Texas House Bill 3933 – A Panacea for Reference Based Pricing Plans?

Look carefully at the definition of Managed Care Plans:

 “Managed care plan means a health benefit plan under which the plan administrator provides or arranges for health care benefits to plan participants and requires or encourages plan participants to use physicians and health care providers the plan designates.”

Question: Does a Reference Based Pricing plan model that has direct agreements in place with certain medical caregivers qualify as a Managed Care Plan under the definition within the bill?

By: Martinez Fischer

H.B. No. 3933

	A BILL TO BE ENTITLED
	AN ACT
	relating to consumer protections against billing and limitations on
	information reported by consumer reporting agencies.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	ARTICLE 1. LIMITATIONS ON SURPRISE BILLING INFORMATION REPORTED BY
	CONSUMER REPORTING AGENCIES
	SECTION 1.01  Section 20.05, Business & Commerce Code, is
	amended by amending Subsection (a) and adding Subsection (d) to
	read as follows:
	(a)  Except as provided by Subsection (b), a consumer
	reporting agency may not furnish a consumer report containing
	information related to:
	(1)  a case under Title 11 of the United States Code or
	under the federal Bankruptcy Act in which the date of entry of the
	order for relief or the date of adjudication predates the consumer
	report by more than 10 years;
	(2)  a suit or judgment in which the date of entry
	predates the consumer report by more than seven years or the
	governing statute of limitations, whichever is longer;
	(3)  a tax lien in which the date of payment predates
	the consumer report by more than seven years;
	(4)  a record of arrest, indictment, or conviction of a
	crime in which the date of disposition, release, or parole predates
	the consumer report by more than seven years; [or]
	(5)  a collection account with a medical industry code,
	if the consumer was covered by a health benefit plan at the time of
	the event giving rise to the collection and the collection is for an
	outstanding balance, after copayments, deductibles, and
	coinsurance, owed to an emergency care provider or a facility-based
	provider for an out-of-network benefit claim; or
	(6)  another item or event that predates the consumer
	report by more than seven years.
	(d)  In this section:
	(1)  “Emergency care provider” means a physician,
	health care practitioner, facility, or other health care provider
	who provides emergency care.
	(2)  “Facility” has the meaning assigned by Section
	324.001, Health and Safety Code.
	(3)  “Facility-based provider” means a physician,
	health care practitioner, or other health care provider who
	provides health care or medical services to patients of a facility.
	(4)  “Health care practitioner” means an individual who
	is licensed to provide health care services.
	ARTICLE 2. ELIMINATION OF SURPRISE BILLING FOR CERTAIN HEALTH
	BENEFIT PLANS
	SECTION 2.01.  Section 1271.155, Insurance Code, is amended
	by amending Subsection (a) and adding Subsection (f) to read as
	follows:
	(a)  A health maintenance organization shall pay for
	emergency care performed by non-network physicians or providers in
	an amount that the organization determines is reasonable for the
	emergency care [at the usual and customary rate] or at an agreed
	rate.
	(f)  A non-network physician or provider may not bill a
	patient described by this section in, and the patient has no
	financial responsibility for, an amount greater than the patient’s
	responsibility under the patient’s health care plan, including an
	applicable copayment, coinsurance, or deductible.
	SECTION 2.02.  Subchapter D, Chapter 1271, Insurance Code,
	is amended by adding Section 1271.157 to read as follows:
	Sec. 1271.157.  NON-NETWORK FACILITY-BASED PROVIDERS. (a)
	In this section, “facility-based provider” means a physician or
	health care provider who provides health care services to patients
	of a health care facility.
	(b)  A health maintenance organization shall pay for a health
	care service performed by a non-network provider who is a
	facility-based provider in an amount that the organization
	determines is reasonable for the service or at an agreed rate if the
	provider performed the service at a health care facility that is a
	network provider.
	(c)  A non-network facility-based provider may not bill a
	patient receiving a health care service described by Subsection (b)
	in, and the patient does not have financial responsibility for, an
	amount greater than the patient’s responsibility under the
	patient’s health care plan, including an applicable copayment,
	coinsurance, or deductible.
	SECTION 2.03.  Subtitle C, Title 8, Insurance Code, is
	amended by adding Chapter 1276 to read as follows:
	CHAPTER 1276. ELECTIVE PROVISIONS FOR SELF-FUNDED OR SELF-INSURED
	MANAGED CARE PLANS
	Sec. 1276.0001.  DEFINITIONS. In this chapter:
	(1)  “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.).
