bill changes late-payment penalty math for health plans

The text as introduced · 248 words

89R658 RDS-D

By: Bell of Montgomery
H.B. No. 4872

A BILL TO BE ENTITLED

AN ACT

relating to the calculation of penalties for violating certain laws

governing the prompt payment of claims submitted by a physician or

health care provider to certain health benefit plan issuers.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 843.342, Insurance Code, is amended by

adding Subsection (o) to read as follows:

(o) For the purposes of calculating a penalty under this

section related to a claim by a physician or provider described by

Section 843.351, the contracted rate for health care services

provided by the physician or provider is the usual and customary

rate for the service in the geographic area in which the service is

provided.

SECTION 2. Section 1301.137, Insurance Code, is amended by

adding Subsection (m) to read as follows:

(m) For the purposes of calculating a penalty under this

section related to a claim by a physician or health care provider

described by Section 1301.069, the contracted rate for health care

services provided by the physician or provider is the usual and

customary rate for the service in the geographic area in which the

service is provided.

SECTION 3. The changes in law made by this Act apply only to

a penalty or interest on a penalty owed with respect to a claim

submitted on or after the effective date of this Act.

SECTION 4. This Act takes effect September 1, 2025.