HB3863 - 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.

  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.