82R10273 PMO-F
By: Eiland H.B. No. 2149
A BILL TO BE ENTITLED
AN ACT
relating to contracts between rural hospitals and certain insurers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter I, Chapter 843, Insurance Code, is
amended by adding Section 843.324 to read as follows:
Sec. 843.324. CONTRACTS WITH RURAL HOSPITALS. (a) In this
section:
(1) "Ancillary services" means laboratory services,
radiology services, physical therapy services, speech therapy
services, or occupational therapy services.
(2) "Rural hospital" means a hospital that:
(A) is designated as a critical access hospital
under and in compliance with 42 U.S.C. Section 1395i-4;
(B) is a sole community hospital, as defined by
42 U.S.C. Section 1395ww(d)(5)(D)(iii); or
(C) is located in a county with a population of
not more than 50,000.
(b) A health maintenance organization that contracts with a
rural hospital to provide services to enrollees under a health care
plan may not deny the hospital the opportunity to provide ancillary
services.
(c) On request of a rural hospital, the commissioner shall
conduct an investigation, review, hearing, or other proceeding to
determine whether a health maintenance organization is in
compliance with this section.
(d) The commissioner shall take reasonable action to ensure
compliance with this section, including issuing orders and imposing
sanctions.
SECTION 2. Subchapter E, Chapter 1301, Insurance Code, is
amended by adding Section 1301.203 to read as follows:
Sec. 1301.203. CONTRACTS WITH RURAL HOSPITALS. (a) In this
section:
(1) "Ancillary services" means laboratory services,
radiology services, physical therapy services, speech therapy
services, or occupational therapy services.
(2) "Rural hospital" means a hospital that:
(A) is designated as a critical access hospital
under and in compliance with 42 U.S.C. Section 1395i-4;
(B) is a sole community hospital, as defined by
42 U.S.C. Section 1395ww(d)(5)(D)(iii); or
(C) is located in a county with a population of
not more than 50,000.
(b) An insurer that contracts with a rural hospital to
provide services to insureds under a preferred provider benefit
plan may not deny the hospital the opportunity to provide ancillary
services as a preferred provider.
(c) On request of a rural hospital, the commissioner shall
conduct an investigation, review, hearing, or other proceeding to
determine whether an insurer is in compliance with this section.
(d) The commissioner shall take reasonable action to ensure
compliance with this section, including issuing orders and imposing
sanctions.
SECTION 3. This Act takes effect September 1, 2011.