Texas Senate Bill SB1796

Texas 2019 - 86th Regular

Caption

Relating to physician and health care practitioner credentialing by managed care plan issuers.

Impact

By codifying these credentialing requirements, SB1796 seeks to enhance the efficiency of healthcare delivery and may lead to improved network adequacy within managed care plans. The bill requires managed care issuers to treat applicants as participating providers during the credentialing process, which allows them to collect copayments and receive payments from the managed care issuers while their applications are under review. This provision aims to ease the financial burden on providers during the often lengthy credentialing timeline and ensures that enrollees are not left without access to necessary services.

Summary

SB1796 is a legislative act that aims to streamline the credentialing process for physicians and healthcare practitioners under managed care plans in Texas. The bill establishes guidelines that mandate managed care plan issuers to promptly evaluate and credential providers, ensuring that decisions are made in a reasonable time frame. The intent of the legislation is to facilitate better access to healthcare services for enrollees by reducing delays in provider participation within these plans.

Contention

There are notable points of contention surrounding this bill. Some stakeholders may view these changes as an attempt to increase the burden on managed care plans, potentially complicating their operations and increasing costs. Furthermore, the bill includes provisions that protect enrollees from being held responsible for charges that exceed in-network rates if their provider does not meet credentialing standards, which highlights the focus on consumer protection. However, critics may argue that the additional regulations could create confusion or bureaucratic challenges for healthcare issuers, potentially leading to unintended consequences in the managed care landscape.