84R11355 SCL-F
By: Price H.B. No. 2348
A BILL TO BE ENTITLED
AN ACT
relating to nondiscrimination against physicians in payment for
telephone consultation services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle F, Title 8, Insurance Code, is amended
by adding Chapter 1459 to read as follows:
CHAPTER 1459. FAIR ACCESS TO TELEPHONE CONSULTATIONS
Sec. 1459.001. DEFINITION. In this chapter, "physician"
means:
(1) an individual licensed to practice medicine in
this state under Subtitle B, Title 3, Occupations Code;
(2) a professional association composed solely of
individuals licensed to practice medicine in this state;
(3) a single legal entity authorized to practice
medicine in this state that is owned by a group of individuals
licensed to practice medicine in this state;
(4) a nonprofit health corporation certified by the
Texas Medical Board under Chapter 162, Occupations Code; or
(5) a partnership composed solely of individuals
licensed to practice medicine in this state.
Sec. 1459.002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to an employee benefit plan or a health benefit plan
that provides benefits for medical or surgical expenses incurred as
a result of a health condition, accident, or sickness, including:
(1) an individual, group, blanket, or franchise
insurance policy or insurance agreement, a group hospital service
contract, or a small or large employer group contract or similar
coverage document that is offered by:
(A) an insurance company;
(B) a group hospital service corporation
operating under Chapter 842;
(C) a fraternal benefit society operating under
Chapter 885;
(D) a stipulated premium company operating under
Chapter 884;
(E) a reciprocal exchange operating under
Chapter 942;
(F) a health maintenance organization operating
under Chapter 843; or
(G) an approved nonprofit health corporation
that holds a certificate of authority under Chapter 844; or
(2) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846, or any other employee
benefit plan.
(b) This chapter applies to group health coverage made
available by a school district in accordance with Section 22.004,
Education Code.
(c) Notwithstanding Section 172.014, Local Government Code,
or any other law, this chapter applies to health and accident
coverage provided by a risk pool created under Chapter 172, Local
Government Code.
(d) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) basic coverage under Chapter 1601.
(e) Notwithstanding Section 1501.251 or any other law, this
chapter applies to a small employer health benefit plan subject to
Chapter 1501.
(f) Notwithstanding Sections 1507.004 and 1507.053, or any
other law, this chapter applies to a consumer choice of benefits
plan issued under Chapter 1507.
(g) Notwithstanding any other law, this chapter applies to:
(1) the state child health plan or the health benefits
plan for children under Chapter 62 or 63, Health and Safety Code;
(2) a Medicaid managed care program operated under
Chapter 533, Government Code; and
(3) a Medicaid program operated under Chapter 32,
Human Resources Code.
Sec. 1459.003. NONDISCRIMINATION IN TELEPHONE CONSULTATION
SERVICES. (a) An employee benefit plan or a health benefit plan
may not:
(1) prohibit a physician from charging for a telephone
consultation with a covered patient if that plan allows another
person to charge for a telephone consultation with a covered
patient;
(2) deny payment to a physician for a medically
necessary telephone consultation with a covered patient if that
plan pays another person for a telephone consultation with a
covered patient; or
(3) discriminate against a physician in determining a
payment amount for a medically necessary telephone consultation
provided to a covered patient if that plan pays another person for a
telephone consultation with a covered patient.
(b) Nothing in this section shall be construed as
prohibiting an employee benefit plan or a health benefit plan from
paying a physician for medically necessary telephone
consultations.
(c) Nothing in this section shall be construed as permitting
a physician to charge or requiring an employee benefit plan or a
health benefit plan to pay for telephonic:
(1) appointment scheduling;
(2) appointment reminders; or
(3) responses to billing or payment inquiries.
SECTION 2. The change in law made by this Act applies only
to an employee benefit plan or a health benefit plan that is
delivered, issued for delivery, or renewed on or after September 1,
2015. An employee benefit plan or a health benefit plan delivered,
issued for delivery, or renewed before September 1, 2015, is
governed by the law as it existed immediately before the effective
date of this Act, and that law is continued in effect for that
purpose.
SECTION 3. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 4. This Act takes effect September 1, 2015.