	(2)  “Emergency care” has the meaning assigned by
	Section 1301.155.
	(3)  “Facility-based provider” means a physician or
	health care provider who provides health care services to patients
	of a health care facility.
	(4)  “Managed care plan” means a health benefit plan
	under which the plan administrator provides or arranges for health
	care benefits to plan participants and requires or encourages plan
	participants to use physicians and health care providers the plan
	designates.
	(5)  “Out-of-network provider” means, with respect to
	an eligible plan, a physician or health care provider who is not a
	participating provider.
	(6)  “Participating provider” means a physician or
	health care provider who has contracted with an eligible plan
	administrator to provide services to enrollees.
	Sec. 1276.0002.  ELECTION FOR SURPRISE HEALTH CARE BILLING
	PROHIBITION AND MEDIATION. (a) A plan sponsor of an eligible plan
	may elect on an annual basis for this section and Chapter 1467 to
	apply to the plan. A sponsor making an election shall provide
	written notice of the election to the department in the form and
	manner required by department rule.
	(b)  An administrator of an eligible plan for which an
	election is made under Subsection (a) shall pay for a health care
	service performed by an out-of-network provider in an amount that
	the administrator determines is reasonable for the service or at an
	agreed rate if:
	(1)  the provider is a facility-based provider who
	performed the service at a health care facility that is a
	participating provider; or
	(2)  the service is emergency care.
	(c)  An out-of-network provider described by Subsection (b)
	may not bill the patient in, and the patient does not have financial
	responsibility for, an amount greater than the patient’s
	responsibility under the patient’s eligible plan, including an
	applicable copayment, coinsurance, or deductible.
	(d)  An administrator of an eligible plan for which an
	election is made under Subsection (a) shall ensure that the plan and
	any evidence of coverage complies with this section and Chapter
	1467.
	SECTION 2.04.  Section 1301.0053, Insurance Code, is amended
	to read as follows:
	Sec. 1301.0053.  EXCLUSIVE PROVIDER BENEFIT PLANS:
	EMERGENCY CARE. (a) If a nonpreferred provider provides emergency
	care as defined by Section 1301.155 to an enrollee in an exclusive
	provider benefit plan, the issuer of the plan shall reimburse the
	nonpreferred provider in an amount that the issuer determines is
	reasonable for the emergency care services [at the usual and
	customary rate] or at a rate agreed to by the issuer and the
	nonpreferred provider for the provision of the services.
	(b)  An out-of-network provider may not bill an insured
	receiving emergency care in, and the insured does not have
	financial responsibility for, an amount greater than the insured’s
	responsibility under the insured’s exclusive provider benefit
	plan, including an applicable copayment, coinsurance, or
	deductible.
	SECTION 2.05.  Section 1301.155, Insurance Code, is amended
	by amending Subsection (b) and adding Subsection (c) to read as
	follows:
	(b)  If an insured cannot reasonably reach a preferred
	provider, an insurer shall provide reimbursement for the following
	emergency care services in an amount that the insurer determines is
	reasonable for the services at the preferred level of benefits
	until the insured can reasonably be expected to transfer to a
	preferred provider:
	(1)  a medical screening examination or other
	evaluation required by state or federal law to be provided in the
	emergency facility of a hospital that is necessary to determine
	whether a medical emergency condition exists;
	(2)  necessary emergency care services, including the
	treatment and stabilization of an emergency medical condition; and
	(3)  services originating in a hospital emergency
	facility or freestanding emergency medical care facility following
	treatment or stabilization of an emergency medical condition.
	(c)  For purposes of Subsection (b), an out-of-network
	provider may not bill an insured in, and the insured does not have
	financial responsibility for, an amount greater than the insured’s
	responsibility under the insured’s preferred provider benefit
	plan, including an applicable copayment, coinsurance, or
	deductible.
	SECTION 2.06.  Subchapter D, Chapter 1301, Insurance Code,
	is amended by adding Section 1301.164 to read as follows:
	Sec. 1301.164.  OUT-OF-NETWORK FACILITY-BASED PROVIDER.
	(a) In this section, “facility-based provider” means a physician,
	or health care provider who provides health care services to
	patients of a health care facility.
	(b)  An insurer shall pay for a health care service performed
	by a nonpreferred provider who is a facility-based provider in an
	amount that the insurer determines is reasonable for the service or
	at an agreed rate if the provider performed the service at a health
	care facility that is a participating provider.
