Texas 2009 - 81st Regular

Texas House Bill HB1930 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R5892 PMO-D
2	2	By: Jackson H.B. No. 1930
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health services provided to health benefit plan
8	8	enrollees by certain out-of-network health care providers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1456.001, Insurance Code, is amended by
11	11	adding Subdivisions (5-a) and (5-b) to read as follows:
12	12	(5-a) "Out-of-network provider" means a health care
13	13	practitioner who has not contracted with a health benefit plan
14	14	issuer to provide services to enrollees.
15	15	(5-b) "Participating provider" means a health care
16	16	practitioner who has contracted with a health benefit plan issuer
17	17	to provide services to enrollees.
18	18	SECTION 2. Chapter 1456, Insurance Code, is amended by
19	19	adding Section 1456.0041 to read as follows:
20	20	Sec. 1456.0041. REQUIRED DISCLOSURE: OUT-OF-NETWORK
21	21	PROVIDER BILLING. (a) A participating provider shall provide
22	22	written notice to an enrollee if the participating provider:
23	23	(1) refers an enrollee to an out-of-network provider;
24	24	(2) has granted clinical privileges to a surgeon, a
25	25	radiologist, an anesthesiologist, a pathologist, or another
26	26	physician who is an out-of-network provider who is to provide
27	27	services to the enrollee as a patient of the facility; or
28	28	(3) otherwise arranges for health care services for
29	29	the enrollee through an out-of-network provider.
30	30	(b) The notice required by this section must substantially
31	31	comply with requirements adopted under Subsection (i) and must
32	32	disclose that the out-of-network provider:
33	33	(1) is not a participating provider for the enrollee's
34	34	managed care plan; and
35	35	(2) may charge the enrollee the balance of the
36	36	provider's fee for services received by the enrollee that is not
37	37	fully paid or reimbursed by the enrollee's managed care plan.
38	38	(c) The notice must include a signature line for the
39	39	enrollee to sign to acknowledge that the enrollee has received the
40	40	notice.
41	41	(d) An out-of-network provider may elect to provide the
42	42	notice required by this section.
43	43	(e) A health care provider that provides notice under this
44	44	section shall maintain a copy of the notice, signed by the enrollee,
45	45	in the provider's records.
46	46	(f) The notice required by this section must be provided to
47	47	an enrollee:
48	48	(1) before services are provided to the enrollee by an
49	49	out-of-network provider; and
50	50	(2) to the extent practicable, sufficiently in advance
51	51	of the time the services are to be provided to allow the enrollee to
52	52	select a participating provider to provide the services.
53	53	(g) If notice is not provided as required by this section,
54	54	the out-of-network provider may not charge the enrollee for any
55	55	portion of that provider's fee that is not paid or reimbursed by the
56	56	enrollee's managed care plan.
57	57	(h) A health care provider is not required to provide the
58	58	notice required by this section, and Subsection (g) does not apply,
59	59	if the enrollee's treating physician reasonably determines, in the
60	60	physician's medical judgment, that an emergency exists and there is
61	61	insufficient time to provide that notice.
62	62	(i) The commissioner shall adopt rules as necessary to
63	63	implement this chapter, including a rule prescribing the form of
64	64	the notice required by this section.
65	65	SECTION 3. This Act applies only to a managed care plan that
66	66	is delivered, issued for delivery, or renewed on or after January 1,
67	67	2010. A managed care plan that is delivered, issued for delivery, or
68	68	renewed before January 1, 2010, is governed by the law as it existed
69	69	immediately before the effective date of this Act, and that law is
70	70	continued in effect for that purpose.
71	71	SECTION 4. This Act takes effect September 1, 2009.