Texas 2015 - 84th Regular

Texas House Bill HB574 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	By: Bonnen of Galveston, Fallon H.B. No. 574
2		-	(Senate Sponsor - Campbell)
3		-	(In the Senate - Received from the House May 4, 2015;
4		-	May 4, 2015, read first time and referred to Committee on Business
5		-	and Commerce; May 15, 2015, reported favorably by the following
6		-	vote: Yeas 8, Nays 0; May 15, 2015, sent to printer.)
7		-	Click here to see the committee vote
	1	+	H.B. No. 574
8	2
9	3
10		-	A BILL TO BE ENTITLED
11	4		AN ACT
12	5		relating to the operation of certain managed care plans with
13	6		respect to certain physicians and health care providers; amending
14	7		provisions subject to a criminal penalty.
15	8		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
16	9		SECTION 1. Subchapter A, Chapter 843, Insurance Code, is
17	10		amended by adding Section 843.010 to read as follows:
18	11		Sec. 843.010. APPLICABILITY OF CERTAIN PROVISIONS TO
19	12		GOVERNMENTAL HEALTH BENEFIT PLANS. Sections 843.306(f) and
20	13		843.363(a)(4) do not apply to coverage under:
21	14		(1) the child health plan program under Chapter 62,
22	15		Health and Safety Code, or the health benefits plan for children
23	16		under Chapter 63, Health and Safety Code; or
24	17		(2) a Medicaid program, including a Medicaid managed
25	18		care program operated under Chapter 533, Government Code.
26	19		SECTION 2. Section 843.306, Insurance Code, is amended by
27	20		adding Subsection (f) to read as follows:
28	21		(f) A health maintenance organization may not terminate
29	22		participation of a physician or provider solely because the
30	23		physician or provider informs an enrollee of the full range of
31	24		physicians and providers available to the enrollee, including
32	25		out-of-network providers.
33	26		SECTION 3. Section 843.363, Insurance Code, is amended by
34	27		amending Subsection (a) and adding Subsection (a-1) to read as
35	28		follows:
36	29		(a) A health maintenance organization may not, as a
37	30		condition of a contract with a physician, dentist, or provider, or
38	31		in any other manner, prohibit, attempt to prohibit, or discourage a
39	32		physician, dentist, or provider from discussing with or
40	33		communicating in good faith with a current, prospective, or former
41	34		patient, or a person designated by a patient, with respect to:
42	35		(1) information or opinions regarding the patient's
43	36		health care, including the patient's medical condition or treatment
44	37		options;
45	38		(2) information or opinions regarding the terms,
46	39		requirements, or services of the health care plan as they relate to
47	40		the medical needs of the patient; [or]
48	41		(3) the termination of the physician's, dentist's, or
49	42		provider's contract with the health care plan or the fact that the
50	43		physician, dentist, or provider will otherwise no longer be
51	44		providing medical care, dental care, or health care services under
52	45		the health care plan; or
53	46		(4) information regarding the availability of
54	47		facilities, both in-network and out-of-network, for the treatment
55	48		of the patient's medical condition.
56	49		(a-1) A health maintenance organization may not, as a
57	50		condition of payment with a physician, dentist, or provider, or in
58	51		any other manner, require a physician, dentist, or provider to
59	52		provide a notification form stating that the physician, dentist, or
60	53		provider is an out-of-network provider to a current, prospective,
61	54		or former patient, or a person designated by the patient, if the
62	55		form contains additional information that is intended, or is
63	56		otherwise required to be presented in a manner that is intended, to
64	57		intimidate the patient.
65	58		SECTION 4. Section 1301.001, Insurance Code, is amended by
66	59		adding Subdivision (5-a) to read as follows:
67	60		(5-a) "Out-of-network provider" means a physician or
68	61		health care provider who is not a preferred provider.
69	62		SECTION 5. Subchapter A, Chapter 1301, Insurance Code, is
70	63		amended by adding Sections 1301.0057 and 1301.0058 to read as
71	64		follows:
72	65		Sec. 1301.0057. ACCESS TO OUT-OF-NETWORK PROVIDERS. An
73	66		insurer may not terminate, or threaten to terminate, an insured's
74	67		participation in a preferred provider benefit plan solely because
75	68		the insured uses an out-of-network provider.
