Texas 2013 - 83rd Regular

Texas House Bill HB3152 Compare Versions

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1	1	By: Giddings (Senate Sponsor - Fraser) H.B. No. 3152
2	2	(In the Senate - Received from the House May 8, 2013;
3	3	May 9, 2013, read first time and referred to Committee on State
4	4	Affairs; May 15, 2013, reported favorably by the following vote:
5	5	Yeas 7, Nays 1; May 15, 2013, sent to printer.)
6	6
7	7
8	8	A BILL TO BE ENTITLED
9	9	AN ACT
10	10	relating to the payment of and contracts with health care providers
11	11	by certain entities under contract with a certified workers'
12	12	compensation network.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	SECTION 1. Section 1305.153, Insurance Code, is amended by
15	15	adding Subsections (f), (g), (h), (i), and (j) to read as follows:
16	16	(f) If, for the purposes of credentialing and contracting
17	17	with health care providers on behalf of the certified network, a
18	18	person is serving as both a management contractor under Section
19	19	1305.102 or a third party to which the network delegates a function
20	20	and as an agent of the health care provider, the contract between
21	21	the management contractor or third party and the health care
22	22	provider must specify:
23	23	(1) the certified network's contract rate for health
24	24	care services; and
25	25	(2) the amount of reimbursement the health care
26	26	provider will be paid after the health care provider agent's fee for
27	27	providing administrative services is applied.
28	28	(g) If a management contractor or third party to which the
29	29	network delegates a function is serving as an agent for health care
30	30	providers in the certified network, the management contractor or
31	31	third party must disclose that relationship in its contract with
32	32	the certified network.
33	33	(h) A contract described by Subsection (f), or a contract
34	34	between a management contractor or third party to which the network
35	35	delegates a function and a certified network, must comply with the
36	36	requirements of this chapter.
37	37	(i) If a contract described by Subsection (f) complies with
38	38	the requirements of this chapter, the health care provider shall be
39	39	reimbursed in accordance with the terms of the contract. If a
40	40	contract described by Subsection (f) does not comply with the
41	41	requirements of this chapter, the health care provider shall be
42	42	reimbursed in accordance with the certified network's contracted
43	43	rate.
44	44	(j) A certified network, management contractor, or third
45	45	party to which the network delegates a function may not require a
46	46	health care provider, as a condition for contracting with the
47	47	certified network, to utilize as a health care provider agent the
48	48	management contractor or the third party.
49	49	SECTION 2. With respect to a contract between a health care
50	50	provider and a network, management contractor, or third party to
51	51	which the network delegates a function, the change in law made by
52	52	this Act applies only to a contract entered into or renewed on or
53	53	after the effective date of this Act. A contract entered into or
54	54	renewed before the effective date of this Act is governed by the law
55	55	in effect immediately before the effective date of this Act, and
56	56	that law is continued in effect for that purpose.
57	57	SECTION 3. With respect to a contract between a certified
58	58	network and a management contractor or third party to which the
59	59	network delegates a function, the change in law made by this Act
60	60	applies to a contract that is in effect on the effective date of
61	61	this Act or entered into on or after that date.
62	62	SECTION 4. This Act takes effect September 1, 2013.
63	63	* * * * *