Relating to expedited credentialing for certain individual health care providers providing services under a managed care plan.
Impact
The bill modifies Chapter 1452 of the Insurance Code by adding a new subchapter dedicated to the expedited credentialing. It establishes eligibility requirements for these providers and outlines the payment processes during the credentialing phase. As a result, it could significantly alter the operational dynamics within the managed care environment by reducing delays associated with the credentialing process for non-physician providers. This could lead to an increase in available healthcare services in various specialties, especially where physician access may be limited.
Summary
SB779 introduces an expedited credentialing process specifically designed for individual healthcare providers who are not physicians and are joining established professional groups with contracts in place with managed care plans. This legislation aims to address the timely inclusion of these healthcare providers into the managed care network, thereby facilitating quicker access to necessary healthcare services for enrollees, which is crucial for meeting healthcare demands effectively and efficiently. The expedited process would enable providers to start practicing sooner while awaiting full credentialing approval.
Contention
While supporters of SB779 argue that it enhances access to health services by allowing faster integration of qualified healthcare providers into managed care networks, there may be concerns regarding the oversight and verification of these expedited processes. Detractors may highlight potential risks, such as the possibility of substandard care if not all providers undergo thorough credentialing, as dictated by established protocols. Balancing the need for expedited processes with the requirement to maintain high healthcare standards is likely to be a key point of contention during discussions surrounding this bill.
Relating to the establishment of the state health benefit plan reimbursement review board and the reimbursement for health care services or supplies provided under certain state-funded health benefit plans.
Relating to the establishment of the Texas Reskilling and Upskilling through Education (TRUE) Program to support workforce education at two-year public institutions of higher education.
Relating to expedited credentialing of certain federally qualified health center providers by managed care plan issuers and Medicaid managed care organizations.