85R11062 PMO-D
By: Muñoz, Jr. H.B. No. 2257
A BILL TO BE ENTITLED
AN ACT
relating to prohibiting an insurer from directing a policyholder to
certain entities to provide certain medical or health care services
and supplies to the policyholder.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 541, Insurance Code, is
amended by adding Section 541.062 to read as follows:
Sec. 541.062. DIRECTING POLICYHOLDER TO CERTAIN ENTITIES
FOR HEALTH CARE SERVICES OR SUPPLIES. (a) In this section,
"insurer" means an entity authorized under this code or another
insurance law of this state to provide health insurance or health
benefits in this state.
(b) An insurer may not direct a policyholder to an entity or
a physician or health care provider working for or under contract
with an entity in which the insurer has an ownership interest or
with which the insurer is affiliated to provide to the policyholder
medical or health care services or supplies described by Subsection
(d).
(c) It is an unfair method of competition or an unfair or
deceptive act or practice in the business of insurance for an
insurer, directly or indirectly through a physician or health care
provider or otherwise, to violate Subsection (b).
(d) Medical or health care services and supplies under
Subsection (b) include:
(1) clinical laboratory services;
(2) physical therapy services;
(3) occupational therapy services;
(4) radiology services;
(5) radiation therapy services and supplies;
(6) durable medical equipment and supplies;
(7) prosthetics, orthotics, and prosthetic devices
and supplies;
(8) home health services; and
(9) outpatient prescription drugs.
(e) An insurer may not provide to a physician, health care
provider, or other person any inducement or incentive to direct a
policyholder to an entity in which the insurer has an ownership
interest or with which the insurer is affiliated to provide to the
policyholder medical or health care services or supplies described
by Subsection (d).
(f) Nothing in this section prohibits a physician or health
care provider from referring a policyholder at the policyholder's
request to a physician or health care provider.
(g) The commissioner shall adopt rules to implement this
section, including rules that prohibit specific acts or practices
that violate this section.
SECTION 2. Section 541.062(e), Insurance Code, as added by
this Act, applies only to a contract between an insurer and a
physician or health care provider that is 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
as it existed immediately before the effective date of this Act, and
that law is continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2017.