior |
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losses, expenses of operation, investment income from claim |
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reserves, and any other cost factors, subject to the limitations |
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[limitation] described in this subsection and Subsection (e-1). In |
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no event may pool premium rates exceed 200 percent of the standard |
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risk rate described by Subsection (d) [rates applicable to
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individual standard risks]. |
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(e-1) Subject to the availability of funds under Section |
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1506.260, discounted premiums shall be offered on a sliding scale, |
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based on financial need, as follows: |
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(1) for an individual whose household income is below |
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200 percent of the federal poverty measure, determined under the |
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United States Department of Health and Human Services poverty |
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guidelines in effect at the time coverage is provided, premium |
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rates shall equal the standard risk rate described by Subsection |
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(d); and |
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(2) for an individual whose household income is at or |
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below 300 percent, but not less than 200 percent, of the federal |
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poverty measure, determined under the United States Department of |
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Health and Human Services poverty guidelines in effect at the time |
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coverage is provided, premium rates shall equal 140 percent of the |
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standard risk rate described by Subsection (d). |
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SECTION 4. Subchapter F, Chapter 1506, Insurance Code, is |
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amended by adding Section 1506.260 to read as follows: |
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Sec. 1506.260. FUNDING FOR PREMIUM DISCOUNTS. The board |
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shall collect penalty payments and interest paid by health |
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maintenance organizations as provided by Section 843.342 and |
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insurers as provided by Section 1301.137. The board may use funds |
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collected under this section only to finance premium discounts |
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under Section 1506.105(e-1). The board may require a health |
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maintenance organization or an insurer to make payments under this |
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section and make reports concerning those payments in a manner |
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determined by the board. |
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SECTION 5. (a) Sections 843.342 and 1301.137, Insurance |
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Code, as amended by this Act, apply only to a penalty or interest on |
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a penalty owed with respect to a clean claim paid on or after the |
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effective date of this Act. A penalty or interest on a penalty owed |
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with respect to a clean claim paid before the effective date of this |
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Act is governed by the law in effect immediately before that date, |
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and that law is continued in effect for that purpose. |
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(b) This Act applies only to premium rates for coverage |
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through the Texas Health Insurance Risk Pool under Chapter 1506, |
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Insurance Code, as amended by this Act, that is in effect on or |
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after January 1, 2011. Premium rates for coverage in effect before |
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January 1, 2011, are governed by the law in effect immediately |
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before the effective date of this Act, and the former law is |
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continued in effect for that purpose. |
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SECTION 6. This Act takes effect January 1, 2010. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I certify that H.B. No. 2064 was passed by the House on April |
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8, 2009, by the following vote: Yeas 145, Nays 0, 1 present, not |
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voting; and that the House concurred in Senate amendments to H.B. |
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No. 2064 on May 18, 2009, by the following vote: Yeas 141, Nays 0, |
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1 present, not voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 2064 was passed by the Senate, with |
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amendments, on May 12, 2009, by the following vote: Yeas 30, Nays |
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1. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: __________________ |
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Date |
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__________________ |
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Governor |