	(c)  A nonpreferred provider who is a facility-based
	provider may not bill an insured receiving a health care service
	described by Subsection (b) in, and the insured does not have
	financial responsibility for, an amount greater than the insured’s
	responsibility under the insured’s health care plan, including an
	applicable copayment, coinsurance, or deductible.
	SECTION 2.07.  Subchapter E, Chapter 1551, Insurance Code,
	is amended by adding Sections 1551.228 and 1551.229 to read as
	follows:
	Sec. 1551.228.  EMERGENCY CARE COVERAGE. (a) In this
	section, “emergency care” has the meaning assigned by Section
	1301.155.
	(b)  A managed care plan provided under the group benefits
	program must provide out-of-network emergency care coverage for
	participants in accordance with this section.
	(c)  The coverage must require the administrator of the plan
	to pay for emergency care performed by an out-of-network provider
	in an amount that the administrator determines is reasonable for
	the emergency care or at an agreed rate.
	(d)  For the purposes of Subsection (c), an out-of-network
	provider may not bill an enrollee in, and the enrollee does not have
	financial responsibility for, an amount greater than the enrollee’s
	responsibility under the enrollee’s managed care plan, including an
	applicable copayment, coinsurance, or deductible.
	Sec. 1551.229.  OUT-OF-NETWORK FACILITY-BASED PROVIDER
	COVERAGE. (a) In this section, “facility-based provider” means a
	physician or health care provider who provides health care services
	to patients of a health care facility.
	(b)  A managed care plan provided under the group benefits
	program out-of-network facility-based provider must provide
	coverage for participants in accordance with this section.
	(c)  The coverage must require the administrator of the plan
	to pay for a health care service performed for an enrollee by an
	out-of-network provider who is a facility-based provider in an
	amount that the administrator determines is reasonable for the
	service or at an agreed rate if the provider performed the service
	at a health care facility that is a participating provider.
	(d)  An out-of-network provider who is a facility-based
	provider may not bill an enrollee receiving a health care service
	described by Subsection (c) in, and the enrollee does not have
	financial responsibility for, an amount greater than the enrollee’s
	responsibility under the enrollee’s managed care plan, including an
	applicable copayment, coinsurance, or deductible.
	SECTION 2.08.  Subchapter D, Chapter 1575, Insurance Code,
	is amended by adding Sections 1575.171 and 1575.172 to read as
	follows:
	Sec. 1575.171.  EMERGENCY CARE COVERAGE. (a) In this
	section, “emergency care” has the meaning assigned by Section
	1301.155.
	(b)  A managed care plan offered under the group program must
	provide out-of-network emergency care coverage in accordance with
	this section.
	(c)  The coverage must require the administrator of the plan
	to pay for emergency care performed by an out-of-network provider
	in an amount that the administrator determines is reasonable for
	the emergency care or at an agreed rate.
	(d)  For the purposes of Subsection (c), an out-of-network
	provider may not bill an enrollee in, and the enrollee does not have
	financial responsibility for, an amount greater than the enrollee’s
	responsibility under the enrollee’s managed care plan, including an
	applicable copayment, coinsurance, or deductible.
	Sec. 1575.172.  OUT-OF-NETWORK FACILITY-BASED PROVIDER
	COVERAGE. (a) In this section, “facility-based provider” means a
	physician or health care provider who provides health care services
	to patients of a health care facility.
	(b)  A managed care plan offered under the group program must
	provide out-of-network facility-based provider coverage in
	accordance with this section.
	(c)  The coverage must require the administrator of the plan
	to pay for a health care service performed for an enrollee by an
	out-of-network provider who is a facility-based provider in an
	amount that the administrator determines is reasonable for the
	service or at an agreed rate if the provider performed the service
	at a health care facility that is a participating provider.
	(d)  An out-of-network provider who is a facility-based
	provider may not bill an enrollee receiving a health care service
	described by Subsection (c) in, and the enrollee does not have
	financial responsibility for, an amount greater than the enrollee’s
	responsibility under the enrollee’s managed care plan, including an
	applicable copayment, coinsurance, or deductible.
	SECTION 2.09.  Subchapter C, Chapter 1579, Insurance Code,
	is amended by adding Sections 1579.109 and 1579.110 to read as
	follows:
	Sec. 1579.109.  EMERGENCY CARE COVERAGE. (a) In this
	section, “emergency care” has the meaning assigned by Section
	1301.155.
	(b)  A managed care plan provided under this chapter must
	provide out-of-network emergency care coverage in accordance with
	this section.
