Texas 2013 - 83rd Regular

Texas House Bill HB2657 Compare Versions

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1	1	83R7384 PMO-F
2	2	By: Zerwas, Bonnen of Galveston H.B. No. 2657
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the operation of certain managed care plans with
8	8	respect to health care providers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 843.306, Insurance Code, is amended by
11	11	adding Subsection (f) to read as follows:
12	12	(f) A health maintenance organization may not terminate
13	13	participation of a physician or provider solely because the
14	14	physician or provider informs an enrollee of the full range of
15	15	physicians and providers available to the enrollee, including
16	16	out-of-network providers.
17	17	SECTION 2. Section 843.363(a), Insurance Code, is amended
18	18	to read as follows:
19	19	(a) A health maintenance organization may not, as a
20	20	condition of a contract with a physician, dentist, or provider, or
21	21	in any other manner, prohibit, attempt to prohibit, or discourage a
22	22	physician, dentist, or provider from discussing with or
23	23	communicating in good faith with a current, prospective, or former
24	24	patient, or a person designated by a patient, with respect to:
25	25	(1) information or opinions regarding the patient's
26	26	health care, including the patient's medical condition or treatment
27	27	options;
28	28	(2) information or opinions regarding the terms,
29	29	requirements, or services of the health care plan as they relate to
30	30	the medical needs of the patient; [or]
31	31	(3) the termination of the physician's, dentist's, or
32	32	provider's contract with the health care plan or the fact that the
33	33	physician, dentist, or provider will otherwise no longer be
34	34	providing medical care, dental care, or health care services under
35	35	the health care plan; or
36	36	(4) information regarding the availability of
37	37	facilities, both in-network and out-of-network, for the treatment
38	38	of the patient's medical condition.
39	39	SECTION 3. Section 1301.001, Insurance Code, is amended by
40	40	adding Subdivision (5-a) to read as follows:
41	41	(5-a) "Out-of-network provider" means a physician or
42	42	health care provider who is not a preferred provider.
43	43	SECTION 4. Subchapter A, Chapter 1301, Insurance Code, is
44	44	amended by adding Sections 1301.0057 and 1301.0058 to read as
45	45	follows:
46	46	Sec. 1301.0057. ACCESS TO OUT-OF-NETWORK PROVIDERS. An
47	47	insurer may not terminate, or threaten to terminate, an insured's
48	48	participation in a preferred provider benefit plan solely because
49	49	the insured uses an out-of-network provider.
50	50	Sec. 1301.0058. PROTECTED COMMUNICATIONS BY PREFERRED
51	51	PROVIDERS. (a) An insurer may not in any manner prohibit, attempt
52	52	to prohibit, penalize, terminate, or otherwise restrict a preferred
53	53	provider from communicating with an insured about the availability
54	54	of out-of-network providers for the provision of the insured's
55	55	medical or health care services.
56	56	(b) An insurer may not terminate the contract of or
57	57	otherwise penalize a preferred provider solely because the
58	58	provider's patients use out-of-network providers for medical or
59	59	health care services.
60	60	(c) An insurer's contract with a preferred provider may
61	61	require that, except in a case of a medical emergency as determined
62	62	by the preferred provider, before the provider may make an
63	63	out-of-network referral for an insured, the preferred provider
64	64	inform the insured:
65	65	(1) that:
66	66	(A) the insured may choose a preferred provider
67	67	or an out-of-network provider; and
68	68	(B) if the insured chooses the out-of-network
69	69	provider the insured may incur higher out-of-pocket expenses; and
70	70	(2) whether the preferred provider has a financial
71	71	interest in the out-of-network provider.
72	72	SECTION 5. Section 1301.057(d), Insurance Code, is amended
73	73	to read as follows:
74	74	(d) On request, an insurer shall provide [make an expedited
75	75	review available] to a practitioner whose participation in a
76	76	preferred provider benefit plan is being terminated:
77	77	(1) an [. The] expedited review conducted in
78	78	accordance with a process that complies [must comply] with rules
79	79	established by the commissioner; and
80	80	(2) all information on which the insurer wholly or
81	81	partly based the termination, including the economic profile of the
82	82	preferred provider, the standards by which the provider is
83	83	measured, and the statistics underlying the profile and standards.
84	84	SECTION 6. (a) Except as provided by this section, the
85	85	changes in law made by this Act apply only to an insurance policy,
86	86	insurance or health maintenance organization contract, or evidence
87	87	of coverage delivered, issued for delivery, or renewed on or after
88	88	January 1, 2014. A policy, contract, or evidence of coverage
89	89	delivered, issued for delivery, or renewed before that date is
90	90	governed by the law in effect immediately before the effective date
91	91	of this Act, and that law is continued in effect for that purpose.
92	92	(b) Sections 843.306, 843.363, and 1301.057(d), Insurance
93	93	Code, as amended by this Act, and Section 1301.0058, Insurance
94	94	Code, as added by this Act, apply only to a contract between a
95	95	health maintenance organization or preferred provider benefit plan
96	96	issuer and a physician or health care provider that is entered into
97	97	or renewed on or after the effective date of this Act. A contract
98	98	entered into or renewed before the effective date of this Act is
99	99	governed by the law in effect immediately before the effective date
100	100	of this Act, and that law is continued in effect for that purpose.
101	101	SECTION 7. This Act takes effect September 1, 2013.