The Texas 88th Legislature passed a slurry of bills affecting group insurance plans. Below are a few of them:
SB 2476 – Ground ambulance balance billing – How To Avoid High Cost Ambulance Services
Expands current balance billing prohibitions to include ground ambulance services. Rather than applying the independent dispute resolution process, SB 2476 directs TDI to create an emergency service provider balance billing rate database. Health plans must reimburse ground ambulance services at:
- A rate set, controlled, or regulated by a political subdivision if the entity has submitted the rate to the TDI database (with an annual increase per Medicare Inflation Index, not to exceed 10%); or
- The lesser of the billed charge or 325% of Medicare.
Effective September 1, 2023. The changes apply on or after January 1, 2024. TDI will adopt rules.
HB 999 – Copay accumulators
Requires a health benefit plan issuer or pharmacy benefit manager to apply any third-party payment for prescription drugs to the enrollee’s deductible, copayment, cost sharing responsibility, or out-of-pocket maximum applicable to prescription drug benefits under the enrollee’s plan.
Effective September 1, 2023. The changes apply on or after January 1, 2024.
HB 711 – Network contracting
Prohibits the following provisions in network provider contracts:
- Anti-steering
- Anti-tiering
- Gag clause
- Most favored nation clause
See legislation for full information on effective dates. TDI will adopt rules.
HB 2002 – Credit for direct provider payments
Requires an insurance company to credit toward the plan deductible and out-of-pocket maximum an amount that the policyholder pays directly to any provider for a medically necessary covered service/supply if:
- A claim for that service/supply isn’t submitted to the insurance company; and
- The amount paid by the policyholder is less than the average discounted rate paid to an equivalently licensed in-network provider.
Effective September 1, 2023. The changes apply on or after January 1, 2024. TDI will adopt rules.