	(c)  The coverage must require the administrator of the plan
	to pay for emergency care performed for an enrollee by an
	out-of-network provider in an amount that the administrator
	determines is reasonable for the emergency care or at an agreed
	rate.
	(d)  For the purposes of Subsection (c), an out-of-network
	provider may not bill an enrollee in, and the enrollee does not have
	financial responsibility for, an amount greater than the enrollee’s
	responsibility under the enrollee’s managed care plan, including an
	applicable copayment, coinsurance, or deductible.
	Sec. 1579.110.  OUT-OF-NETWORK FACILITY-BASED PROVIDER
	COVERAGE. (a) In this section, “facility-based provider” means a
	physician or health care provider who provides health care services
	to patients of a health care facility.
	(b)  A managed care plan provided under this chapter must
	provide out-of-network facility-based provider coverage in
	accordance with this section.
	(c)  The coverage must require the administrator of the plan
	to pay for a health care service performed for an enrollee by an
	out-of-network provider who is a facility-based provider in an
	amount that the administrator determines is reasonable for the
	service or at an agreed rate if the provider performed the service
	at a health care facility that is a participating provider.
	(d)  An out-of-network provider who is a facility-based
	provider may not bill an enrollee receiving a health care service
	described by Subsection (c) in, and the enrollee does not have
	financial responsibility for, an amount greater than the enrollee’s
	responsibility under the enrollee’s managed care plan, including an
	applicable copayment, coinsurance, or deductible.
	ARTICLE 3. MANDATORY MEDIATION REQUESTED BY PROVIDER, ISSUER, OR
	ADMINISTRATOR
	SECTION 3.01.  Sections 1467.001(1), (3), (5), and (7),
	Insurance Code, are amended to read as follows:
	(1)  “Administrator” means:
	(A)  an administering firm for a health benefit
	plan providing coverage under Chapter 1551, 1575, or 1579; [and]
	(B)  if applicable, the claims administrator for
	the health benefit plan; and
	(C)  if applicable, an administrating firm for an
	eligible plan for which an election is made under Section
	1276.0002.
	(3)  “Enrollee” means an individual who is eligible to
	receive benefits through a [preferred provider benefit plan or a]
	health benefit plan subject to this chapter [under Chapter 1551,
	1575, or 1579].
	(5)  “Mediation” means a process in which an impartial
	mediator facilitates and promotes agreement between the health
	[insurer offering a preferred provider] benefit plan issuer or the
	administrator and a facility-based provider or emergency care
	provider or the provider’s representative to settle a health
	benefit claim of an enrollee.
	(7)  “Party” means a health benefit plan issuer [an
	insurer] offering a health [a preferred provider] benefit plan, an
	administrator, or a facility-based provider or emergency care
	provider or the provider’s representative who participates in a
	mediation conducted under this chapter. [The enrollee is also
	considered a party to the mediation.]
	SECTION 3.02.  Sections 1467.002 and 1467.005, Insurance
	Code, are amended to read as follows:
	Sec. 1467.002.  APPLICABILITY OF CHAPTER. This chapter
	applies to:
	(1)  a health benefit plan offered by a health
	maintenance organization operating under Chapter 843;
	(2)  a preferred provider benefit plan, including an
	exclusive provider benefit plan, offered by an insurer under
	Chapter 1301; and
	(3) [(2)]  an administrator of a health benefit plan,
	other than a health maintenance organization plan, under Chapter
	1551, 1575, or 1579 or of an eligible plan for which an election is
	made under Section 1276.0002.
	Sec. 1467.005.  REFORM. This chapter may not be construed to
	prohibit:
	(1)  a health [an insurer offering a preferred
	provider] benefit plan issuer or administrator from, at any time,
	offering a reformed claim settlement; or
	(2)  a facility-based provider or emergency care
	provider from, at any time, offering a reformed charge for health
	care or medical services or supplies.
	SECTION 3.03.  Sections 1467.051(a) and (b), Insurance Code,
	are amended to read as follows:
	(a)  A facility-based provider, emergency care provider,
	health benefit plan issuer, or administrator [An enrollee] may
	request mediation of a settlement of an out-of-network health
	benefit claim if:
	(1)  the amount charged by the provider and unpaid by
	the issuer or administrator [for which the enrollee is responsible
	to a facility-based provider or emergency care provider], after
	copayments, deductibles, and coinsurance, [including the amount
	unpaid by the administrator or insurer,] is greater than $500; and
	(2)  the health benefit claim is for:
	(A)  emergency care; or
	(B)  a health care or medical service or supply
	provided by a facility-based provider in a facility that is a
	preferred provider or that has a contract with the administrator.
