HB4872 - 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.

  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.