| 1 | 1 | | 82R10273 PMO-F |
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| 2 | 2 | | By: Eiland H.B. No. 2149 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to contracts between rural hospitals and certain insurers. |
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| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 9 | | SECTION 1. Subchapter I, Chapter 843, Insurance Code, is |
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| 10 | 10 | | amended by adding Section 843.324 to read as follows: |
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| 11 | 11 | | Sec. 843.324. CONTRACTS WITH RURAL HOSPITALS. (a) In this |
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| 12 | 12 | | section: |
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| 13 | 13 | | (1) "Ancillary services" means laboratory services, |
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| 14 | 14 | | radiology services, physical therapy services, speech therapy |
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| 15 | 15 | | services, or occupational therapy services. |
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| 16 | 16 | | (2) "Rural hospital" means a hospital that: |
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| 17 | 17 | | (A) is designated as a critical access hospital |
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| 18 | 18 | | under and in compliance with 42 U.S.C. Section 1395i-4; |
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| 19 | 19 | | (B) is a sole community hospital, as defined by |
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| 20 | 20 | | 42 U.S.C. Section 1395ww(d)(5)(D)(iii); or |
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| 21 | 21 | | (C) is located in a county with a population of |
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| 22 | 22 | | not more than 50,000. |
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| 23 | 23 | | (b) A health maintenance organization that contracts with a |
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| 24 | 24 | | rural hospital to provide services to enrollees under a health care |
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| 25 | 25 | | plan may not deny the hospital the opportunity to provide ancillary |
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| 26 | 26 | | services. |
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| 27 | 27 | | (c) On request of a rural hospital, the commissioner shall |
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| 28 | 28 | | conduct an investigation, review, hearing, or other proceeding to |
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| 29 | 29 | | determine whether a health maintenance organization is in |
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| 30 | 30 | | compliance with this section. |
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| 31 | 31 | | (d) The commissioner shall take reasonable action to ensure |
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| 32 | 32 | | compliance with this section, including issuing orders and imposing |
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| 33 | 33 | | sanctions. |
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| 34 | 34 | | SECTION 2. Subchapter E, Chapter 1301, Insurance Code, is |
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| 35 | 35 | | amended by adding Section 1301.203 to read as follows: |
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| 36 | 36 | | Sec. 1301.203. CONTRACTS WITH RURAL HOSPITALS. (a) In this |
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| 37 | 37 | | section: |
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| 38 | 38 | | (1) "Ancillary services" means laboratory services, |
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| 39 | 39 | | radiology services, physical therapy services, speech therapy |
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| 40 | 40 | | services, or occupational therapy services. |
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| 41 | 41 | | (2) "Rural hospital" means a hospital that: |
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| 42 | 42 | | (A) is designated as a critical access hospital |
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| 43 | 43 | | under and in compliance with 42 U.S.C. Section 1395i-4; |
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| 44 | 44 | | (B) is a sole community hospital, as defined by |
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| 45 | 45 | | 42 U.S.C. Section 1395ww(d)(5)(D)(iii); or |
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| 46 | 46 | | (C) is located in a county with a population of |
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| 47 | 47 | | not more than 50,000. |
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| 48 | 48 | | (b) An insurer that contracts with a rural hospital to |
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| 49 | 49 | | provide services to insureds under a preferred provider benefit |
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| 50 | 50 | | plan may not deny the hospital the opportunity to provide ancillary |
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| 51 | 51 | | services as a preferred provider. |
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| 52 | 52 | | (c) On request of a rural hospital, the commissioner shall |
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| 53 | 53 | | conduct an investigation, review, hearing, or other proceeding to |
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| 54 | 54 | | determine whether an insurer is in compliance with this section. |
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| 55 | 55 | | (d) The commissioner shall take reasonable action to ensure |
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| 56 | 56 | | compliance with this section, including issuing orders and imposing |
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| 57 | 57 | | sanctions. |
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| 58 | 58 | | SECTION 3. This Act takes effect September 1, 2011. |
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