	(b)  If a person [Except as provided by Subsections (c) and
	(d), if an enrollee] requests mediation under this subchapter, the
	facility-based provider or emergency care provider, or the
	provider’s representative, and the health benefit plan issuer
	[insurer] or the administrator, as appropriate, shall participate
	in the mediation.
	SECTION 3.04.  Section 1467.052(c), Insurance Code, is
	amended to read as follows:
	(c)  A person may not act as mediator for a claim settlement
	dispute if the person has been employed by, consulted for, or
	otherwise had a business relationship with a health benefit plan
	issuer or administrator of a health [an insurer offering the
	preferred provider] benefit plan that is subject to this chapter or
	a physician, health care practitioner, or other health care
	provider during the three years immediately preceding the request
	for mediation.
	SECTION 3.05.  Section 1467.053(d), Insurance Code, is
	amended to read as follows:
	(d)  The mediator’s fees shall be split evenly and paid by
	the health benefit plan issuer [insurer] or administrator and the
	facility-based provider or emergency care provider.
	SECTION 3.06.  Sections 1467.054(a), (b), (c), and (d),
	Insurance Code, are amended to read as follows:
	(a)  A facility-based provider, emergency care provider,
	health benefit plan issuer, or administrator [An enrollee] may
	request mandatory mediation under this subchapter [chapter].
	(b)  A request for mandatory mediation must be provided to
	the department on a form prescribed by the commissioner and must
	include:
	(1)  the name of the person [enrollee] requesting
	mediation;
	(2)  a brief description of the claim to be mediated;
	(3)  contact information, including a telephone
	number, for the requesting person [enrollee] and the person’s
	[enrollee’s] counsel, if the person [enrollee] retains counsel;
	(4)  the name of the facility-based provider or
	emergency care provider and name of the health benefit plan issuer
	[insurer] or administrator; and
	(5)  any other information the commissioner may require
	by rule.
	(c)  On receipt of a request for mediation, the department
	shall notify, as applicable, the facility-based provider or
	emergency care provider and health benefit plan issuer [insurer] or
	administrator of the request.
	(d)  In an effort to settle the claim before mediation, all
	parties must participate in an informal settlement teleconference
	not later than the 30th day after the date on which a person [the
	enrollee] submits a request for mediation under this subchapter
	[section].
	SECTION 3.07.  Section 1467.055(g), Insurance Code, is
	amended to read as follows:
	(g)  A [Except at the request of an enrollee, a] mediation
	shall be held not later than the 180th day after the date of the
	request for mediation.
	SECTION 3.08.  Sections 1467.056(a), (b), and (d), Insurance
	Code, are amended to read as follows:
	(a)  In a mediation under this subchapter [chapter], the
	parties shall[:
	[(1)]  evaluate whether:
	(1) [(A)]  the amount charged by the facility-based
	provider or emergency care provider for the health care or medical
	service or supply is excessive; and
	(2) [(B)]  the amount paid by the health benefit plan
	issuer [insurer] or administrator represents a reasonable amount
	[the usual and customary rate] for the health care or medical
	service or supply or is unreasonably low[; and
	[(2)     as a result of the amounts described by
	Subdivision (1), determine the amount, after copayments,
	deductibles, and coinsurance are applied, for which an enrollee is
	responsible to the facility-based provider or emergency care
	provider].
	(b)  The facility-based provider or emergency care provider
	may present information regarding the amount charged for the health
	care or medical service or supply. The health benefit plan issuer
	[insurer] or administrator may present information regarding the
	amount paid by the issuer [insurer] or administrator.
	(d)  The goal of the mediation is to reach an agreement among
	[the enrollee,] the facility-based provider or emergency care
	provider[,] and the health benefit plan issuer [insurer] or
	administrator, as applicable, as to the amount paid by the issuer
	[insurer] or administrator to the facility-based provider or
	emergency care provider and[,] the amount charged by the
	facility-based provider or emergency care provider[, and the amount
	paid to the facility-based provider or emergency care provider by
	the enrollee].
	SECTION 3.09.  Sections 1467.058 and 1467.059, Insurance
	Code, are amended to read as follows:
	Sec. 1467.058.  CONTINUATION OF MEDIATION. After a referral
	is made under Section 1467.057, the facility-based provider or
	emergency care provider and the health benefit plan issuer
	[insurer] or administrator may elect to continue the mediation to
	further determine their responsibilities. [Continuation of
	mediation under this section does not affect the amount of the
	billed charge to the enrollee.]
