TITLE: 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.

SUMMARY: 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.

FULL TEXT:
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.