By: Giddings (Senate Sponsor - Fraser) H.B. No. 3152
(In the Senate - Received from the House May 8, 2013;
May 9, 2013, read first time and referred to Committee on State
Affairs; May 15, 2013, reported favorably by the following vote:
Yeas 7, Nays 1; May 15, 2013, sent to printer.)
A BILL TO BE ENTITLED
AN ACT
relating to the payment of and contracts with health care providers
by certain entities under contract with a certified workers'
compensation network.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1305.153, Insurance Code, is amended by
adding Subsections (f), (g), (h), (i), and (j) to read as follows:
(f) If, for the purposes of credentialing and contracting
with health care providers on behalf of the certified network, a
person is serving as both a management contractor under Section
1305.102 or a third party to which the network delegates a function
and as an agent of the health care provider, the contract between
the management contractor or third party and the health care
provider must specify:
(1) the certified network's contract rate for health
care services; and
(2) the amount of reimbursement the health care
provider will be paid after the health care provider agent's fee for
providing administrative services is applied.
(g) If a management contractor or third party to which the
network delegates a function is serving as an agent for health care
providers in the certified network, the management contractor or
third party must disclose that relationship in its contract with
the certified network.
(h) A contract described by Subsection (f), or a contract
between a management contractor or third party to which the network
delegates a function and a certified network, must comply with the
requirements of this chapter.
(i) If a contract described by Subsection (f) complies with
the requirements of this chapter, the health care provider shall be
reimbursed in accordance with the terms of the contract. If a
contract described by Subsection (f) does not comply with the
requirements of this chapter, the health care provider shall be
reimbursed in accordance with the certified network's contracted
rate.
(j) A certified network, management contractor, or third
party to which the network delegates a function may not require a
health care provider, as a condition for contracting with the
certified network, to utilize as a health care provider agent the
management contractor or the third party.
SECTION 2. With respect to a contract between a health care
provider and a network, management contractor, or third party to
which the network delegates a function, the change in law made by
this Act applies only to a contract entered into or renewed on or
after the effective date of this Act. A contract entered into or
renewed before the effective date of this Act is governed by the law
in effect immediately before the effective date of this Act, and
that law is continued in effect for that purpose.
SECTION 3. With respect to a contract between a certified
network and a management contractor or third party to which the
network delegates a function, the change in law made by this Act
applies to a contract that is in effect on the effective date of
this Act or entered into on or after that date.
SECTION 4. This Act takes effect September 1, 2013.
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