	Sec. 1467.059.  MEDIATION AGREEMENT. The mediator shall
	prepare a confidential mediation agreement and order that states[:
	[(1)     the total amount for which the enrollee will be
	responsible to the facility-based provider or emergency care
	provider, after copayments, deductibles, and coinsurance; and
	[(2)]  any agreement reached by the parties under
	Section 1467.058.
	SECTION 3.10.  Section 1467.101(a), Insurance Code, is
	amended to read as follows:
	(a)  The following conduct constitutes bad faith mediation
	for purposes of this chapter:
	(1)  failing to participate in the mediation;
	(2)  failing to provide information the mediator
	believes is necessary to facilitate an agreement; [or]
	(3)  failing to designate a representative
	participating in the mediation with full authority to enter into
	any mediated agreement; or
	(4)  failing to appear for mediation.
	SECTION 2.11.  Section 1467.151(b), Insurance Code, is
	amended to read as follows:
	(b)  The department and the Texas Medical Board or other
	appropriate regulatory agency shall maintain information:
	(1)  on each complaint filed that concerns a claim or
	mediation subject to this chapter; and
	(2)  related to a claim that is the basis of an enrollee
	complaint, including:
	(A)  the type of services that gave rise to the
	dispute;
	(B)  the type and specialty, if any, of the
	facility-based provider or emergency care provider who provided the
	out-of-network service;
	(C)  the county and metropolitan area in which the
	health care or medical service or supply was provided;
	(D)  whether the health care or medical service or
	supply was for emergency care; and
	(E)  any other information about:
	(i)  the health benefit plan issuer
	[insurer] or administrator that the commissioner by rule requires;
	or
	(ii)  the facility-based provider or
	emergency care provider that the Texas Medical Board or other
	appropriate regulatory agency by rule requires.
	ARTICLE 4. CONFORMING AMENDMENTS
	SECTION 4.01.  Sections 1456.002(a) and (c), Insurance Code,
	are amended to read as follows:
	(a)  This chapter applies to any health benefit plan that:
	(1)  provides benefits for medical or surgical expenses
	incurred as a result of a health condition, accident, or sickness,
	including an individual, group, blanket, or franchise insurance
	policy or insurance agreement, a group hospital service contract,
	or an individual or group evidence of coverage that is offered by:
	(A)  an insurance company;
	(B)  a group hospital service corporation
	operating under Chapter 842;
	(C)  a fraternal benefit society operating under
	Chapter 885;
	(D)  a stipulated premium company operating under
	Chapter 884;
	(E)  [a health maintenance organization operating
	under Chapter 843;
	[(F)] a multiple employer welfare arrangement
	that holds a certificate of authority under Chapter 846;
	(F) [(G)]  an approved nonprofit health
	corporation that holds a certificate of authority under Chapter
	844; or
	(G) [(H)]  an entity not authorized under this
	code or another insurance law of this state that contracts directly
	for health care services on a risk-sharing basis, including a
	capitation basis; or
	(2)  provides health and accident coverage through a
	risk pool created under Chapter 172, Local Government Code,
	notwithstanding Section 172.014, Local Government Code, or any
	other law.
	(c)  This chapter does not apply to:
	(1)  Medicaid managed care programs operated under
	Chapter 533, Government Code;
	(2)  Medicaid programs operated under Chapter 32, Human
	Resources Code; [or]
	(3)  the state child health plan operated under Chapter
	62 or 63, Health and Safety Code; or
	(4)  a health benefit plan subject to Section 1271.155,
	1301.164, 1551.229, 1575.172, or 1579.110, or an eligible plan for
	which an election is made under Section 1276.0002.
	SECTION 4.02.  The following provisions of the Insurance
	Code are repealed:
	(1)  Sections 1467.051(c) and (d);
	(2)  Section 1467.0511;
	(3)  Sections 1467.054(f) and (g);
	(4)  Section 1467.055(d); and
	(5)  Section 1467.151(d).
	ARTICLE 5. TRANSITION AND EFFECTIVE DATE
	SECTION 5.01.  The changes in law made by this Act apply only
	to a health care or medical service or supply provided on or after
	the effective date of this Act. A health care or medical service or
	supply provided before the effective date of this Act is governed by
	the law in effect immediately before the effective date of this Act,
	and that law is continued in effect for that purpose.
	SECTION 4.02.  This Act takes effect September 1, 2019.