Texas 2015 - 84th Regular

Texas House Bill HB2348 Compare Versions

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Version 2 (New)

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1	1	84R11355 SCL-F
2	2	By: Price H.B. No. 2348
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to nondiscrimination against physicians in payment for
8	8	telephone consultation services.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1459 to read as follows:
12	12	CHAPTER 1459. FAIR ACCESS TO TELEPHONE CONSULTATIONS
13	13	Sec. 1459.001. DEFINITION. In this chapter, "physician"
14	14	means:
15	15	(1) an individual licensed to practice medicine in
16	16	this state under Subtitle B, Title 3, Occupations Code;
17	17	(2) a professional association composed solely of
18	18	individuals licensed to practice medicine in this state;
19	19	(3) a single legal entity authorized to practice
20	20	medicine in this state that is owned by a group of individuals
21	21	licensed to practice medicine in this state;
22	22	(4) a nonprofit health corporation certified by the
23	23	Texas Medical Board under Chapter 162, Occupations Code; or
24	24	(5) a partnership composed solely of individuals
25	25	licensed to practice medicine in this state.
26	26	Sec. 1459.002. APPLICABILITY OF CHAPTER. (a) This chapter
27	27	applies only to an employee benefit plan or a health benefit plan
28	28	that provides benefits for medical or surgical expenses incurred as
29	29	a result of a health condition, accident, or sickness, including:
30	30	(1) an individual, group, blanket, or franchise
31	31	insurance policy or insurance agreement, a group hospital service
32	32	contract, or a small or large employer group contract or similar
33	33	coverage document that is offered by:
34	34	(A) an insurance company;
35	35	(B) a group hospital service corporation
36	36	operating under Chapter 842;
37	37	(C) a fraternal benefit society operating under
38	38	Chapter 885;
39	39	(D) a stipulated premium company operating under
40	40	Chapter 884;
41	41	(E) a reciprocal exchange operating under
42	42	Chapter 942;
43	43	(F) a health maintenance organization operating
44	44	under Chapter 843; or
45	45	(G) an approved nonprofit health corporation
46	46	that holds a certificate of authority under Chapter 844; or
47	47	(2) a multiple employer welfare arrangement that holds
48	48	a certificate of authority under Chapter 846, or any other employee
49	49	benefit plan.
50	50	(b) This chapter applies to group health coverage made
51	51	available by a school district in accordance with Section 22.004,
52	52	Education Code.
53	53	(c) Notwithstanding Section 172.014, Local Government Code,
54	54	or any other law, this chapter applies to health and accident
55	55	coverage provided by a risk pool created under Chapter 172, Local
56	56	Government Code.
57	57	(d) Notwithstanding any provision in Chapter 1551, 1575,
58	58	1579, or 1601 or any other law, this chapter applies to:
59	59	(1) a basic coverage plan under Chapter 1551;
60	60	(2) a basic plan under Chapter 1575;
61	61	(3) a primary care coverage plan under Chapter 1579;
62	62	and
63	63	(4) basic coverage under Chapter 1601.
64	64	(e) Notwithstanding Section 1501.251 or any other law, this
65	65	chapter applies to a small employer health benefit plan subject to
66	66	Chapter 1501.
67	67	(f) Notwithstanding Sections 1507.004 and 1507.053, or any
68	68	other law, this chapter applies to a consumer choice of benefits
69	69	plan issued under Chapter 1507.
70	70	(g) Notwithstanding any other law, this chapter applies to:
71	71	(1) the state child health plan or the health benefits
72	72	plan for children under Chapter 62 or 63, Health and Safety Code;
73	73	(2) a Medicaid managed care program operated under
74	74	Chapter 533, Government Code; and
75	75	(3) a Medicaid program operated under Chapter 32,
76	76	Human Resources Code.
77	77	Sec. 1459.003. NONDISCRIMINATION IN TELEPHONE CONSULTATION
78	78	SERVICES. (a) An employee benefit plan or a health benefit plan
79	79	may not:
80	80	(1) prohibit a physician from charging for a telephone
81	81	consultation with a covered patient if that plan allows another
82	82	person to charge for a telephone consultation with a covered
83	83	patient;
84	84	(2) deny payment to a physician for a medically
85	85	necessary telephone consultation with a covered patient if that
86	86	plan pays another person for a telephone consultation with a
87	87	covered patient; or
88	88	(3) discriminate against a physician in determining a
89	89	payment amount for a medically necessary telephone consultation
90	90	provided to a covered patient if that plan pays another person for a
91	91	telephone consultation with a covered patient.
92	92	(b) Nothing in this section shall be construed as
93	93	prohibiting an employee benefit plan or a health benefit plan from
94	94	paying a physician for medically necessary telephone
95	95	consultations.
96	96	(c) Nothing in this section shall be construed as permitting
97	97	a physician to charge or requiring an employee benefit plan or a
98	98	health benefit plan to pay for telephonic:
99	99	(1) appointment scheduling;
100	100	(2) appointment reminders; or
101	101	(3) responses to billing or payment inquiries.
102	102	SECTION 2. The change in law made by this Act applies only
103	103	to an employee benefit plan or a health benefit plan that is
104	104	delivered, issued for delivery, or renewed on or after September 1,
105	105	2015. An employee benefit plan or a health benefit plan delivered,
106	106	issued for delivery, or renewed before September 1, 2015, is
107	107	governed by the law as it existed immediately before the effective
108	108	date of this Act, and that law is continued in effect for that
109	109	purpose.
110	110	SECTION 3. If before implementing any provision of this Act
111	111	a state agency determines that a waiver or authorization from a
112	112	federal agency is necessary for implementation of that provision,
113	113	the agency affected by the provision shall request the waiver or
114	114	authorization and may delay implementing that provision until the
115	115	waiver or authorization is granted.
116	116	SECTION 4. This Act takes effect September 1, 2015.