Texas Considers Balance Billing Legislation For Self-Funded Plans

At first glance Texas Senate Bill 1530 looks appealing. Balance billing protection for self-funded health & welfare plans would be a welcomed gift from government, especially among purveyors of Reference Based Pricing plans. 

“SB 1530, would allow purchasers of self-funded plans regulated at the federal level under ERISA to opt-in to currently existing mediation procedures at the Texas Department of Insurance.”

However self-funded plans in effect prior to September 2021 are prohibited from enjoying the benefits of medical bill protections addressed in the legislation.

“A managed care plan delivered, issued for delivery, or renewed before September 1, 2021, 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.”

So what about self-funded Reference Based Pricing plans, a growing market phenomenon? Are these plans eligible? Not according to the language in the bill:

“Eligible plan” means a managed care plan that is a self-funded or self-insured employee welfare benefit plan that provides health benefits and is established in accordance with the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.).”

The article below gives false hope to self-funded plan sponsors. They should understand that the devil is in the details.

Senate approves surprise medical bill protections

April 18th, 2019 by Associated Press

AUSTIN—Patients wouldn’t have to worry about receiving bills for medical procedures they thought were covered by their insurance under a measure passed by the Senate on Tuesday. Surprise billing happens when a person goes to a medical facility within their insurance network, only to find out later that care was provided by contracted providers who aren’t in their network. Since these contractors bill the insurance company at out-of-network rates, the patient can find themselves responsible for hundreds or thousands of dollars in medical expenses that they thought were in-network. What should happen, says North Richland Hills Senator Kelly Hancock, is that the insurer and health care providers should work this out between themselves, and leave the patient out of it. His bill, SB 1264, would protect patients from surprise billing while providing arbitration procedures to resolve billing disputes between providers. Following passage of the bill, Houston Senator Paul Bettencourt commended his colleague for his work on the bill. “People need help with this, because it’s not just the money, it’s the tremendous amount of time it takes to straighten these problems out,” he said.

Under the bill, if a patient receives care at an in-network facility, they are only responsible for the expected co-pays, deductibles and other out-of-pocket expenses they agreed to when they joined their insurance plan. If there is a dispute between an insurer and a healthcare provider, the bill provides an arbitration system modelled after the one used by Major League Baseball. In this system, each party presents an offer to an impartial third-party arbitrator, and he or she picks the most reasonable offer. This is intended to discourage low- or high-ball offers, and incentivizes parties to move towards the middle to avoid getting far less, or paying far more, than they would like. The bill would only apply to state-regulated insurance plans. Another bill by Hancock, SB 1530, would allow purchasers of self-funded plans regulated at the federal level under ERISA to opt-in to currently existing mediation procedures at the Texas Department of Insurance.

Also Tuesday, the Senate gave tentative approval to a bill that would prohibit cities, counties and other local governmental entities from using public funds to hire professional lobbyists. Edgewood Senator Bob Hall thinks it’s wrong when local governments use taxpayer money to hire lobbyists to go to Austin and fight legislation he believes will benefit those same taxpayers. “Taxpayer-funded lobbyists overwhelm the voices of citizens and elected officials, the very people we as legislators are elected to represent,” he said. His bill, SB 29, wouldn’t prevent local officials like mayors or city managers from coming to the statehouse to support or oppose legislation. The bill needs a final vote, likely Wednesday, to proceed to the House.

Finally on Tuesday, the Senate approved the last two of a four bill package from Conroe Senator Brandon Creighton that would prohibit municipalities from imposing regulations relating to benefits and other employment practices on private businesses. He believes that these regulations stifle economic growth in Texas. Last week, the Senate passed two of his bills that would prevent cities from mandating sick leave and paid time-off policies to local businesses. Another bill passed Tuesday would also prohibit municipal regulations on scheduling requirements and overtime policies. “If enacted, these local policies would be catastrophic to businesses large and small,” said Creighton. “Construction companies, restaurants, retail, hospitality and many other industries would be devastated.” The final bill in the package would prohibit “ban the box” ordinances: rules preventing private employers from inquiring about past criminal history on employment applications. These measures will also need another, final vote Wednesday.

The Senate will reconvene Tuesday, April 23 at 11 a.m.

 

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