HB 1015: Insurance Claims Payments to Health Care Providers

GENERAL BILL by Cassel

Insurance Claims Payments to Health Care Providers; Prohibits payment adjudicators from downcoding health care services under certain circumstances; requires health insurers to ensure that their downcoding policies are updated & to ensure compliance with specified provisions on downcoding; authorizes investigations & actions against noncompliance; provides certain presumption in favor of physicians' determination regarding patients' diagnoses & service orders; provides calculations of interests on health insurers' nonpayment & underpayment due to downcoding; provides causes of action for health care providers; prohibits utilization review entities from implementing new requirements, restrictions, & changes on prior authorizations under certain circumstances; provides requirements for adverse determinations made by such entities on health care providers' claims; revises requirements & timeframes for responses from health insurers & HMOs to submitted claims.

Current Bill Version Posted: 1/5/2026 04:10 PM

• Related Bills (1)

  Bill Number Subject Filed By Last Action and Location	Relationship Learn more about bill relationships
  S 1130 by Massullo Insurance Claims Payments to Health Care Providers Last Action: 3/13/2026 S Died in Banking and Insurance	Similar

• Citations - Statute (5)

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  395.1065	Criminal and administrative penalties; moratorium.	Page 64 (pdf)
  627.4193		Page 3 (pdf)
  627.42392	Prior authorization.	Page 8 (pdf)
  627.6131	Payment of claims.	Page 23 (pdf)
  641.3155	Prompt payment of claims.	Page 45 (pdf)

• Bill History

  S = Senate, H = House

  1/5/2026	H	• Filed
  1/12/2026	H	• Referred to Insurance & Banking Subcommittee • Referred to Health Care Facilities & Systems Subcommittee • Referred to Commerce Committee • Now in Insurance & Banking Subcommittee
  1/13/2026	H	• 1st Reading (Original Filed Version)
  3/13/2026	H	• Died in Insurance & Banking Subcommittee