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89(R) HB 3863 - Engrossed version - Bill Text
89R27001 SCF-F
By: Canales, Oliverson, Hull
H.B. No. 3863
A BILL TO BE ENTITLED
AN ACT
relating to the form of a claim payment to a health care provider by
a health maintenance organization, preferred provider benefit
plan, or managed care organization.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 540.0265, Government Code, is amended by
adding Subsection (c) to read as follows:
(c)
A contract to which this subchapter applies must
prohibit the contracting Medicaid managed care organization from
requiring a physician or provider to accept a claim payment in the
form of a virtual credit card or any other payment method with
respect to which a fee, including a processing fee, administrative
fee, percentage amount, or dollar amount, is assessed to receive
the payment. A nominal fee assessed by the physician's or provider's
bank to receive an electronic funds transfer is not considered to be
a prohibited fee for purposes of this subsection.
SECTION 2. Section 843.346, Insurance Code, is amended to
read as follows:
Sec. 843.346. PAYMENT OF CLAIMS.
(a)
Except as provided by
this subchapter, a health maintenance organization shall pay a
physician or provider for health care services and benefits
provided to an enrollee not later than:
(1) the 45th day after the date on which a claim for
payment is received with the documentation reasonably necessary to
process the claim; or
(2) if applicable, within the number of calendar days
specified by written agreement between the physician or provider
and the health maintenance organization.
(b)
A health maintenance organization may not require a
physician or provider to accept a claim payment in the form of a
virtual credit card or any other payment method with respect to
which a fee, including a processing fee, administrative fee,
percentage amount, or dollar amount, is assessed to receive the
payment. A nominal fee assessed by the physician's or provider's
bank to receive an electronic funds transfer is not considered to be
a prohibited fee for purposes of this subsection.
SECTION 3. Subchapter C-1, Chapter 1301, Insurance Code, is
amended by adding Section 1301.141 to read as follows:
Sec.
1301.141.
FORM OF CLAIM PAYMENTS. An insurer may not
require a physician or health care provider to accept a claim
payment in the form of a virtual credit card or any other payment
method with respect to which a fee, including a processing fee,
administrative fee, percentage amount, or dollar amount, is
assessed to receive the payment. A nominal fee assessed by the
physician's or provider's bank to receive an electronic funds
transfer is not considered to be a prohibited fee for purposes of
this subsection.
SECTION 4. (a) Section 540.0265(c), Government Code, as
added by this Act, applies only to a contract entered into on or
after the effective date of this Act. A contract entered into
before the effective date of this Act is governed by the law as it
existed immediately before the effective date of this Act, and that
law is continued in effect for that purpose.
(b) Sections 843.346(b) and 1301.141, Insurance Code, as
added by this Act, apply only to a claim submitted on or after the
effective date of this Act. A claim submitted before the effective
date of this Act is governed by the law as it existed immediately
before the effective date of this Act, and that law is continued in
effect for that purpose.
SECTION 5. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 6. This Act takes effect September 1, 2025.