76	69		Sec. 1301.0058. PROTECTED COMMUNICATIONS BY PREFERRED
77	70		PROVIDERS. (a) An insurer may not in any manner prohibit, attempt
78	71		to prohibit, penalize, terminate, or otherwise restrict a preferred
79	72		provider from communicating with an insured about the availability
80	73		of out-of-network providers for the provision of the insured's
81	74		medical or health care services.
82	75		(b) An insurer may not terminate the contract of or
83	76		otherwise penalize a preferred provider solely because the
84	77		provider's patients use out-of-network providers for medical or
85	78		health care services.
86	79		(c) An insurer's contract with a preferred provider may
87	80		require that, except in a case of a medical emergency as determined
88	81		by the preferred provider, before the provider may make an
89	82		out-of-network referral for an insured, the preferred provider
90	83		inform the insured:
91	84		(1) that:
92	85		(A) the insured may choose a preferred provider
93	86		or an out-of-network provider; and
94	87		(B) if the insured chooses the out-of-network
95	88		provider the insured may incur higher out-of-pocket expenses; and
96	89		(2) whether the preferred provider has a financial
97	90		interest in the out-of-network provider.
98	91		SECTION 6. Section 1301.057(d), Insurance Code, is amended
99	92		to read as follows:
100	93		(d) On request, an insurer shall provide [make an expedited
101	94		review available] to a practitioner whose participation in a
102	95		preferred provider benefit plan is being terminated:
103	96		(1) an [. The] expedited review conducted in
104	97		accordance with a process that complies [must comply] with rules
105	98		established by the commissioner; and
106	99		(2) all information on which the insurer wholly or
107	100		partly based the termination, including the economic profile of the
108	101		preferred provider, the standards by which the provider is
109	102		measured, and the statistics underlying the profile and standards.
110	103		SECTION 7. Section 1301.067, Insurance Code, is amended by
111	104		adding Subsection (a-1) to read as follows:
112	105		(a-1) An insurer may not, as a condition of payment with a
113	106		physician or health care provider or in any other manner, require a
114	107		physician or health care provider to provide a notification form
115	108		stating that the physician or health care provider is an
116	109		out-of-network provider to a current, prospective, or former
117	110		patient, or a person designated by the patient, if the form contains
118	111		additional information that is intended, or is otherwise required
119	112		to be presented in a manner that is intended, to intimidate the
120	113		patient.
121	114		SECTION 8. (a) Except as provided by this section, the
122	115		changes in law made by this Act apply only to an insurance policy,
123	116		insurance or health maintenance organization contract, or evidence
124	117		of coverage delivered, issued for delivery, or renewed on or after
125	118		January 1, 2016. A policy, contract, or evidence of coverage
126	119		delivered, issued for delivery, or renewed before that date is
127	120		governed by the law in effect immediately before the effective date
128	121		of this Act, and that law is continued in effect for that purpose.
129	122		(b) Sections 843.306, 843.363, and 1301.057(d), Insurance
130	123		Code, as amended by this Act, and Section 1301.0058, Insurance
131	124		Code, as added by this Act, apply only to a contract between a
132	125		health maintenance organization or insurer and a physician or
133	126		health care provider that is entered into or renewed on or after the
134	127		effective date of this Act. A contract entered into or renewed
135	128		before the effective date of this Act is governed by the law as it
136	129		existed immediately before the effective date of this Act, and that
137	130		law is continued in effect for that purpose.
138	131		SECTION 9. This Act takes effect September 1, 2015.
139		-	* * * * *
	132	+	______________________________ ______________________________
	133	+	President of the Senate Speaker of the House
	134	+	I certify that H.B. No. 574 was passed by the House on May 1,
	135	+	2015, by the following vote: Yeas 139, Nays 0, 2 present, not
	136	+	voting.
	137	+	______________________________
	138	+	Chief Clerk of the House
	139	+	I certify that H.B. No. 574 was passed by the Senate on May
	140	+	20, 2015, by the following vote: Yeas 29, Nays 1.
	141	+	______________________________
	142	+	Secretary of the Senate
	143	+	APPROVED: _____________________
	144	+	Date
	145	+	_____________________
	146	+	Governor