Testimony On HB 1236: Prudent Layperson Mandate

The Texas Association of Health Plans (TAHP) opposes HB 1236 without the amendment added on the House Floor which would clarify that diagnosis codes can be used to identify fraud and abuse in ER billing. Patients should be protected from unfair denials as well as fraudulent and abusive billing practices.

TAHP worked for months with the House bill author to ensure that patients are protected from coverage denials but are also still protected from ER billing fraud. We believe there is a way to address both of the concerns at the same time.

HB 1236 seeks to modify the “prudent layperson standard” for emergency care health insurance coverage in Texas, ensuring that a health plan cannot deny coverage for ER care based on a final diagnosis. However, the bill’s language extends beyond this intent, creating significant unintended consequences for combating emergency department fraud in Texas. It is crucial to note that both current Texas law and federal law already prohibit a health plan from denying ER coverage based on a final diagnosis.

Read TAHP’s full written testimony.

Become a Member

Membership with TAHP is an invaluable tool for integrating, building relationships, exchanging information and best practices, and promoting your services. You will be well-armed with the most timely and accurate information, strong relationships with key Texas leaders, and access to seasoned policy and regulatory experts.