83R6069 KKR-F
By: Van de Putte S.B. No. 1322
A BILL TO BE ENTITLED
AN ACT
relating to the provision of ancillary services through limited
services networks; providing penalties.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1305, Insurance Code, is amended by
adding Subchapter C-1 to read as follows:
SUBCHAPTER C-1. LIMITED ANCILLARY SERVICES NETWORKS
Sec. 1305.131. PURPOSE. The purpose of this subchapter is
to:
(1) authorize the establishment of limited ancillary
services networks for the provision of workers' compensation
ancillary services to injured employees;
(2) increase availability and access to ancillary
services for injured employees; and
(3) provide for the authorization of vendors and
suppliers of ancillary services.
Sec. 1305.132. DEFINITIONS. In this subchapter:
(1) "Ancillary service" means the provision of medical
equipment or supplies, including those used to make modifications
to a home or vehicle. An ancillary service does not include the
provision of:
(A) medical equipment or supplies provided
incident to a physician's professional service that are commonly
furnished in a physician's office and are commonly rendered without
charge or are included as a charge in a physician's bill;
(B) an object or device that is surgically
implanted, embedded, inserted, or otherwise applied;
(C) related equipment necessary to operate,
program, or recharge the object or device described by Paragraph B;
or
(D) an intrathecal pump.
(2) "Limited ancillary services network" means a
network within which contractual relationships exist between
selected participating ancillary services vendors and suppliers
and a certified network.
Sec. 1305.133. AUTHORIZATION REQUIRED. (a) An ancillary
services vendor or supplier, or a group of ancillary services
vendors or suppliers, that seeks to provide services through a
limited ancillary services network must obtain approval from the
department.
(b) The department may approve a request to provide
ancillary services as a limited ancillary services network if:
(1) each proposed ancillary services vendor or
supplier within the network is registered with the department; and
(2) the proposed limited ancillary services network
has an adequate number and distribution of ancillary services
vendors and suppliers to provide services that are available and
accessible to employees within the certified network.
(c) The commissioner by rule shall establish standards for
the adequacy and accessibility of limited ancillary services
networks.
Sec. 1305.134. USE OF CERTAIN INSURANCE TERMS PROHIBITED.
A limited ancillary services network is not an insurer and may not
use:
(1) the words "insurance," "casualty," "surety," or
"mutual"; or
(2) any other word that is:
(A) descriptive of the insurance, casualty, or
surety business; or
(B) deceptively similar to the name or
description of an insurer or surety corporation engaging in the
business of insurance in this state.
Sec. 1305.135. CONTRACTS WITH CERTIFIED NETWORKS. (a) If a
certified network contracts with a limited ancillary services
network to provide ancillary services, the certified network shall:
(1) provide notice regarding the limited ancillary
services network to each employee receiving health care services
under the certified network who will be affected by the use of a
limited ancillary services network; and
(2) ensure that a covered ancillary service that is
not available within the limited ancillary services network is
provided to an employee receiving health care services under the
certified network at no additional cost to the employee.
(b) The certified network and the limited ancillary
services network may negotiate and enter into contracts for agreed
upon reimbursement amounts.
(c) A contract between a certified network and a limited
ancillary services network must be filed with the department.
(d) A contract filed with the department under Subsection
(c) is confidential and is not subject to disclosure as public
information under Chapter 552, Government Code.
Sec. 1305.136. APPLICABILITY OF OTHER LAW. A limited
ancillary services network established under this subchapter is not
subject to any other provisions of this chapter except Subchapter
L.
SECTION 2. Section 1305.551(a), Insurance Code, is amended
to read as follows:
(a) If the commissioner determines that a certified
network, insurance carrier, limited ancillary services network as
defined by Section 1305.132, or any other person or third party
operating under this chapter, including a third party to which a
network delegates a function, or any third party with which a
network contracts for management services, is in violation of this
chapter, rules adopted by the commissioner under this chapter, or
applicable provisions of the Labor Code or rules adopted under that
code, the commissioner or a designated representative may notify
the certified network, insurance carrier, limited ancillary
services network, person, or third party of the alleged violation
and may compel the production of any documents or other information
as necessary to determine whether the violation occurred.
SECTION 3. Section 1305.552, Insurance Code, is amended to
read as follows:
Sec. 1305.552. DISCIPLINARY ACTIONS. If under Section
1305.551 the commissioner determines that a certified network,
insurance carrier, limited ancillary services network as defined by
Section 1305.132, or other person or third party described under
Section 1305.551 has violated or is violating this chapter, rules
adopted by the commissioner under this chapter, or the Labor Code or
rules adopted under that code, the commissioner may:
(1) suspend or revoke a certificate or other
authorization issued under this code;
(2) impose sanctions under Chapter 82;
(3) issue a cease and desist order under Chapter 83;
(4) impose administrative penalties under Chapter 84;
or
(5) take any combination of these actions.
SECTION 4. Subchapter B, Chapter 408, Labor Code, is
amended by adding Section 408.0283 to read as follows:
Sec. 408.0283. REIMBURSEMENT FOR ANCILLARY SERVICES. (a)
In this section:
(1) "Ancillary service" means the provision of medical
equipment or supplies, including those used to make modifications
to a home or vehicle. An ancillary service does not include the
provision of:
(A) medical equipment or supplies provided
incident to a physician's professional service that are commonly
furnished in a physician's office and are commonly rendered without
charge or are included as a charge in a physician's bill;
(B) an object or device that is surgically
implanted, embedded, inserted, or otherwise applied;
(C) related equipment necessary to operate,
program, or recharge the object or device described by Paragraph B;
or
(D) an intrathecal pump.
(2) "Limited ancillary services network" means a
network within which contractual relationships exist between
selected participating ancillary services vendors and suppliers
and an insurance carrier.
(b) An ancillary services vendor or supplier, or a group of
ancillary services vendors or suppliers, that seeks to provide
services under contract with a workers' compensation insurance
carrier through a limited ancillary services network must obtain
approval from the division.
(c) The division may approve a request to provide ancillary
services through a limited ancillary services network if the
proposed ancillary services vendor or supplier within the network
is registered with the department.
(d) If an insurance carrier contracts with a limited
ancillary services network to provide ancillary services, the
carrier shall:
(1) provide notice regarding the limited ancillary
services network to each employee who will be affected by the use of
a limited ancillary services network; and
(2) ensure that a covered ancillary service that is
not available within the limited ancillary services network is
provided to an employee receiving health care services at no
additional cost to the employee.
(e) A contract between an insurance carrier and a limited
ancillary services network must be filed with the division.
(f) A contract filed with the division under Subsection (e)
is confidential and is not subject to disclosure as public
information under Chapter 552, Government Code.
(g) Notwithstanding any other provision of this title,
Section 504.053, or any provision of Chapter 1305, Insurance Code,
ancillary services provided through a limited ancillary services
network approved by the division may be reimbursed in accordance
with the fee guidelines adopted by the commissioner or at a contract
rate in accordance with this section.
(h) Notwithstanding Section 1305.003(b), Insurance Code, in
the event of a conflict between this section and Section 413.016 or
any other provision of Chapter 413 of this code or Chapter 1305,
Insurance Code, this section prevails.
SECTION 5. This Act takes effect September 1, 2013.